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Tracheobronchial obstruction: follow-up study of 100 children treated with airway stenting
Paola Serio1, Valentina Fainardi, Roberto Leone
1Respiratory Endoscopy Unit, Department of Paediatric Anesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy.
Insights
Pediatric airway stenting effectively treated severe obstruction in 100 children, with 66% achieving complete resolution. This study highlights stenting as a safe, conservative option for pediatric airway management.
Area of Science:
- Pediatric Pulmonology
- Interventional Pulmonology
- Biomaterials in Medicine
Background:
- Airway obstruction in children presents significant management challenges.
- Stent placement offers a less invasive approach compared to surgery for airway stenosis.
- Limited data exists on the long-term outcomes of airway stenting in pediatric populations.
Purpose of the Study:
- To evaluate the safety and clinical effectiveness of airway stenting in a large cohort of pediatric patients.
- To analyze outcomes based on different stent types used for severe airway obstruction.
- To report the largest series of pediatric airway stenting outcomes in the literature.
Main Methods:
- Retrospective analysis of 100 consecutive pediatric patients undergoing stent insertion (January 2005 - May 2012).
- Inclusion of diverse stent types: silicone, metallic (Nitinol), and biodegradable (PDS).
- Statistical analysis using exact likelihood methods.
Main Results:
- 235 stents placed in 100 children for severe airway obstruction.
- 80% of patients showed clinical improvement; 17 were weaned from mechanical ventilation.
- At median 41.4 months follow-up, 66% achieved complete resolution; no fatal stent-related complications were observed.
Conclusions:
- Airway stenting is a safe and effective conservative treatment for selected pediatric patients with airway obstruction.
- Expertise in rigid and flexible bronchoscopy is crucial for successful outcomes.
- Stenting can be a valuable alternative before considering more invasive surgical interventions.
Objective:
We described a cohort of 100 children with a wide variety of airway obstruction who underwent stent positioning in the last 7 years. The study examined the outcomes of this treatment in the largest series of paediatric patients reported in the literature with special concern over safety and clinical effectiveness.
Methods:
We performed a retrospective analysis of 100 consecutive paediatric patients who underwent stent insertions between January 2005 and May 2012. Statistical analysis was performed and exact likelihood was used.
Results:
A total of 235 stents were placed for severe airway obstruction. One hundred and twelve silicone stents (cylinder, hourglass or Y-shaped), 120 metallic stents (covered Nitinol stents, expandable coronary and vascular stents) and 3 biodegradable polydioxanone (PDS) stents were used. Eighty patients presented clinical improvement after stent insertion, 17 were weaned off mechanical ventilation and 3 showed no significant clinical improvement [95% confidence interval (CI) 0.1-8.0%]. Complications were different according to stent type. In our cohort, no fatal stent-related complications have been observed. At follow-up (median 41.4 months, range 1.1-145.4) complete resolution was registered for 60 patients (66%; 95% CI 55-76%), 17 are still under treatment, 9 were lost to follow-up, 8 underwent surgery and 6 died of causes not stent related.
Conclusion:
Airway stenting represents a conservative treatment before more invasive surgical procedures and can be very effective when performed in selected children and in specialized centres by physicians experienced in rigid and flexible bronchoscopy.
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