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Tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants

Winston M Manimtim1,2, Douglas C Rivard3,4, Ashley K Sherman5

  • 1Division of Neonatology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. wmmanimtim@cmh.edu.

Pediatric Radiology
|August 20, 2016
PubMed

Insights

Tracheobronchomalacia affects 40% of ventilator-dependent infants, particularly premature infants with bronchopulmonary dysplasia. Tracheobronchography safely assesses airway function and determines optimal positive end-expiratory pressure.

Area of Science:

  • Pediatric Pulmonology
  • Neonatology
  • Medical Imaging

Background:

  • Tracheobronchomalacia is common in premature infants requiring prolonged mechanical ventilation.
  • Understanding its prevalence and characteristics is crucial for effective management.

Purpose of the Study:

  • To determine the prevalence of tracheobronchomalacia in ventilator-dependent infants using tracheobronchography.
  • To describe the demographic and clinical features of infants with tracheobronchomalacia.
  • To assess dynamic airway characteristics and optimal positive end-expiratory pressure (PEEP).

Main Methods:

  • Retrospective review of 198 tracheobronchograms in 158 ventilator-dependent infants (<2 years).
  • Dynamic airway assessment during tracheobronchography to identify optimal PEEP for expiratory airway patency.
  • Analysis of demographic and clinical data, including primary diagnoses and prematurity.

Main Results:

  • Overall tracheobronchomalacia prevalence was 40%; 48% in infants with bronchopulmonary dysplasia.
  • Prematurity (P=0.01) and higher baseline PEEP (P=0.04) were associated with tracheobronchomalacia.
  • Tracheobronchography demonstrated significant airway opening at optimal PEEP (P<0.001) with no immediate complications.

Conclusions:

  • Tracheobronchomalacia is prevalent in ventilator-dependent infants, especially those with bronchopulmonary dysplasia.
  • Prematurity and high PEEP requirements are risk factors for tracheobronchomalacia.
  • Tracheobronchography is a safe and effective tool for assessing dynamic airway function and guiding PEEP.
Abstract

Keywords:
AirwayBronchopulmonary dysplasiaInfantsNeonatologyRespiratoryTracheobronchographyTracheobronchomalacia

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