Search Results (2)

Background: Tracheobronchial disease, including tracheomalacia (TM) and tracheobronchomalacia (TBM), is a spectrum of congenital and acquired airway disorders characterized by the collapse of the tracheal or mainstem bronchial walls during expiration, particularly when there are increased intrathoracic pressures. Traditional surgical approaches to treat severe medically refractory TM include anterior approaches, such as aortopexy or anterior tracheopexy. Recently, posterior tracheopexy has emerged to address the widened and mobile posterior tracheal membrane which can cause transient airway obstruction. Method: The National Institute of Health, National Library of Medicine, PubMed, and MEDLINE databases were queried for manuscripts related to posterior tracheopexy in the pediatric population. Preoperative diagnostics, anesthetic considerations, operative technique, clinical outcomes, and operative complications were analyzed in each manuscript. Results: Patients with severe medically refractory cases of TM who are being considered for posterior tracheopexy should undergo thorough preoperative workup by a multidisciplinary team. Cross-sectional, dynamic thoracic imaging and a “quadruple endoscopy”, incorporating laryngoscopy, dynamic bronchoscopy, distal bronchoscopy, and esophagogastroduodenoscopy (EGD) should be obtained as part of a standardized preoperative assessment. Posterior tracheopexy for pre-existing TM significantly improves respiratory symptoms, respiratory infection rates, brief resolved unexplained events, and ventilatory dependence. Recently, posterior tracheopexy during TEF/EA repair has been described and aims to reduce the risk of patients developing TM, the risk of TEF recurrence, and respiratory morbidity following TEF/EA repair. An ongoing randomized controlled trial may help to elucidate the efficacy of primary posterior tracheopexy in select neonates with TEF/EA. Conclusions: Posterior tracheopexy is a valuable surgical technique for the treatment of TM or the reduction in respiratory morbidity following TEF/EA repair in select neonates. Full article

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. Full article