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Updated: Jun 19, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Single-center review on safety of biodegradable airway stenting in pediatric population
Federico Minen1, Andrew Durward2, Paul James1
1Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK.
Insights
Biodegradable Ella stents (BES) show promise for treating pediatric airway malacia and vascular compression, offering a low rate of adverse effects. This study highlights their potential as an effective interventional option for challenging cases.
Area of Science:
- Pediatric Pulmonology
- Interventional Pulmonology
- Biomaterials in Medicine
Background:
- Tracheobronchomalacia (TBM) and airway stenosis cause pediatric airway obstruction, often requiring complex management and leading to long-term morbidity.
- Traditional metallic or silicone stents have shown limited success and high complication rates in managing these conditions.
- Biodegradable Ella stents (BES) present a promising alternative interventional option.
Purpose of the Study:
- To evaluate the clinical experience with biodegradable Ella stents (BES) in treating pediatric tracheobronchomalacia (TBM) and vascular airway compression.
- To assess the efficacy and safety of deliberately downsized BES to minimize granulation tissue formation.
Main Methods:
- A retrospective study was conducted over an 8-year period (November 2012 - December 2020).
- Pediatric patients with severe airway obstruction requiring airway stenting for conditions like extubation failure, malacic spells, recurrent infections, or lung collapse were included.
- Data on stent implantation, patient characteristics, and outcomes were analyzed.
Main Results:
- Fifty-five BES were implanted in 33 pediatric patients (5 tracheal, 28 bronchial diseases), including a neonate weighing 1.8 kg.
- No cases of stent erosion, infection, or obstructive granuloma requiring removal were observed.
- Three patients experienced stent migration, and three stent grids occluded with secretions requiring bronchoscopic lavage.
Conclusions:
- Biodegradable Ella stents (BES) demonstrate potential as a treatment for specific pediatric airway malacia and vascular compression cases.
- The use of BES in this cohort was associated with a low rate of adverse effects.
- Further research is warranted to fully establish the role of BES in pediatric airway management.
Background:
Tracheobronchomalacia (TBM) and airway stenosis are recognized etiologies of airway obstruction among children. Their management is often challenging, requiring multiple interventions and prolonged respiratory support with associated long-term morbidity. Metallic or silicone stents have been used with mixed success and high complication rates. More recently biodegradable Ella stents (BES) provided an attractive interventional option.
Objectives:
We report our experience in the treatment of TBM and vascular airway compression using BES. We deliberately downsized them to minimize intraluminal granulation tissue formation.
Materials And Methods:
Retrospective study over an 8-year period between November 2012 and December 2020 of pediatric patients with severe airway obstruction requiring airway stenting for extubation failure, malacic death spells, recurrent chest infections, or lung collapse.
Results:
Thirty-three patients (5 tracheal and 28 bronchial diseases) required 55 BES during the study period. The smallest patient weighed 1.8 kg. Median age of patient at first stent implantation was 13.1 months (IQR 4.9-58.3). The majority of the bronchial stents were in the left main bronchus (93%), of which 57% for vascular compression. Repeat stents were used in 19 patients (57.7%), with a range of two to four times. We did not experience erosion, infection, or obstructive granuloma needing removal by forceps or lasering. Three stent grid occluded with secretions needing bronchoscopic lavage. Stent migration occurred in three patients.
Conclusions:
BES holds promise as a treatment option with low rate of adverse effects for a specific subset of pediatric patients with airway malacia or vascular compression. Further studies are warranted.
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