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Management of tracheobronchomalacia with continuous positive airway pressure
Insights
Severe tracheobronchomalacia (TBM) in infants can be effectively managed using long-term continuous positive airway pressure (CPAP) delivered via tracheostomy. This approach facilitates successful weaning from respiratory support and decannulation.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Critical Care
Background:
- Infants with severe tracheobronchomalacia (TBM) often experience respiratory distress and airway obstruction.
- Recurrent hyperinflation, atelectasis, and pneumonia are common complications.
- Gastroesophageal reflux and aspiration can exacerbate TBM symptoms.
Abstract:
Three infants presenting with respiratory distress required early ventilator support. With attempts at extubation recurrent airway obstruction occurred. The clinical course was marked by recurrent episodes of hyperinflation, atelectasis, and pneumonia. Bronchoscopy, bronchography, and chest fluoroscopy revealed extensive collapse of the trachea and main stem bronchi. Two of the infants had gastroesophageal reflux and recurrent aspiration. Treatment of tracheobronchomalacia (TBM) was carried out with a tracheostomy tube attached to a portable CPAP apparatus. Initially CPAP was maintained at 10 cm of water and subsequently weaning was achieved by gradual decreasing of both positive pressure and hours of treatment per day. Total treatment time ranged from 13 to 25 months. Feedings were carried out via gastrostomy. Two infants with severe gastroesophageal reflux underwent fundoplication. Each infant was successfully weaned from distending pressure and decanulated. The treatment of severe TBM with long-term CPAP appears to be a reasonable alternative or adjunct to surgical procedures such as tracheopexy, resection, external splinting and tracheobronchoplasty.