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Yan C, Hu Y, Qiu G, Gong X, Elda D. The clinical safety and efficacy of flexible bronchoscopy in a neonatal intensive care unit. Exp Ther Med 2020; 20:95. [PMID: 32973944 DOI: 10.3892/etm.2020.9223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/22/2020] [Indexed: 12/22/2022] Open
Abstract
Flexible bronchoscopy (FB), developed in the 1960s, is widely used in the clinical practice of pediatrics and has demonstrated fundamental value in clinical diagnoses and treatment. However, as an invasive procedure, the use of FB is limited due to concerns regarding the tolerance of the procedure and the possible complications in neonatal units. Thus, the present study aimed to investigate the clinical safety and efficacy of flexible bronchoscopy (FB) in a neonatal intensive care unit (NICU). Neonates (n=54) who received FB in the NICU of Shanghai Children's Hospital between January 2012 and December 2016 were enrolled as the experimental group and another 54 neonates who required nebulization and tracheal secretion suction treatments were the control group. Indicators including blood gas, complete blood count, C-reactive protein (CRP), X-ray, patient breathing rate, temperature and blood pressure were monitored prior to and following the procedure. No significant differences in sex, gestational age, birth weight or postnatal age were observed between the experimental group and the control group (P>0.05). Among the 54 FB patients, several cases with side effect were identified, including 18 (33.3%) with respiratory tract stenosis, nine (16.7%) with malacia and stenosis and six (11.1%) with esophagotracheal fistula. Among the 54 members of the control group, 44 neonates (81.4%) were discharged with improved condition, five (9.3%) succumbed and five patients (9.3%) abandoned the treatment and left the hospital. Bronchoalveolar lavage demonstrated consistent results with respiratory secretion culture or tracheal tube culture. In comparison between the experimental and the control groups, no significant difference in pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2) and HCO3 - was observed, while there were no statistical differences in the values of pH, PCO2 and HCO3 - (P>0.05). However, PO2 was significantly increased, and CRP was significantly reduced, following FB procedure compared with prior to FB (P<0.05). No pneumothorax, shock, other severe complications, fever or diffused pneumonia were observed during or after FB. The data from the present study demonstrated that FB is a safe and effective strategy for the diagnosis and differentiation of neonatal respiratory diseases in NICU.
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Affiliation(s)
- Chongbing Yan
- Department of Neonatology, Shanghai Children's Hospital, Shanghai 200062, P.R. China
| | - Yong Hu
- Department of Neonatology, Shanghai Children's Hospital, Shanghai 200062, P.R. China
| | - Gang Qiu
- Department of Neonatology, Shanghai Children's Hospital, Shanghai 200062, P.R. China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, Shanghai 200062, P.R. China
| | - Dermyshi Elda
- Department of Neonatology, Shanghai Children's Hospital, Shanghai 200062, P.R. China
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Wallis C, McLaren CA. Tracheobronchial stenting for airway malacia. Paediatr Respir Rev 2018; 27:48-59. [PMID: 29174374 DOI: 10.1016/j.prrv.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022]
Abstract
Tracheobronchomalacia is a rare but clinically troublesome condition in paediatrics. The softening of the major airways - which can include some or all of the tracheobronchial tree can lead to symptoms ranging from the minor (harsh barking cough, recurrent chest infections) to severe respiratory difficulties including prolonged ventilator support and 'near death attacks'. The causes are broadly divided into intrinsic softening of the airway wall which is considered a primary defect (e.g. syndromes; post tracheo-oesophageal fistula repair; extreme prematurity) or secondary malacia due to external compression from vascular structures or cardiac components. These secondary changes can persist even when the external compression is relieved, for example, following the repair of a pulmonary artery sling or double aortic arch. For children with severe clinical symptoms attributed to malacia, consideration is given to possible surgical remedies such as an aortopexy for short limited areas of malacia, or long term positive pressure support with CPAP either by non invasive or tracheostomy interface. More recently the role of stenting in children is receiving attention, especially with the development of newer techniques such as bioabsorbable stents which buy time for a natural history of improvement in the malacia to occur. This paper reviews the stents available and discusses the pros and cons of stenting in paediatric airway malacia.
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Affiliation(s)
- Colin Wallis
- Department of Respiratory Paediatrics, Great Ormond Street Hospital for Children, London, UK.
| | - Clare A McLaren
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
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Schweiger C, Cohen AP, Rutter MJ. Tracheal and bronchial stenoses and other obstructive conditions. J Thorac Dis 2016; 8:3369-3378. [PMID: 28066618 DOI: 10.21037/jtd.2016.11.74] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although tracheal stenosis and bronchial stenosis are relatively rare in the pediatric population, they are both associated with significant morbidity and mortality. While most cases of congenital tracheal stenosis in children present as complete tracheal rings (CTRs), other congenital tracheal obstructions are also encountered in clinical practice. In addition, acquired obstructive tracheal conditions stemming from endotracheal trauma or previous surgical interventions may occur. Many affected children also have associated cardiovascular malformations, further complicating their management. Optimal management of children with tracheal or bronchial stenoses requires comprehensive diagnostic evaluation and optimization prior to surgery. Slide tracheoplasty has been the operative intervention of choice in the treatment of the majority of these children.
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Affiliation(s)
- Claudia Schweiger
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; ; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Xu X, Ding H, Liu X, Zhu B, Feng Z. Emergency management for congenital tracheal stenosis with endoluminal stenting in pediatric intensive care units. Ther Adv Respir Dis 2016; 10:310-7. [PMID: 27126522 DOI: 10.1177/1753465816645478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to share our experience in the management of congenital tracheal stenosis (CTS) using self-expanding intraluminal stents in infants. METHODS From January 2010 to August 2012, 31 infants with CTS treated using stents by bronchoscope in pediatric intensive care units (PICUs) were recruited for this study. RESULTS Among the 31 patients, 17 were male and 14 were female with their ages ranging from 55 days to 22 months. CTS was associated with congenital heart disease (CHD) in 22 patients. There were no immediate stent-related airway complications. A significant and immediate improvement of respiratory obstruction following stent placement in all 31 patients led to successful weaning from the breathing machine and extubation. Granulation tissue formation as a complication was observed in three (9.7%) patients, but all were successfully managed using cryotherapy. During follow up (up to 24 months), stents in 29 infants remained functional. In seven cases, stents were retrieved under bronchoscope (the same day to 10 months), and three cases required stent replacement (each of the three cases had the stent replaced three times). Nine infants died after stenting due to other causes and two infants abandoned treatment. CONCLUSION Airway stenting may provide an important therapeutic option in infants with CTS.
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Affiliation(s)
- Xuan Xu
- Bayi Children's Hospital, Affiliated to Beijing Military General Hospital, Beijing, China
| | - Hui Ding
- Pediatrics Department, Affiliated Hospital of Logistical University of Chinese People's Armed Police Forces, Tianjin, China
| | | | - Bin Zhu
- Bayi Children's Hospital, Affiliated to Beijing Military General Hospital, Beijing, China
| | - Zhichun Feng
- Bayi Children's Hospital, Affiliated to Beijing Military General Hospital, No.5, Dongsi Road, Dongcheng District, Beijing 100700, China
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Kurada S, Karthekeyan RB, Vakamudi M, Thangavelu P. Management of tracheomalacia in an infant with Tetralogy of Fallot. Indian J Anaesth 2015; 59:240-3. [PMID: 25937651 PMCID: PMC4408653 DOI: 10.4103/0019-5049.155002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Most infants with tracheomalacia do not need specific therapy as it usually resolves spontaneously by the age of 1–2 years. Severe forms of tracheomalacia characterized by recurrent respiratory infections require active treatment which includes chest physiotherapy, long term intubation or tracheostomy. Aortopexy seems to be the treatment of choice for secondary and even primary forms of severe tracheomalacia. Itentails tracking and suturing the anterior wall of the aorta to the posterior surface of the sternum. Consequently, the anterior wall of the trachea is also pulled forward preventing its collapse. A 3-month-old girl baby who was on ventilatory support for 2 months due to severe tracheomalacia associated with a cyanotic congenital heart disease underwent intracardiac repair and aortopexy along with Lecompte's procedure as all the conservative measures to wean off the ventilator failed. The baby was extubated on the third post-operative day and the post-operative period was uneventful.
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Affiliation(s)
- Santoshi Kurada
- Department of Anaesthesiology Critical Care and Pain Medicine, Sri Ramachandra Medical College and Research Centre, Chennai, Tamil Nadu, India
| | - Ranjith B Karthekeyan
- Department of Anaesthesiology Critical Care and Pain Medicine, Sri Ramachandra Medical College and Research Centre, Chennai, Tamil Nadu, India
| | - Mahesh Vakamudi
- Department of Anaesthesiology Critical Care and Pain Medicine, Sri Ramachandra Medical College and Research Centre, Chennai, Tamil Nadu, India
| | - Periyasamy Thangavelu
- Department of Anaesthesiology Critical Care and Pain Medicine, Sri Ramachandra Medical College and Research Centre, Chennai, Tamil Nadu, India
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Leung L, Chung PHY, Wong KKY, Tam PKH. Management of tracheobronchial obstruction in infants using metallic stents: long-term outcome. Pediatr Surg Int 2015; 31:249-54. [PMID: 25616564 DOI: 10.1007/s00383-015-3666-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tracheobronchial obstruction, although uncommon in the pediatric age group, remains a challenging problem. We review the long-term outcome of endoscopic metallic stenting in infants with tracheobronchial obstruction. MATERIALS AND METHODS Medical records of all pediatric surgical patients who underwent tracheobronchial metallic stenting in our center were reviewed retrospectively from 1996 to 2014. Patients' demographic data, including etiology, associated anomalies and nature of obstruction were reviewed. Outcome measures include complications such as re-stenosis, granulation tissue, stent migration, fractured stent, maximal tracheal diameter achieved, weaning of ventilator and growth at interval follow-up. RESULTS Twelve balloon-expandable metallic stents were placed in the trachea (n = 10) and/or bronchi (n = 2) of 5 patients with a median age of 13 months (range 5-30 months). Etiology of the airway obstruction included congenital tracheal stenosis (n = 4), giant cervical and superior mediastinal lymphatic malformation with tracheobronchomalacia (n = 1). Seven complications were reported (3 patients developed granulation tissue, 2 patients had re-stenosis, 1 stent migrated, 1 stent fractured). All patients survived and were in good condition with a median follow-up of 16 years (range 11-18 years). Three patients weaned off ventilator and oxygen. CONCLUSIONS Endoscopic stenting with metallic stent has satisfactory long-term outcome in treating infants with tracheobronchial obstruction.
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Affiliation(s)
- Ling Leung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong
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Ley S, Loukanov T, Ley-Zaporozhan J, Springer W, Sebening C, Sommerburg O, Hagl S, Gorenflo M. Long-Term Outcome After External Tracheal Stabilization Due to Congenital Tracheal Instability. Ann Thorac Surg 2010; 89:918-25. [DOI: 10.1016/j.athoracsur.2009.11.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 11/21/2009] [Accepted: 11/23/2009] [Indexed: 10/19/2022]
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Chae Y, Protsenko D, Holden PK, Chlebicki C, Wong BJF. Thermoforming of tracheal cartilage: viability, shape change, and mechanical behavior. Lasers Surg Med 2009; 40:550-61. [PMID: 18798288 DOI: 10.1002/lsm.20666] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Trauma, emergent tracheostomy, and prolonged intubation are common causes of severe deformation and narrowing of the trachea. Laser technology may be used to reshape tracheal cartilage using minimally invasive methods. The objectives of this study were to determine: (1) the dependence of tracheal cartilage shape change on temperature and laser dosimetry using heated saline bath immersion and laser irradiation, respectively, (2) the effect of temperature on the mechanical behavior of cartilage, and (3) tissue viability as a function of laser dosimetry. MATERIALS AND METHODS Ex vivo rabbit trachea cartilage specimens were bent and secured around a cylinder (6 mm), and then immersed in a saline bath (45 and 72 degrees C) for 5-100 seconds. In separate experiments, tracheal specimens were irradiated with a diode laser (lambda = 1.45 microm, 220-400 J/cm(2)). Mechanical analysis was then used to determine the elastic modulus in tension after irradiation. Fluorescent viability assays combined with laser scanning confocal microscopy (LSCM) were employed to image and identify thermal injury regions. RESULTS Shape change transition zones, between 62 and 66 degrees C in the saline heating bath and above power densities of 350 J/cm(2) (peak temperatures 65+/-10 degrees C) for laser irradiation were identified. Above these zones, the elastic moduli were higher (8.2+/-4 MPa) than at lower temperatures (4.5+/-3 MPa). LSCM identified significant loss of viable chondrocytes within the laser-irradiation zones. CONCLUSION Our results indicate a change in mechanical properties occurs with laser irradiation and further demonstrates that significant thermal damage is concurrent with clinically relevant shape change in the elastic cartilage tissues of the rabbit trachea using the present laser and dosimetry parameters.
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Affiliation(s)
- Yongseok Chae
- The Beckman Laser Institute, 1002 Health Sciences Rd East, Irvine, California 92697, USA.
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Mostafa BE, Dessouky OY. The role of endoluminal self-expanding stents in the management of pediatric tracheal stenosis. Int J Pediatr Otorhinolaryngol 2008; 72:1371-6. [PMID: 18606458 DOI: 10.1016/j.ijporl.2008.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 05/23/2008] [Accepted: 05/26/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Review of our experience in the management of pediatric tracheal stenosis using endoscopic techniques and self-expanding intraluminal stents. METHODS Thirteen children (aged 1 week to 14 years) with various causes of tracheal stenosis were treated. A total of 15 stents were used, 13 self-expanding nitinol stents and 3 silicone self-expanding stents. Follow-up ranged from 6 month to 8 years. RESULTS There were no stent related mortalities. Serious complications occurred in 4 patients [30.7%] but all were managed successfully. The most frequent problem was granulation tissue formation. Patient follow-up ranged from 6 months to 8 years. In the short-term (18-24 months) 12 stents remained patent and functional. On the longer term (5 years) 3 stents required removal, one required replacement and another resulted in stenosis. CONCLUSION Endoluminal stenting can have an increasing role in the management of selected cases pediatric tracheal stenosis with acceptable morbidity and stable long-term results.
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Affiliation(s)
- Badr Eldin Mostafa
- Department of Otorhinolaryngology Head and Neck surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
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Acquired Nonneoplastic Neonatal and Pediatric Diseases. DAIL AND HAMMAR’S PULMONARY PATHOLOGY 2008. [PMCID: PMC7122323 DOI: 10.1007/978-0-387-68792-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The lung biopsy is an established procedure to procure a pathologic diagnosis in a child with a suspected pneumonic process of undetermined etiology. Improvements in pediatric anesthesia and surgery have reduced the operative complications to a minimum. A biopsy can usually be taken through a small intercostal incision when localization is not especially important in a patient with diffuse changes (see Chapter 1). The alternative method for tissue sampling is the endoscopic transbronchial biopsy. There is less risk to the patient, but the specimen is smaller and crush artifacts from the instrument are more common.
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