Outcomes of Virtually Assisted Personalized Tracheostomy Tubes for Congenital Airway Anomalies

To measure clinical outcomes and respiratory trajectories after the placement of virtually assisted personalized tracheostomy tubes (vapTT) designed for patients with congenital airway anomalies (CAA).

Retrospective review was performed of vapTT candidates, which included patients with CAA experiencing recurrent respiratory failure due to ongoing TT obstruction despite exhaustion of commercially available TT. VapTT design used a previously reported protocol for virtual modeling from CT images correlated with endoscopy findings. Outcomes obtained from medical records included the presence of TT-related granulation/ulceration, symptomatic tracheoscopy frequency, progression of inpatient care, ventilatory parameters, and serum bicarbonate levels.

Six patients were included. CAA pathology included tracheal cartilaginous sleeve, tortuosity, and stenosis in the setting of conditions such as craniosynostosis syndromes, skeletal dysplasia, and long-gap esophageal atresia with scoliosis. Three patients were hospitalized for greater than 5 months at the time of vapTT implementation; all three demonstrated improvement in acute obstructive events, resolution of granulation on tracheoscopy, significant improvement in serum bicarbonate (p < 0.005), and progression of care to discharge. Of the three outpatients undergoing vapTT implementation, one patient experienced resolution of recurrent tracheitis and one had resolution of acutely symptomatic airway events. For the group, there was a significant decrease in compiled serum bicarbonate levels after vapTT implementation (3.6, 95% CI: 2.85-4.31, p < 0.001).

VapTT is a feasible option when airway obstruction cannot be overcome with standard TTs in children with CAA. Our early experience with vapTT demonstrated improved respiratory function without significant adverse events. Future studies are required to investigate long-term outcomes of vapTT.