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Diagnosis, Treatment, and Follow-Up of Tracheo/Bronchomalacia in Children: The Italian Multicenter Experience
Angelo Florio1, Michele Ghezzi2, Francesca Rizzo3
1UOC Pneumologia Pediatrica ed Endoscopia Respiratoria IRCCS G. Gaslini, 16147 Genova, Italy.
Insights
Tracheobronchomalacia (TBM) in children involves airway collapse, often presenting with a barking cough. This review emphasizes standardizing diagnosis and treatment, particularly using static and dynamic videobronchoscopy for severity assessment.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Pediatric Surgery
Background:
- Pediatric airways are flexible, prone to collapse causing tracheobronchomalacia (TBM).
- Increased intrathoracic pressure exacerbates airway collapse in TBM.
- TBM can lead to partial or complete airway occlusion and characteristic biphasic cough.
Purpose of the Study:
- Standardize diagnostic criteria for pediatric tracheobronchomalacia (TBM).
- Establish consistent treatment protocols for TBM across pediatric centers.
- Improve the management of TBM in pediatric patients.
Main Methods:
- Convened a meeting of Italian pediatricians and pediatric surgeons specializing in TBM.
- Collected and synthesized interventions from experts in the field.
- Compiled a comprehensive overview of TBM diagnosis and treatment.
Main Results:
- Highlights the importance of static and dynamic videobronchoscopy (S/DVBS).
- Emphasizes S/DVBS for verifying tracheal lumen patency and assessing TBM severity.
- Provides guidance on optimal diagnostic and treatment strategies for TBM.
Conclusions:
- This work offers a comprehensive guide to TBM diagnosis and treatment.
- Aims to assist pediatricians in managing pediatric patients with TBM.
- Promotes standardized approaches for better patient outcomes.
Background:
In pediatric age, the central airways are more flexible and mobile, with tracheal and bronchial walls easily tending to collapse, allowing partial or complete occlusion of the lumen: a situation described as tracheobronchomalacia (TBM). This is a condition that causes an increase in intrathoracic pressure that may accentuate airway collapse, and a biphasic or barking cough appears.
Objectives:
Although TBM is relatively frequent in pediatric age, the diagnostic criteria and subsequent treatment do not follow well-standardized criteria and often vary from pediatric center to center. Therefore, there is a need to standardize diagnostic procedures and the resulting medical or surgical treatments.
Methods:
We therefore organized a day of meetings to talk about TBM, inviting all Italian pediatricians and pediatric surgeons who diagnose and treat patients with this pathology on a daily basis.
Results:
This work, collecting all the meeting interventions, is a compendium that deals with all aspects of TBM, emphasizing the most correct criteria to diagnose and therefore best treat each pediatric patient with this clinical condition. We give particular emphasis to the need to perform static and dynamic videobronchoscopy (S/DVBS) to verify the patency of the tracheal lumen, so as to evaluate the severity of TBM.
Conclusions:
this work deals with TBM in all its diagnostic and treatment aspects and can be a valid help for all pediatricians who treat these patients.
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