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Intensive Care Med. 2001 Apr;27(4):722-9.

Current management and outcome of tracheobronchial malacia and stenosis presenting to the paediatric intensive care unit.

Author information

1
Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. D.Inwald@ich.ucl.ac.uk

Abstract

OBJECTIVE:

To identify factors associated with mortality and prolonged ventilatory requirements in patients admitted to our paediatric intensive care unit (PICU) with tracheobronchial malacia and stenosis diagnosed by dynamic contrast bronchograms.

DESIGN:

Retrospective review.

SETTING:

Tertiary paediatric intensive care unit.

PATIENTS:

Forty-eight cases admitted to our PICU over a 5-year period in whom a diagnosis of tracheobronchial malacia or stenosis was made by dynamic contrast bronchography (1994-1999).

INTERVENTIONS:

Conservative management, tracheostomy and long-term ventilation, surgical correction, internal or external airway stenting.

MEASUREMENTS AND RESULTS:

Recording of clinical details, length of invasive ventilation and appearance at contrast bronchography. Five groups of patients were defined: isolated primary airway pathology (n = 7), ex-premature infants (n = 11), vascular rings (n = 9), complex cardiac and/or syndromic pathology (n = 17) and tracheo-oesophageal fistulae (n = 4). The overall mortality was 29%. Median length of invasive ventilation in survivors was 38 days and in patients who died 45. Mortality was highest in the patients with complex cardiac and/or syndromic pathology (p = 0.039 Cox regression analysis) but was not related to any other factor. Patients with stenosis required a significantly longer period of ventilatory support (median length of ventilation 59 days) than patients with malacia (39 days).

CONCLUSIONS:

Length of ventilation and bronchographic diagnosis did not predict survival. The only factor found to contribute significantly to mortality was the presence of complex cardiac and/or syndromic pathology. However, patients with stenosis required longer ventilatory support than patients with malacia.

PMID:
11398700
DOI:
10.1007/s001340000822
[Indexed for MEDLINE]

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