Related Experiment Video
Updated: Jul 26, 2025
Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA
Published on: July 14, 2023
Long-term sleep apnea CPAP via tracheostomy in children with tracheomalacia: 20-year experience
Tidarat Sriboonyong1, Aroonwan Preutthipan1, Malinee Nugboon2
1Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Continuous positive airway pressure (CPAP) machines, typically for sleep apnea, were successfully used for pediatric tracheomalacia. This cost-effective method offers a viable alternative for long-term ventilation in resource-limited settings.
Area of Science:
- Pediatric Pulmonology
- Biomedical Engineering
- Critical Care Medicine
Background:
- Severe tracheobronchomalacia often necessitates tracheostomies and prolonged mechanical ventilation in children.
- Financial constraints limit access to standard ventilation equipment in many healthcare settings.
- Continuous Positive Airway Pressure (CPAP) machines, designed for adult obstructive sleep apnea, have been explored as an alternative.
Purpose of the Study:
- To report the 20-year experience of utilizing adult CPAP machines for pediatric tracheomalacia at a single institution.
- To evaluate the outcomes and feasibility of this approach in a pediatric population with severe airway issues.
Main Methods:
- A retrospective study was conducted from 2001 to 2021.
- Data were collected on 15 children with severe tracheomalacia who received CPAP via tracheostomy.
- Patient demographics, comorbidities, readmission rates, and outcomes were analyzed.
Main Results:
- Fifteen children (9 boys, aged 3 months–5.6 years) were treated with CPAP via tracheostomy.
- Common comorbidities included gastroesophageal reflux (60%), neuromuscular disorders (40%), and genetic abnormalities (40%).
- The 1-year readmission rate was 66%, with no CPAP-related complications; 33% were weaned off CPAP, and 3 children died (2 from sepsis, 1 unknown cause).
Conclusions:
- The use of adult CPAP machines via tracheostomy is a feasible and effective option for managing pediatric tracheomalacia, particularly in resource-limited environments.
- Adequate caregiver training is crucial for the safe and successful implementation of CPAP therapy in children.
- This approach offers a cost-effective alternative for long-term invasive ventilatory support in pediatric patients with severe tracheobronchomalacia.
Introduction:
Children with severe tracheobronchomalacia may need placements of tracheostomies and long-term mechanical ventilation. Due to financial constraints, continuous positive airway pressure (CPAP) machines commonly used to treat obstructive sleep apnea in adults have been utilized to deliver positive distending pressure to such children at our institution for more than 20 years with favorable outcomes. We, therefore, reported our experience with 15 children using this machine.
Methods:
This is a retrospective study during 2001-2021.
Results:
Fifteen children, 9 boys, aged ranged 3 months-5.6 years, were discharged home with CPAP via tracheostomies. All had co-morbidities including gastroesophageal reflux (n = 9, 60%), neuromuscular disorders (n = 6, 40%), genetic abnormalities (n = 6, 40%), cardiac diseases (n = 4, 27%) and chronic lungs (n = 3, 20%). Eight (53%) children were aged less than 1 year old. The smallest child was aged 3 months old, weighing 4.9 kg. All caregivers were relatives and non-medical health professionals. The 1-month and 1-year readmission rates were 13% and 66% respectively. No factor-associated unfavorable outcomes were statistically identified. No complications related to CPAP malfunction were found. Five (33%) were weaned off CPAP, and 3 died (2 from sepsis and 1 from a sudden unknown cause).
Conclusion:
We first reported the use of sleep apnea CPAP via tracheostomy in children with severe tracheomalacia. In limited-resource countries, this simple device may be another option for long-term invasive ventilatory support. The CPAP use in children with tracheobronchomalacia requires adequately trained caregivers.
Related Concept Videos
01:22Trachea
Anatomical Features:
Location: About half of the trachea is situated in the neck, anterior to the esophagus, and extends from the larynx (at the level of...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:28Tracheostomy: Procedure and Tubes
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:16Tracheostomy Care I: Pre-procedural Steps
Required Equipment
The equipment necessary for tracheostomy care includes: