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Kennelly SS, Hovland V, Matthews IL, Reinholt FP, Skjerven H, Heimdal K, Crowley S. Tracheobronchomalacia is common in children with primary ciliary dyskinesia-A case note review. Pediatr Pulmonol 2024. [PMID: 39291788 DOI: 10.1002/ppul.27262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/06/2024] [Accepted: 09/03/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND The estimated prevalence of tracheobronchomalacia (TBM) in children is about 1:2100. Prevalence of intrathoracic malacia is higher in children with chronic lung disease such as bronchiectasis and cystic fibrosis (CF) and may contribute to increased morbidity. OBJECTIVE To determine the prevalence and assess clinical features of tracheomalacia (TM), TBM and bronchomalacia (BM) in patients with primary ciliary dyskinesia (PCD). METHODS We performed a retrospective case-note review of all children with a confirmed or highly likely diagnosis of PCD attending Oslo University Hospital between 2000 and 2021. We selected those who had undergone flexible fiberoptic bronchoscopy (FB) and in whom the presence of TBM was assessed. We retrieved demographic and clinical data, including airway symptoms, PCD-diagnostic criteria, indication for bronchoscopy, the presence of lobar atelectasis, microbiology and the descriptive and unblinded video-recorded results of FB. Complications occurring during and after bronchoscopy were noted. RESULTS Of 71 children with PCD, 32 underwent FB and were included in the review. The remaining 39 were included for TBM prevalence calculation only. Median age at FB was 6.0 years (3.1-11.9). Twenty-two children (69%) had intrathoracic airway malacia. Four (13%) had isolated TM, seven (22%) had TBM, and 11 (34%) had isolated BM affecting either main (n = 4) or lobar bronchi (n = 7) (LBM), including four with associated lobar atelectasis. FB related complications, one major, 12 minor, were documented in 13 children (41%). CONCLUSION We found a high prevalence of TBM among children with PCD undergoing FB. This may represent a significant comorbidity and have implications for patient management.
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Affiliation(s)
- Synne S Kennelly
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Department of Paediatric Training and Education, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vegard Hovland
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Iren Lindbak Matthews
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Finn P Reinholt
- Department of Pathology, Core Facility of Electron Microscopy, Oslo University Hospital, Oslo, Norway
| | - Håvard Skjerven
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Department of Paediatric Research, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Ketil Heimdal
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
- Norwegian Center for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
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von Allmen DC, Hysinger EB, Bates AJ, Higano NS, Garrison A, Walther A, de Alarcon A, Woods J, Kingma P. Correlation of Tracheomalacia Severity With Esophageal Gap Length as Assessed by Ultrashort Echo-time MRI. J Pediatr Surg 2024:161880. [PMID: 39244418 DOI: 10.1016/j.jpedsurg.2024.161880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 08/18/2024] [Accepted: 08/21/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Tracheomalacia severity is difficult to quantify, however, ultrashort echo-time MRI objectively quantifies tracheomalacia in infants without sedation, radiation, or intubation. Patients with tracheoesophageal fistula and esophageal atresia (TEF/EA) commonly have tracheomalacia, however, the relationship between tracheomalacia severity and esophageal atresia has not been well defined. The primary objective of this study was to establish the relationship between EA and tracheomalacia severity and identify possible predictors of tracheomalacia severity. METHODS A retrospective review of neonates with TEF/EA who had previously undergone UTE MRI was performed. The trachea was divided into thirds. Maximal eccentricity in each third was calculated by measuring the anterior posterior dimension (MinD) and dividing it by the maximum width of the trachea (MaxD). Frequency of respiratory related admissions, number of upper respiratory infections, and number of steroids courses were quantified in addition to eccentricity in short and long gap esophageal atresia patients. RESULTS A total of 16 TEF/EA patients were included. Patients with long gap esophageal atresia had more severe tracheomalacia than short gap as measured by eccentricity in the upper (0.60 vs 0.72, p = 0.03), middle (0.48 vs 0.61, p = 0.02), and lower (0.5 vs 0.65, p = 0.01) trachea. Long gap esophageal atresia patients had more frequent respiratory readmissions (1.87 admissions/year vs 0.54 admissions/year) (p = 0.03). Following TEF/EA repair the trachea was less eccentric in the upper third (0.64 pre, 0.79 post, p < 0.01) and more eccentric in the lower third (0.69 pre, 0.56 post, p < 0.01). CONCLUSION Differences in esophageal gap and repair status correlate with airway eccentricity and tracheomalacia symptoms. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Douglas C von Allmen
- Cincinnati Children's Hospital Medical Center, Department of Otolaryngology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Otolaryngology, Cincinnati, OH, USA.
| | - Erik B Hysinger
- Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Alister J Bates
- Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Nara S Higano
- Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Aaron Garrison
- Cincinnati Children's Hospital Medical Center, Department of Surgery, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Surgery, Cincinnati, OH, USA
| | - Ashley Walther
- Cincinnati Children's Hospital Medical Center, Department of Surgery, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Surgery, Cincinnati, OH, USA
| | - Alessandro de Alarcon
- Cincinnati Children's Hospital Medical Center, Department of Otolaryngology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Otolaryngology, Cincinnati, OH, USA
| | - Jason Woods
- Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Paul Kingma
- University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, Division of Neonatology and Pulmonary Biology, Cincinnati, OH, USA
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Torre M, Reali S, Rizzo F, Guerriero V, Palo F, Arrigo S, Sacco O, Mattioli G. Posterior Tracheopexy for Tracheomalacia: A Study of Clinical and Radiological Consequences on Esophagus. Eur J Pediatr Surg 2024; 34:306-313. [PMID: 37328153 DOI: 10.1055/a-2111-5605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Posterior tracheopexy (PT) directly addresses the posterior trachealis membrane intrusion in severe tracheomalacia. During PT, the esophagus is mobilized and membranous trachea is sutured to the prevertebral fascia. Although dysphagia has been reported as a possible complication of PT, in the literature there are no data investigating postoperative esophageal anatomy and digestive symptoms. Our aim was to study clinical and radiological consequences of PT on esophagus. METHODS Patients with symptomatic tracheobronchomalacia scheduled for PT between May 2019 and November 2022 underwent pre- and postoperative esophagogram. For each patient, we analyzed radiological images and measured esophageal deviation providing new radiological parameters. RESULTS All 12 patients underwent thoracoscopic PT (n = 3) or robot-assisted thoracoscopic PT (n = 9). For all patients, the postoperative esophagogram showed a right dislocation of the thoracic esophagus (median postoperative deviation = 27.5 mm). We report an esophageal perforation at postoperative day 7 in a patient affected by esophageal atresia, who underwent several surgical procedures before. A stent was placed and esophagus healed. Another patient with severe right dislocation referred transient dysphagia to solids, which resolved gradually in the first postoperative year. All the other patients did not present any esophageal symptoms. CONCLUSION For the first time, we demonstrate the right dislocation of the esophagus after PT and we propose an objective method to measure it. In most patients, PT is a procedure not affecting esophageal function, but dysphagia can occur if dislocation is important. Esophagus mobilization during PT should be cautious, especially in patients who underwent previous thoracic procedures.
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Affiliation(s)
- Michele Torre
- Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
- Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
| | - Serena Reali
- Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
- Department of Pediatric Surgery, UNIGE DiNOGMI, Genova, Liguria, Italy
| | - Francesca Rizzo
- Department of Radiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
- Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
| | - Vittorio Guerriero
- Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
- Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
| | - Federico Palo
- Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
| | - Serena Arrigo
- Department of Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
- Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
| | - Oliviero Sacco
- Department of Pulmonology Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
- Department of Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
| | - Girolamo Mattioli
- Department of Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Liguria, Italy
- Department of Pediatric Surgery, UNIGE DiNOGMI, Genova, Liguria, Italy
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Ikeda K, Hasegawa H, Yamada Y, Mizogami M, Wasa M. Airway diseases in very low birth weight infants. J Perinatol 2024:10.1038/s41372-024-02071-6. [PMID: 39039224 DOI: 10.1038/s41372-024-02071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE To identify the incidence and characteristics of airway diseases in very low birth weight infants (VLBWIs). METHODS A retrospective study of 214 inborn VLBWIs admitted to our NICU between April 2009 and March 2022 (approval no: 2023-0008). Neonatologists ourselves performed bronchoscopy to diagnose airway diseases. RESULTS Symptomatic airway diseases were present in 36/214 (16.8%) of VLBWIs. Common airway diseases were tracheobronchomalacia (TBM) and pharyngomalacia. Infants with airway diseases had shorter gestational age, lower birth weight, more boys, and more moderate/severe bronchopulmonary dysplasia (BPD). Regarding treatment, more infants with airway diseases required intubation were intubated longer, used more dexamethasone, were on ventilators and oxygen longer, and were hospitalized longer. CONCLUSION We found that VLBWIs were more frequently complicated with airway diseases, especially TBM. We also observed many pharyngeal lesions, which have not been previously reported. Intensity of prematurity, BPD, and the need for stronger respiratory management were risks for airway diseases. In VLBWIs, bronchoscopy should be actively performed because airway diseases are important complications.
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Affiliation(s)
- Kenta Ikeda
- Department of Neonatology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
| | - Hisaya Hasegawa
- Department of Neonatology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Yosuke Yamada
- Department of Neonatology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Masae Mizogami
- Department of Neonatology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Masanori Wasa
- Department of Neonatology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
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van Hal AFRL, Aanen IP, Wijnen RMH, Pullens B, Vlot J. The Value of Preoperative Rigid Tracheobronchoscopy for the Diagnosis of Tracheomalacia in Oesophageal Atresia Patients. J Pediatr Surg 2024:S0022-3468(24)00415-9. [PMID: 39089893 DOI: 10.1016/j.jpedsurg.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Oesophageal atresia (OA) is often accompanied by tracheomalacia (TM). The aim of this study was to evaluate its presence in OA patients during routine rigid tracheobronchoscopy (TBS) before primary correction and compare this to postoperative TBS and clinical signs of TM. METHODS This retrospective cohort study included patients born with OA between June 2013 and December 2022 who had received a TBS before OA correction and had been followed for at least twelve months. Definite TM was postoperatively diagnosed through TBS, and probable TM was defined as having symptoms of TM. RESULTS We analysed data from 79 patients, of whom 87% with OA type C. Preoperatively, TM was observed in 33 patients (42% of all patients), seven of whom had severe TM. Definite TM was observed in 21 patients (27%), of whom 15 had severe TM. Forty-one patients (52% of all patients) had developed symptoms of TM within twelve months, including harsh barking cough (n = 15), stridor and/or wheezing (n = 20), recurrent respiratory insufficiency (n = 11), or needing airway surgery (n = 7). The sensitivity of preoperative TBS for the presence of postoperative (definite and probable combined) TM is 50.0%, 95% CI [35.2-64.8], and the specificity 67.6%, 95% CI [51.7-81.1]. Clinical characteristics did not differ between the patients with or without postoperative TM. CONCLUSIONS More than half of the studied patients with OA experienced symptoms of TM. While preoperative TBS is routinely performed prior to surgical OA correction, its predictive value for the presence of postoperative TM remains limited. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Study of Diagnostics Test.
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Affiliation(s)
- Anne-Fleur R L van Hal
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Irene P Aanen
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - John Vlot
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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Mukharesh L, Krone KA, Hamilton TE, Shieh HF, Smithers CJ, Winthrop ZA, Muise ED, Jennings RW, Mohammed S, Demehri FR, Zendejas B, Visner GA. Outcomes of surgical treatment of tracheobronchomalacia in children. Pediatr Pulmonol 2024; 59:1922-1931. [PMID: 38629381 DOI: 10.1002/ppul.27012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/25/2024] [Accepted: 04/04/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Tracheobronchomalacia (TBM) is characterized by excessive dynamic airway collapse. Severe TBM can be associated with substantial morbidity. Children with secondary TBM associated with esophageal atresia/tracheoesophageal fistula (EA/TEF) and vascular-related airway compression (VRAC) demonstrate clinical improvement following airway pexy surgery. It is unclear if children with severe primary TBM, without secondary etiologies (EA/TEF, vascular ring, intrinsic pulmonary pathology, or complex cardiac disease) demonstrate clinical improvement following airway pexy surgery. MATERIALS AND METHODS The study cohort consisted of 73 children with severe primary TBM who underwent airway pexy surgery between 2013 and 2020 at Boston Children's Hospital. Pre- and postoperative symptoms as well as bronchoscopic findings were compared with Fisher exact test for categorical data and Student's t-test for continuous data. RESULTS Statistically significant improvements in clinical symptoms were observed, including cough, noisy breathing, prolonged respiratory infections, pneumonias, exercise intolerance, cyanotic spells, brief resolved unexplained events (BRUE), and noninvasive positive pressure ventilation (NIPPV) dependence. No significant differences were seen regarding oxygen dependence, ventilator dependence, or respiratory distress requiring NIPPV. Comparison of pre- and postoperative dynamic bronchoscopy findings revealed statistically significant improvement in the percent of airway collapse in all anatomic locations except at the level of the upper trachea (usually not malacic). Despite some initial improvements, 21 (29%) patients remained symptomatic and underwent additional airway pexies with improvement in symptoms. CONCLUSION Airway pexy surgery resulted in significant improvement in clinical symptoms and bronchoscopic findings for children with severe primary TBM; however, future prospective and long-term studies are needed to confirm this benefit.
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Affiliation(s)
- Lana Mukharesh
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Katie A Krone
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas E Hamilton
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Charles J Smithers
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Zachary A Winthrop
- Department of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Eleanor D Muise
- Division of Pulmonary Medicine, Hassenfeld Children's Hospital at NYU Langone Health, New York, New York, USA
| | - Russell W Jennings
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Somala Mohammed
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Farokh R Demehri
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gary A Visner
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Fareed A, Siblini R, Rammal Z, Siblini D. Flexible solutions for tiny airways: hydrogels in treating pediatric tracheomalacia. Int J Surg 2024; 110:4011-4013. [PMID: 38573121 PMCID: PMC11254280 DOI: 10.1097/js9.0000000000001420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Areeba Fareed
- Karachi Medical and Dental College, North Nazimabad, Karachi, Pakistan
| | - Rima Siblini
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Zeina Rammal
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Dima Siblini
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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8
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Davis SE, Davis C, Patel N, Kubba H, Clement WA. Long-term Airway Outcomes and Interventions in Children With Oesophageal Atresia With Tracheoesophageal Fistula: A 20-year Single Centre Observational Study. J Pediatr Surg 2024; 59:1066-1071. [PMID: 38429129 DOI: 10.1016/j.jpedsurg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Airway anomalies, symptoms and interventions are commonly reported in children with oesophageal atresia with tracheoesophageal fistula (OA/TOF). The purpose of this study was to assess the incidence of these airway pathologies and those requiring interventions in the long-term. METHODS A retrospective case note review of all patients admitted to the Neonatal Unit at the Royal Hospital for Children, Glasgow between January 2000 and December 2015 diagnosed with OA/TOF. Included patients had a minimum of 5 years follow-up. RESULTS 121 patients were identified. 118 proceeded to OA/TOF repair. 115 patients had long-term follow-up data. Ninety-five (83%) children had one or more airway symptom recorded. Thirty-six (31%) neonates underwent airway endoscopy at the time of their initial OA/TOF repair. Forty-six (40%) children underwent airway endoscopy at a later date due to airway symptoms. Airway pathologies identified included airway malacia, thirty-two (28%), subglottic stenosis, eleven (10%), tracheal pouch, twenty-five (22%), laryngeal cleft, seven (6%) and recurrent fistula, five (4%). Airway interventions included endoscopic division of tracheal pouch, ten (9%), tracheostomy, seven (6%), aortopexy, six (5%), repair of recurrent fistula, five (4%), endoscopic repair of laryngeal cleft, three (3%) and four (3%) required open airway reconstruction for subglottic stenosis. One child (1%) remains tracheostomy dependent. CONCLUSIONS Long-term airway pathologies are common in children with OA/TOF. Many of these are remediable with surgical intervention. Clinicians should be cognisant of this and refer to Airway Services appropriately.
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Affiliation(s)
- Sandra E Davis
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, United Kingdom.
| | - Carl Davis
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - W Andrew Clement
- Department of Paediatric Otolaryngology Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
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Zirek F, Özcan G, Tekin MN, Can Selvi Ö, Çobanoğlu N. Prevalence and Clinical Characteristics of Pediatric Lower Airway Malacia: Case Series from a Tertiary Center in Turkey. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2024; 37:41-46. [PMID: 38836764 DOI: 10.1089/ped.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Introduction: Lower airway malacia (LAM) is characterized by a reduction in the cross-sectional luminal area during quiet respiration. There is no gold standard diagnostic test; however, flexible fiberoptic bronchoscopy (FFB) is most frequently utilized. The exact prevalence and incidence of LAM are unknown. This study aimed to determine the prevalence rates of pediatric patients diagnosed with LAM, offer a detailed understanding of their demographic and clinical characteristics, and investigate distinctions between two specific types of LAM, namely, tracheomalacia (TM) and bronchomalacia (BM). Materials and Methods: Patients younger than 18 years diagnosed with LAM using FFB were included in this retrospective case series. Demographic and clinical characteristics and comorbid disorders were compared between patients with isolated BM and those with isolated TM or tracheobronchomalacia (TM/TBM). Results: Among 390 patients who underwent FFB, 65 (16.6%) were diagnosed with LAM, 16 (24.6%) with TM, and 56 (86.2%) with BM. The median age at diagnosis was 15 months. Among them, 59 (90.8%) had other comorbidities; gastrointestinal (GI) disorders were the most common (38.5%). The most common indications for bronchoscopy were recurrent/prolonged lower respiratory tract infections (LRTI) or wheezing (43.1%), while the most frequently observed respiratory physical examination finding was stridor (35.4%). Patients with TM/TBM had significantly higher frequencies of premature births, stridor, retraction, and GI disorders. Conclusion: Patients with stridor without typical laryngomalacia features or recurrent or prolonged LRTI should undergo prompt evaluation for LAM. The potential coexistence of GI disorders such as gastroesophageal reflux disease and swallowing dysfunction should also be considered.
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Affiliation(s)
- Fazılcan Zirek
- Department of Paediatric Pulmonology, Ankara University School of Medicine, Ankara, Turkey
| | - Gizem Özcan
- Department of Paediatric Pulmonology, Ankara University School of Medicine, Ankara, Turkey
| | - Merve Nur Tekin
- Department of Paediatric Pulmonology, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Can Selvi
- Department of Anaesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Paediatric Pulmonology, Ankara University School of Medicine, Ankara, Turkey
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Leon-Astudillo C, Dy FJ, McCown MY, Perez IA, Chhabra D, Bansal M, Maloney MA, Bedoya M, Ezmigna D, Bush D, Okorie CUA, Gross JE. ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants. Pediatr Pulmonol 2024; 59:1552-1568. [PMID: 38545994 DOI: 10.1002/ppul.26961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 05/28/2024]
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in pediatric pulmonary disease. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2023 American Thoracic Society International Conference. The respiratory disorders of infancy discussed in this year's review include: the care of the patient with bronchopulmonary dysplasia in the neonatal intensive care unit, clinical phenotypes and comorbidities; diffuse lung disease; pulmonary hypertension; central and obstructive sleep apnea. The care of infants with respiratory disorders often poses significant challenges to the general pediatric pulmonologist, sleep clinician, and neonatologist. This review aims to highlight the most clinically relevant aspects of the evaluation, management, and outcomes of infants with these key respiratory disorders, while emphasizing the importance of multidisciplinary care. Furthermore, this document summarizes essential aspects of genetic testing, novel imaging and treatment modalities, and includes multiple resources for clinical practice.
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Affiliation(s)
- Carmen Leon-Astudillo
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Fei J Dy
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Michael Y McCown
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Virginia, USA
| | - Iris A Perez
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Divya Chhabra
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Manvi Bansal
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Melissa A Maloney
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mariana Bedoya
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Monroe Carrell Jr. Children's Hospital of Vanderbilt, Nashville, Tennessee, USA
| | - Dima Ezmigna
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Douglas Bush
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Caroline U A Okorie
- Department of Pediatrics, Stanford Children's Health, Stanford, California, USA
| | - Jane E Gross
- Departments of Pediatrics and Medicine, National Jewish Health, Denver, Colorado, USA
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11
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Masci M, Missineo A, Campanale CM, Moras P, Colucci MC, Pasquini L, Toscano A. Case Report: An unusual case of a transposition of the great arteries with a double aortic arch: a highly complex fetal diagnosis with an unpredictable outcome. Front Cardiovasc Med 2024; 11:1351530. [PMID: 38682104 PMCID: PMC11045998 DOI: 10.3389/fcvm.2024.1351530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Published data estimate the prevalence of the vascular ring at approximately 7 per 10,000 live births. The association of a double aortic arch with a D-transposition of the great arteries has been rarely described in the literature. In this study, we report the prenatal diagnosis of a 28-year-old woman. A fetal echocardiography at a gestational age of 24 weeks + 6 days showed a D-transposition of the great arteries and a double aortic arch with a ventricular septal defect and pulmonary stenosis. On the first night after birth, the baby experienced an increase in lactate levels, with the rate of oxygen saturation consistently below 80%. A few hours after birth, the patient underwent a Rashkind procedure. An echocardiography, CT chest x-ray, and CT angiogram confirmed a diagnosis with a severe reduction of the tracheal lumen (>85%) and bronchomalacia. Then, the patient underwent posterior tracheopexy and aortopexy and later an arterial switch operation, ventricular septal defect closure, and resection of a part of the infundibular septum, accepting the risk of potential neoaortic obstruction. The literature has reported only two cases of patients with a fetal echocardiogram diagnosis. Therefore, our patient is only the third one with a fetal diagnosis and the second one with a complex intracardiac anatomy, characterized not only by a ventricular septal defect but also by two separate components of the obstruction (a bicuspid valve and a dysplastic valve with a posterior deviation of the infundibular septum). In conclusion, a D-transposition of the great arteries with a double aortic arch remains an extremely unusual association. The clinical outcome of these patients presents a high degree of variability and is entirely unpredictable in prenatal life. Our greatest aim as fetal and perinatal cardiologists is to improve the management and outcome of these patients through a fetal diagnosis, recognizing types of congenital heart disease in newborns who require early neonatal invasive procedures.
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Affiliation(s)
- M. Masci
- Perinatal Cardiology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - A. Missineo
- Perinatal Cardiology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - C. M. Campanale
- Perinatal Cardiology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - P. Moras
- Perinatal Cardiology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - M. C. Colucci
- Perinatal Cardiology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - L. Pasquini
- Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - A. Toscano
- Perinatal Cardiology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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12
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Holmquist A, Wendt M, Papatziamos G, Svensson J, Wester T, Burgos CM, Gahm C. Endoscopic Chemocauterization with Trichloroacetic Acid for Congenital or Recurrent Tracheoesophageal Fistula in Children with Esophageal Atresia: Experience from a Tertiary Center. J Pediatr Surg 2024; 59:678-683. [PMID: 37978000 DOI: 10.1016/j.jpedsurg.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Recurrent tracheoesophageal fistula (rTEF) is a well-known complication after surgery of EA, occurring in roughly 3-10% of the patients. Recent studies have highlighted safety and efficacy of endoscopic management of recurrent TEF. The aim of this study was to evaluate the efficacy of chemocauterization with trichloroacetic acid (TCA) in rTEF and congenital tracheoesophageal fistula (cTEF). METHODS Retrospective chart review of consecutive patients with recurrent or congenital TEF who underwent endoscopic chemo-cauterization between 2018 and 2022 at a tertiary center. Children diagnosed with TEF who underwent primary or secondary endoscopic treatment were included. Median follow up time was 19 months for rTEF and 33 months for cTEF. RESULTS During the study period, 18 patients were treated endoscopically by chemocatuerization with TCA at our institution. Treatment of recurrent TEF was successful in 13 of 14 patients (93%) Treatment of congenital TEF was successful in 2 of 4 patients (50%). In 14 patients, closure was seen after 1-2 treatments. There were no serious adverse reactions or complications to the endoscopic treatment of TEF. CONCLUSION Endoscopic chemocauterization is a minimal invasive technique with low morbidity and high success rate and may be considered as primary treatment for recurrent TEF. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anders Holmquist
- Department for Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden.
| | - Malin Wendt
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Papatziamos
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jan Svensson
- Department for Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Wester
- Department for Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Carmen Mesas Burgos
- Department for Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Gahm
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Head Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
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13
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Sumida W, Yasui A, Shirota C, Makita S, Okamoto M, Ogata S, Takimoto A, Takada S, Nakagawa Y, Kato D, Gohda Y, Amano H, Guo Y, Hinoki A, Uchida H. Update on aortopexy and posterior tracheopexy for tracheomalacia in patients with esophageal atresia. Surg Today 2024; 54:211-219. [PMID: 36729255 DOI: 10.1007/s00595-023-02652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/25/2022] [Indexed: 02/03/2023]
Abstract
Despite improving the survival after repair of esophageal atresia (EA), the morbidity of EA repair remains high. Specifically, tracheomalacia (TM) is one of the most frequent complications of EA repair. Continuous positive airway pressure is generally applied for the treatment of TM. However, surgical intervention is required against an apparent life-threatening event or inability to perform extubation for a long period. According to our review, most cases of TM showed symptom improvement after aortopexy. The ratio of the trachea's lateral and anterior-posterior diameter at the brachiocephalic artery crossing the trachea, which reflects the compression of the trachea by the brachiocephalic artery, is a good indicator of aortopexy. Our finding suggests that most TM cases associated with EA may not be caused by tracheal fragility alone, but may involve blood vessel compression. Posterior tracheopexy (PT) is also an effective treatment for TM. Recently, open or thoracoscopic PT was able to be performed simultaneously with EA repair. In many cases, aortopexy or PT is a safe and effective surgical treatment for TM with EA. Other surgical procedures, such as external stenting, should be considered for patients with diffuse-type TM for whom aortopexy and PT appear relatively ineffective.
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Affiliation(s)
- Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Seiya Ogata
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yousuke Gohda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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14
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Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Ghezzi M, Garancini N, De Santis R, Gianolio L, Zirpoli S, Mandelli A, Farolfi A, D’Auria E, Zuccotti GV. Recurrent Respiratory Infections in Children with Down Syndrome: A Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:246. [PMID: 38397357 PMCID: PMC10888118 DOI: 10.3390/children11020246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent Respiratory tract Infections (RRIs), leading to an increased rate of hospitalisation, a higher need for intensive care and fatality. With a literature review, we summarise here the main etiological factors for RRI in this category of patients, particularly focusing on airway malformations such as tracheomalacia, tracheal bronchus and bronchomalacia, comorbidities associated with the syndrome, like congenital heart diseases, dysphagia, gastroesophageal reflux, musculoskeletal involvement and obesity, and immunologic impairments, involving both innate and adaptive immunity. For these patients, a multidisciplinary approach is imperative as well as some preventive strategies, in particular vaccinations in accordance with their national schedule for immunization.
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Affiliation(s)
- Michele Ghezzi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Nicolò Garancini
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Raffaella De Santis
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Laura Gianolio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Salvatore Zirpoli
- Pediatric Radiology Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Anna Mandelli
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Andrea Farolfi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Enza D’Auria
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Gian Vincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
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16
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Pugh CP, Akmyradov C, Courtney SE, Agarwal A, Chandler A, Matlock DN. The effect of bethanechol on tracheobronchomalacia in preterm infants with bronchopulmonary dysplasia: a retrospective cohort study. J Perinatol 2024; 44:288-293. [PMID: 37848605 DOI: 10.1038/s41372-023-01799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Bethanechol has demonstrated improvement in trachealis tone in animal models, but no trials have studied efficacy in infants. This study aimed to examine if bethanechol improves a standardized pulmonary severity score (PSS) in infants with severe bronchopulmonary dysplasia with a diagnosis of tracheobronchomalacia (TBM). STUDY DESIGN This retrospective cohort study evaluated cases treated with bethanechol matched with controls who did not receive bethanechol. TBM was diagnosed by dynamic computography. Daily PSS was recorded for each infant from 40 to 55 weeks post-menstrual age. RESULTS Cases' mean PSS change was 21% lower than the controls' mean PSS change pre- and post-bethanechol (95% CI -40%, -2%) by paired t-test (p = 0.03). Matched differences (controls' PSS - cases' PSS) demonstrated greater mean PSS difference post-bethanechol compared to pre-bethanechol 0.17, (95% CI 0.05, 0.29) by paired t-test (p = 0.009). CONCLUSION Infants with TBM treated with bethanechol compared to those not treated had a lower PSS reflecting improved respiratory status.
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Affiliation(s)
- C Preston Pugh
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Chary Akmyradov
- Biostatistics, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Sherry E Courtney
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amit Agarwal
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Angela Chandler
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David N Matlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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17
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Sutton L, Maughan E, Pianosi K, Jama G, Rouhani MJ, Hewitt R, Muthialu N, Butler C, De Coppi P. Open and Thoracoscopic Aortopexy for Airway Malacia in Children: 15 Year Single Centre Experience. J Pediatr Surg 2024; 59:197-201. [PMID: 37949688 DOI: 10.1016/j.jpedsurg.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The objective was to report and analyse the characteristics and results of open aortopexy and thoracoscopic aortopexy for the treatment of airway malacia in a paediatric population. METHODS We report a retrospective consecutive case series of paediatric patients undergoing aortopexy for the treatment of airway malacia at a quaternary referral centre between December 2006 and January 2021. Outcome measures included days to extubation, continued need for non-invasive ventilation, further intervention in the form of tracheostomy and death. RESULTS 169 patients underwent aortopexy: 147 had open procedures (135 via median/limited median sternotomy and 12 thoracotomy) and 22 thoracoscopic. Mean follow up was 8.46 yrs (range 1-20 yrs). Most common site of airway malacia was the trachea (n = 106, 62.7 %), and 48 (28.4 %) had additional involvement at the bronchi with tracheobronchomalacia (TBM). 15 (8.9 %) had bronchomalacia (BM) only. Incidence of bronchial disease was lower in the thoracoscopic than open group (13.6 % vs 40.82 %; p < 0.0001). Mean time to extubation was 1.45 days, 2.59 days, 5.23 days in tracheomalacia, TBM and BM groups, respectively (p = 0.0047). Mean time to extubation was 1.35 days, 2 days, 3.67 days, and 5 days in patients with external vascular compression, TOF/OA, primary airway malacia, and laryngeal reconstruction, respectively (p = 0.0002). There were 21 deaths across the cohort, and all were in the open group. 71.4 % (n = 15) had bronchial involvement of their airway malacia. CONCLUSIONS Open and thoracoscopic aortopexy are effective treatments for airway malacia in children. We have identified that involvement of the bronchi is a risk factor for adverse outcomes, and the optimum treatment for this patient cohort is still debatable. LEVEL OF EVIDENCE IV. TYPE OF STUDY Retrospective Study.
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Affiliation(s)
- Liam Sutton
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK; Tracheal Team, Great Ormond Street Hospital, London, UK
| | - Elizabeth Maughan
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK
| | - Kiersten Pianosi
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK
| | - Guled Jama
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK
| | - Maral J Rouhani
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Richard Hewitt
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK; Tracheal Team, Great Ormond Street Hospital, London, UK
| | - Nagarajan Muthialu
- Tracheal Team, Great Ormond Street Hospital, London, UK; Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Colin Butler
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK; Tracheal Team, Great Ormond Street Hospital, London, UK; Department of Academic Surgery, Institute of Child Health, UCL, London, UK
| | - Paolo De Coppi
- Tracheal Team, Great Ormond Street Hospital, London, UK; Department of Academic Surgery, Institute of Child Health, UCL, London, UK; Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK.
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18
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Corcoran A, Foran A, Phinizy P, Biko DM, Piccione JC, Rapp JB. Dynamic airway computed tomography and flexible bronchoscopy for diagnosis of tracheomalacia in children: A comparison study. Pediatr Pulmonol 2024. [PMID: 38197524 DOI: 10.1002/ppul.26844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Tracheomalacia (TM) is an important cause of respiratory morbidity. Dynamic flexible bronchoscopy is considered the gold standard for diagnosis. Dynamic airway computed tomography (DACT) is a low radiation, noninvasive diagnostic tool utilizing images obtained continuously over several respiratory cycles. We aimed to assess the accuracy of DACT in TM diagnosis. METHODS Retrospective analysis of all patients who underwent both DACT and flexible bronchoscopy within 6 months. Airway anterior-posterior (AP) diameter was measured on multiplanar reconstructions CT in both the inspiratory and expiratory phases. Using still images from the bronchoscopy videos, the AP diameter of the trachea was measured at points of maximal and minimal diameter during tidal breathing. Degree of TM on both DACT and flexible bronchoscopy were graded using a scaling system of 50%-74%, 75%-89%, and 90%-100% as described by the European Respiratory Society. RESULTS Twenty-four patients met inclusion criteria with an average time of 19.5 days between CT and bronchoscopy. The specificity and sensitivity of DACT for the overall diagnosis of TM was 100% and 68%, respectively, with a positive predictive value of 100% and a negative predictive value of 62%. There was a strong positive correlation between DACT and flexible bronchoscopy in the measurement of tracheal AP diameter changes (ρ = 0.773, R2 0.597, p = 0.00001). Mean effective radiation dose for DACT was 0.1 mSv. CONCLUSION Ultralow dose DACT has excellent specificity and positive predictive value for both detection of TM and categorizing severity of tracheal collapse but is not sufficiently sensitive to rule it out.
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Affiliation(s)
- Aoife Corcoran
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ann Foran
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pelton Phinizy
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph C Piccione
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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19
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Singh M, Varkki S, Kinimi I, Das RR, Goyal JP, Bhat M, Dayal R, Kalyan P, Gairolla J, Khosla I. Expert group recommendation on inhaled mucoactive drugs in pediatric respiratory diseases: an Indian perspective. Front Pediatr 2023; 11:1322360. [PMID: 38111626 PMCID: PMC10725989 DOI: 10.3389/fped.2023.1322360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Background Currently, there are no guidelines or consensus statements about the usage of inhaled mucoactive drugs in pediatric respiratory disease conditions from an Indian perspective. Objective To develop a practical consensus document to help pediatricians in clinical decision-making when choosing an appropriate mucoactive drug for the management of specific respiratory disease conditions. Methods A committee of nine experts with significant experience in pediatric respiratory disease conditions and a microbiological expert constituted the panel. An electronic search of the PubMed/MEDLINE, Cochrane Library, Scopus, and Embase databases was undertaken to identify relevant articles. Various combinations of keywords such as inhaled, nebulized, mucoactive, mucolytic, mucokinetic, expectorants, mucoregulators, mucociliary clearance, respiratory disorders, pediatric, cystic fibrosis (CF), non-CF bronchiectasis, acute wheezing, asthma, primary ciliary dyskinesia (PCD), critically ill, mechanical ventilation, tracheomalacia, tracheobronchomalacia, esophageal atresia (EA), tracheoesophageal fistula (TEF), acute bronchiolitis, sputum induction, guideline, and management were used. Twelve questions were drafted for discussion. A roundtable meeting of experts was conducted to arrive at a consensus. The level of evidence and class of recommendation were weighed and graded. Conclusions Inhaled mucoactive drugs (hypertonic saline, dry powder mannitol, and dornase alfa) can enhance mucociliary clearance in children with CF. Experts opined that hypertonic saline could be beneficial in non-CF bronchiectasis, acute bronchiolitis, and PCD. The current state of evidence is inadequate to support the use of inhaled mucoactive drugs in asthma, acute wheezing, tracheomalacia, tracheobronchomalacia, and EA with TEF.
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Affiliation(s)
- Meenu Singh
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Sneha Varkki
- Department of Pediatrics, Christian Medical College, Vellore, India
| | - Ilin Kinimi
- Department of Pediatrics, Manipal Hospitals, Bengaluru, India
| | - Rashmi R. Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Mushtaq Bhat
- Department of Pediatrics and Neonatology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Rajeshwar Dayal
- Department of Pediatrics, Sarojini Naidu Medical College, Agra, India
| | - Pawan Kalyan
- Department of Pediatrics, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinaoutapally, India
| | - Jitender Gairolla
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Indu Khosla
- Dr Indu’s Newborn and Pediatric Center, Mumbai, India
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20
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Minen F, Durward A, James P, Diamantopoulos A, Jogeesvaran H, Morgan GJ, Nyman A. Single-center review on safety of biodegradable airway stenting in pediatric population. Pediatr Pulmonol 2023; 58:3437-3446. [PMID: 37728230 DOI: 10.1002/ppul.26670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 07/12/2023] [Accepted: 08/12/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Tracheobronchomalacia (TBM) and airway stenosis are recognized etiologies of airway obstruction among children. Their management is often challenging, requiring multiple interventions and prolonged respiratory support with associated long-term morbidity. Metallic or silicone stents have been used with mixed success and high complication rates. More recently biodegradable Ella stents (BES) provided an attractive interventional option. OBJECTIVES We report our experience in the treatment of TBM and vascular airway compression using BES. We deliberately downsized them to minimize intraluminal granulation tissue formation. MATERIALS AND METHODS Retrospective study over an 8-year period between November 2012 and December 2020 of pediatric patients with severe airway obstruction requiring airway stenting for extubation failure, malacic death spells, recurrent chest infections, or lung collapse. RESULTS Thirty-three patients (5 tracheal and 28 bronchial diseases) required 55 BES during the study period. The smallest patient weighed 1.8 kg. Median age of patient at first stent implantation was 13.1 months (IQR 4.9-58.3). The majority of the bronchial stents were in the left main bronchus (93%), of which 57% for vascular compression. Repeat stents were used in 19 patients (57.7%), with a range of two to four times. We did not experience erosion, infection, or obstructive granuloma needing removal by forceps or lasering. Three stent grid occluded with secretions needing bronchoscopic lavage. Stent migration occurred in three patients. CONCLUSIONS BES holds promise as a treatment option with low rate of adverse effects for a specific subset of pediatric patients with airway malacia or vascular compression. Further studies are warranted.
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Affiliation(s)
- Federico Minen
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Andrew Durward
- Paediatric Intensive Care Unit, Sidra Medicine, Doha, Qatar
| | - Paul James
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | | | - Haran Jogeesvaran
- Paediatric Radiology, Evelina London Children's Hospital, London, UK
| | - Gareth J Morgan
- Paediatric Cardiology, Evelina London Children's Hospital, London, UK
- The Heart Institute, Children's Hospital of Colorado, University of Colorado, Denver, Colorado, USA
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
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21
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Pugh CP, Ali S, Agarwal A, Matlock DN, Sharma M. Dynamic computed tomography for evaluation of tracheobronchomalacia in premature infants with bronchopulmonary dysplasia. Pediatr Pulmonol 2023; 58:3255-3263. [PMID: 37646125 PMCID: PMC10993911 DOI: 10.1002/ppul.26652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/26/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Dynamic computed tomography (dCT) gives real-time physiological information and objective descriptions of airway narrowing in tracheobronchomalacia (TBM). There is a paucity of literature in the evaluation of TBM by dCT in premature infants with bronchopulmonary dysplasia (BPD). The aim of this study is to describe the findings of dCT and resultant changes in management in premature infants with TBM. METHODS A retrospective study of 70 infants was performed. Infants included were <32 weeks gestation without major anomalies. TBM was defined as ≥50% expiratory reduction in cross-sectional area with severity defined as mild (50%-75%), moderate (≥75%-90%), or severe (≥90%). RESULTS Dynamic CT diagnosed malacia in 53% of infants. Tracheomalacia was identified in 49% of infants with severity as 76% mild, 18% moderate, and 6% severe. Bronchomalacia was identified in 43% of infants with varying severity (53% mild, 40% moderate, 7% severe). Resultant management changes included PEEP titration (44%), initiation of bethanechol (23%), planned tracheostomy (20%), extubation trial (13%), and inhaled ipratropium bromide (7%). CONCLUSION Dynamic CT is a useful noninvasive diagnostic tool for airway evaluation of premature infants. Presence and severity of TBM can provide actionable information to guide more precise clinical decision making.
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Affiliation(s)
- C. Preston Pugh
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sumera Ali
- Department of Radiology, Emory University, Children’s Hospital of Atlanta, GA
| | - Amit Agarwal
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - David N. Matlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megha Sharma
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
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22
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Abstract
Bronchopulmonary dysplasia (BPD) remains the most common complication of premature birth, imposing a significant and potentially life-long burden on patients and their families. Despite advances in our understanding of the mechanisms that contribute to patterns of lung injury and dysfunctional repair, current therapeutic strategies remain non-specific with limited success. Contemporary definitions of BPD continue to rely on clinician prescribed respiratory support requirements at specific time points. While these criteria may be helpful in broadly identifying infants at higher risk of adverse outcomes, they do not offer any precise information regarding the degree to which each compartment of the lung is affected. In this review we will outline the different pulmonary phenotypes of BPD and discuss important features in the pathogenesis, clinical presentation, and management of these frequently overlapping scenarios.
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Affiliation(s)
- Margaret Gilfillan
- Division of Neonatology, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, PA, USA
| | - Vineet Bhandari
- Division of Neonatology, The Children's Regional Hospital at Cooper/Cooper Medical School of Rowan University, Camden, NJ 08103, USA.
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23
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Wingfield Digby J, King J, Al-Sheklly B, Marsden P, Fowler S, Smith J. Bronchoscopy for refractory/unexplained cough with mucus. Respir Med 2023; 217:107335. [PMID: 37468018 DOI: 10.1016/j.rmed.2023.107335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Refractory/unexplained cough (RUCC) is typically associated with throat symptoms and a dry cough. Some patients attending specialist cough clinics however, report sputum production (>1 tablespoon daily) and atypical sensations (urge-to-cough in chest). Bronchoscopy findings in this specific cohort have rarely been described. AIMS We aimed to evaluate bronchoscopy, bronchoalveolar lavage (BAL) cell differential and microbiology findings in RUCC with mucus production. METHODS We retrospectively reviewed case notes, procedure results and treatment of patients undergoing bronchoscopy for RUCC with more than a tablespoon of sputum daily. RESULTS Data were included from 54 patients with RUCC, normal or trivial findings on CT (Computerised Tomography) imaging and no response to guideline-directed treatment of their cough. Most (84%) patients had BAL neutrophilia and excessive dynamic airway collapse (EDAC) was seen in 31%. Treatment strategies in these patients differed to those adopted in typical RUCC associated with a dry cough. Management was influenced or changed in 48/54 (89%) of the patients undergoing bronchoscopy. CONCLUSIONS Bronchoscopy provides high diagnostic value in RUCC with mucus production (>1 tbsp daily), identifying specific treatable traits including neutrophilic airway inflammation and EDAC.
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Affiliation(s)
- James Wingfield Digby
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
| | - Jenny King
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Bashar Al-Sheklly
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Marsden
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Steve Fowler
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Jaclyn Smith
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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24
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Depiazzi J, Bourke C, Stick S, Withers A. Prevalence of tracheobronchomalacia is higher than previously reported in children with cystic fibrosis. Pediatr Pulmonol 2023; 58:2568-2573. [PMID: 37294078 DOI: 10.1002/ppul.26550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/03/2023] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Tracheobronchomalacia (TBM) is estimated to be present in 1 in 2100 children. Previous reports suggest the prevalence is higher in children with cystic fibrosis (CF). This has clinical implications with potential to influence airway clearance and lung health. AIM To determine the prevalence and clinical associations of TBM in Western Australian children with CF. METHODS Children with CF born between 2001 and 2016 were included. Operation reports from bronchoscopies performed until the age of 4 were retrospectively reviewed. Data were collected on the presence, persistence defined as a repeat diagnosis, and severity of TBM. Data on genotype, pancreatic status, and symptoms at CF diagnosis were extracted from the medical record. Associations between categorical variables were compared using χ2 and Fisher's exact test. RESULTS Of 167 children (79 male), 68 (41%) were diagnosed with TBM at least once, with TBM persistent in 37 (22%) and severe in 31 (19%). TBM was significantly associated with pancreatic insufficiency (χ2 = 7.874, p < 0.05, odds ratio [OR] 3.4), delta F508 gene mutation (χ2 = 6.489, p < 0.05, OR 2.3), and a presentation of meconium ileus (χ2 = 8.615, p < 0.05, OR 5.0). Severe malacia was less likley in females (χ2 = 4.523, p < 0.05, OR 0.42) . No significant relationship was found with respiratory symptoms at the time of CF diagnosis (χ2 = 0.742, p = 0.39). CONCLUSIONS TBM was common in this group of children under the age of 4 with CF. A high index of suspicion for airway malacia should be considered in children with CF, particularly those who present with meconium ileus and have gastrointestinal symptoms at diagnosis.
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Affiliation(s)
- Julie Depiazzi
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Crystal Bourke
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Stephen Stick
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Adelaide Withers
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
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25
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Gangadharan SP, Mathew F. Thermoablative Techniques to Treat Excessive Central Airway Collapse. Thorac Surg Clin 2023; 33:299-308. [PMID: 37414486 DOI: 10.1016/j.thorsurg.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Excessive central airway collapse (ECAC) is a condition characterized by the excessive narrowing of the trachea and mainstem bronchi during expiration, which can be caused by Tracheobronchomalacia (TBM) or Excessive Dynamic Airway Collapse (EDAC). The initial standard of care for central airway collapse is to address any underlying conditions such as asthma, COPD, and gastro-esophageal reflux. In severe cases, when medical treatment fails, a stent-trial is offered to determine if surgical correction is a viable option, and tracheobronchoplasty is suggested as a definitive treatment approach. Thermoablative bronchoscopic treatments, such as Argon plasma coagulation (APC) and laser techniques (potassium-titanyl-phosphate [KTP], holmium and yttrium aluminum pevroskyte [YAP]) are a promising alternative to traditional surgery. However, further research is needed to assess their safety and effectiveness in humans before being widely used.
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Affiliation(s)
- Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, W/DC 201, 185 Pilgrim Road, Boston, MA 02215, USA.
| | - Fleming Mathew
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, W/DC 201, 185 Pilgrim Road, Boston, MA 02215, USA
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26
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Uslu E, Rana VK, Anagnostopoulos S, Karami P, Bergadano A, Courbon C, Gorostidi F, Sandu K, Stergiopulos N, Pioletti DP. Wet adhesive hydrogels to correct malacic trachea (tracheomalacia) A proof of concept. iScience 2023; 26:107168. [PMID: 37456833 PMCID: PMC10338288 DOI: 10.1016/j.isci.2023.107168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/17/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Tracheomalacia (TM) is a condition characterized by a weak tracheal cartilage and/or muscle, resulting in excessive collapse of the airway in the newborns. Current treatments including tracheal reconstruction, tracheoplasty, endo- and extra-luminal stents have limitations. To address these limitations, this work proposes a new strategy by wrapping an adhesive hydrogel patch around a malacic trachea. Through a numerical model, first it was demonstrated that a hydrogel patch with sufficient mechanical and adhesion strength can preserve the trachea's physiological shape. Accordingly, a new hydrogel providing robust adhesion on wet tracheal surfaces was synthesized employing the hydroxyethyl acrylamide (HEAam) and polyethylene glycol methacrylate (PEGDMA) as main polymer network and crosslinker, respectively. Ex vivo experiments revealed that the adhesive hydrogel patches can restrain the collapsing of malacic trachea under negative pressure. This study may open the possibility of using an adhesive hydrogel as a new approach in the difficult clinical situation of tracheomalacia.
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Affiliation(s)
- Ece Uslu
- Laboratory of Biomechanical Orthopedics, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Vijay Kumar Rana
- Laboratory of Biomechanical Orthopedics, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Sokratis Anagnostopoulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Peyman Karami
- Laboratory of Biomechanical Orthopedics, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | | | - Cecile Courbon
- Department of Anesthesiology, University Hospital, CHUV, Lausanne, Switzerland
| | - Francois Gorostidi
- Department of Otorhinolaryngology, Airway Sector, University Hospital, CHUV, Lausanne, Switzerland
| | - Kishore Sandu
- Department of Otorhinolaryngology, Airway Sector, University Hospital, CHUV, Lausanne, Switzerland
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Dominique P. Pioletti
- Laboratory of Biomechanical Orthopedics, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
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27
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Bush D, Juliano C, Bowler S, Tiozzo C. Development and Disorders of the Airway in Bronchopulmonary Dysplasia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1127. [PMID: 37508624 PMCID: PMC10378517 DOI: 10.3390/children10071127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/07/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Bronchopulmonary dysplasia (BPD), a disorder characterized by arrested lung development, is a frequent cause of morbidity and mortality in premature infants. Parenchymal lung changes in BPD are relatively well-characterized and highly studied; however, there has been less emphasis placed on the role that airways disease plays in the pathophysiology of BPD. In preterm infants born between 22 and 32 weeks gestation, the conducting airways are fully formed but still immature and therefore susceptible to injury and further disruption of development. The arrest of maturation results in more compliant airways that are more susceptible to deformation and damage. Consequently, neonates with BPD are prone to developing airway pathology, particularly for patients who require intubation and positive-pressure ventilation. Airway pathology, which can be divided into large and small airways disease, results in increased respiratory morbidity in neonates with chronic lung disease of prematurity.
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Affiliation(s)
- Douglas Bush
- Division of Pediatric Pulmonology, Department of Pediatrics, Mount Sinai Hospital, Icahn School of Medicine, New York, NY 10029, USA
| | - Courtney Juliano
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, Icahn School of Medicine, New York, NY 10029, USA
| | - Selina Bowler
- Department of Pediatrics, New York University Langone-Long Island, Mineola, NY 11501, USA
| | - Caterina Tiozzo
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, Icahn School of Medicine, New York, NY 10029, USA
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28
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Weinberger M. Chronic Cough and Causes in Children. J Clin Med 2023; 12:3947. [PMID: 37373643 DOI: 10.3390/jcm12123947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Coughing is a natural means to clear the airway [...].
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Affiliation(s)
- Miles Weinberger
- Respiratory Department, Rady Children's Hospital, University of California San Diego, La Jolla, CA 92093, USA
- Pediatric Department, University of Iowa, Iowa City, IA 52242, USA
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29
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Brooks KA, Lai AY, Tucker SJ, Ramaraju H, Verga A, Shashidharan S, Maher KO, Simon DM, Hollister SJ, Landry AM, Goudy SL. External airway splint placement for severe pediatric tracheobronchomalacia. Int J Pediatr Otorhinolaryngol 2023; 169:111559. [PMID: 37126976 DOI: 10.1016/j.ijporl.2023.111559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To present external airway splinting with bioabsorbable airway supportive devices (ASD) for severe, life-threatening cases of pediatric tracheomalacia (TM) or tracheobronchomalacia (TBM). METHODS A retrospective cohort was performed for 5 pediatric patients with severe TM or TBM who underwent ASD placement. Devices were designed and 3D-printed from a bioabsorbable material, polycaprolactone (PCL). Pre-operative planning included 3-dimensional airway modeling of tracheal collapse and tracheal suture placement using nonlinear finite element (FE) methods. Pre-operative modeling revealed that triads along the ASD open edges and center were the most effective suture locations for optimizing airway patency. Pediatric cardiothoracic surgery and otolaryngology applied the ASDs by suspending the trachea to the ASD with synchronous bronchoscopy. Respiratory needs were trended for all cases. Data from pediatric patients with tracheostomy and diagnosis of TM or TBM, but without ASD, were included for discussion. RESULTS Five patients (2 Females, 3 Males, ages 2-9 months at time of ASD) were included. Three patients were unable to wean from respiratory support after vascular ring division; all three weaned to room air post-ASD. Two patients received tracheostomies prior to ASD placement, but continued to experience apparent life-threatening events (ALTE) and required ventilation with supraphysiologic ventilator settings. One patient weaned respiratory support successfully after ASD placement. The last patient died post-ASD due to significant respiratory co-morbidity. CONCLUSION ASD can significantly benefit patients with severe, unrelenting tracheomalacia or tracheobronchomalacia. Proper multidisciplinary case deliberation and selection are key to success with ASD. Pre-operative airway modeling allows proper suture placement to optimally address the underlying airway collapse.
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Affiliation(s)
- Kaitlyn A Brooks
- Department of Otolaryngology- Head and Neck Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
| | - Annie Y Lai
- Scheller College of Business, Georgia Institute of Technology, Atlanta, GA, USA; Pediatric Intensive Care Unit, Children's Healthcare of Atlanta - Egleston, Atlanta, GA, USA
| | - Sarah J Tucker
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Harsha Ramaraju
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Adam Verga
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Subhadra Shashidharan
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Kevin O Maher
- Division of Cardiology, Pediatric Cardiology, Children's Healthcare of Atlanta Heart Center, Emory University School of Medicine Department of Pediatrics, Atlanta, GA, USA
| | - Dawn M Simon
- Division of Pulmonology, Pediatric Pulmonology, Children's Healthcare of Atlanta, Emory University School of Medicine Department of Pediatrics, Atlanta, GA, USA
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - April M Landry
- Department of Otolaryngology- Head and Neck Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven L Goudy
- Department of Otolaryngology- Head and Neck Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
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30
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Sriboonyong T, Preutthipan A, Nugboon M. Long-term sleep apnea CPAP via tracheostomy in children with tracheomalacia: 20-year experience. Front Pediatr 2023; 11:1169613. [PMID: 37325360 PMCID: PMC10266409 DOI: 10.3389/fped.2023.1169613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Children with severe tracheobronchomalacia may need placements of tracheostomies and long-term mechanical ventilation. Due to financial constraints, continuous positive airway pressure (CPAP) machines commonly used to treat obstructive sleep apnea in adults have been utilized to deliver positive distending pressure to such children at our institution for more than 20 years with favorable outcomes. We, therefore, reported our experience with 15 children using this machine. Methods This is a retrospective study during 2001-2021. Results Fifteen children, 9 boys, aged ranged 3 months-5.6 years, were discharged home with CPAP via tracheostomies. All had co-morbidities including gastroesophageal reflux (n = 9, 60%), neuromuscular disorders (n = 6, 40%), genetic abnormalities (n = 6, 40%), cardiac diseases (n = 4, 27%) and chronic lungs (n = 3, 20%). Eight (53%) children were aged less than 1 year old. The smallest child was aged 3 months old, weighing 4.9 kg. All caregivers were relatives and non-medical health professionals. The 1-month and 1-year readmission rates were 13% and 66% respectively. No factor-associated unfavorable outcomes were statistically identified. No complications related to CPAP malfunction were found. Five (33%) were weaned off CPAP, and 3 died (2 from sepsis and 1 from a sudden unknown cause). Conclusion We first reported the use of sleep apnea CPAP via tracheostomy in children with severe tracheomalacia. In limited-resource countries, this simple device may be another option for long-term invasive ventilatory support. The CPAP use in children with tracheobronchomalacia requires adequately trained caregivers.
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Affiliation(s)
- Tidarat Sriboonyong
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aroonwan Preutthipan
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Malinee Nugboon
- Nursing Affairs, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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31
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Zhou YH, Gallins PJ, Pace RG, Dang H, Aksit MA, Blue EE, Buckingham KJ, Collaco JM, Faino AV, Gordon WW, Hetrick KN, Ling H, Liu W, Onchiri FM, Pagel K, Pugh EW, Raraigh KS, Rosenfeld M, Sun Q, Wen J, Li Y, Corvol H, Strug LJ, Bamshad MJ, Blackman SM, Cutting GR, Gibson RL, O’Neal WK, Wright FA, Knowles MR. Genetic Modifiers of Cystic Fibrosis Lung Disease Severity: Whole-Genome Analysis of 7,840 Patients. Am J Respir Crit Care Med 2023; 207:1324-1333. [PMID: 36921087 PMCID: PMC10595435 DOI: 10.1164/rccm.202209-1653oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Rationale: Lung disease is the major cause of morbidity and mortality in persons with cystic fibrosis (pwCF). Variability in CF lung disease has substantial non-CFTR (CF transmembrane conductance regulator) genetic influence. Identification of genetic modifiers has prognostic and therapeutic importance. Objectives: Identify genetic modifier loci and genes/pathways associated with pulmonary disease severity. Methods: Whole-genome sequencing data on 4,248 unique pwCF with pancreatic insufficiency and lung function measures were combined with imputed genotypes from an additional 3,592 patients with pancreatic insufficiency from the United States, Canada, and France. This report describes association of approximately 15.9 million SNPs using the quantitative Kulich normal residual mortality-adjusted (KNoRMA) lung disease phenotype in 7,840 pwCF using premodulator lung function data. Measurements and Main Results: Testing included common and rare SNPs, transcriptome-wide association, gene-level, and pathway analyses. Pathway analyses identified novel associations with genes that have key roles in organ development, and we hypothesize that these genes may relate to dysanapsis and/or variability in lung repair. Results confirmed and extended previous genome-wide association study findings. These whole-genome sequencing data provide finely mapped genetic information to support mechanistic studies. No novel primary associations with common single variants or rare variants were found. Multilocus effects at chr5p13 (SLC9A3/CEP72) and chr11p13 (EHF/APIP) were identified. Variant effect size estimates at associated loci were consistently ordered across the cohorts, indicating possible age or birth cohort effects. Conclusions: This premodulator genomic, transcriptomic, and pathway association study of 7,840 pwCF will facilitate mechanistic and postmodulator genetic studies and the development of novel therapeutics for CF lung disease.
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Affiliation(s)
- Yi-Hui Zhou
- Bioinformatics Research Center
- Department of Biological Sciences, and
| | | | - Rhonda G. Pace
- Marsico Lung Institute/UNC CF Research Center, School of Medicine
| | - Hong Dang
- Marsico Lung Institute/UNC CF Research Center, School of Medicine
| | | | - Elizabeth E. Blue
- Brotman Baty Institute for Precision Medicine, Seattle, Washington
- Division of Medical Genetics, Department of Medicine
| | | | | | - Anna V. Faino
- Children’s Core for Biostatistics, Epidemiology and Analytics in Research and
| | | | - Kurt N. Hetrick
- Department of Genetic Medicine, Center for Inherited Disease Research, and
| | - Hua Ling
- Department of Genetic Medicine, Center for Inherited Disease Research, and
| | | | | | - Kymberleigh Pagel
- The Institute for Computational Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth W. Pugh
- Department of Genetic Medicine, Center for Inherited Disease Research, and
| | | | - Margaret Rosenfeld
- Department of Pediatrics, and
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | | | | | - Yun Li
- Department of Biostatistics
- Department of Genetics, and
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Harriet Corvol
- Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Paris, France
- Centre de Recherche Saint Antoine, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Lisa J. Strug
- Division of Biostatistics, Dalla Lana School of Public Health
- Department of Statistical Sciences, and
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada; and
- Program in Genetics and Genome Biology and
- The Center for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael J. Bamshad
- Brotman Baty Institute for Precision Medicine, Seattle, Washington
- Division of Genetic Medicine, Department of Pediatrics
- Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Scott M. Blackman
- McKusick-Nathans Department of Genetic Medicine
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ronald L. Gibson
- Department of Pediatrics, and
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Wanda K. O’Neal
- Marsico Lung Institute/UNC CF Research Center, School of Medicine
| | - Fred A. Wright
- Bioinformatics Research Center
- Department of Biological Sciences, and
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
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32
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Zhou C, Dong J, Li B, Li M, Zou C, Xiao Y, Xu G, Li B. Effects of primary posterior tracheopexy in thoracoscopic repair of esophageal atresia. Heliyon 2023; 9:e15931. [PMID: 37215794 PMCID: PMC10195884 DOI: 10.1016/j.heliyon.2023.e15931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
Background This study aimed to evaluate the effectiveness of primary posterior tracheopexy (PPT) in reducing ventilator dependence after repair of esophageal atresia (EA), and the risk of respiratory tract infections (RTI) requiring readmissions within one year. Methods This retrospective cohort study recruited patients with EA admitted to our hospital between June 2020 and December 2021. Results In the PPT group (n = 17), the time to extubation after surgery was 86.7 h for 12 patients, with one patient (8.3%) requiring repeated postoperation intubation; six-in-sixteen patients (37.5%) experience at least one RTI requiring hospitalization in one year. In the non-PPT group (n = 17), the time to extubation was 127.0 h for 14 patients, with six-in-fourteen patients (42.9%) requiring repeated intubation; twelve-in-seventeen patients (70.6%) experienced at least one RTI requiring hospitalization in one year. Conclusions Although the differences did not reach statistical significance due to limited number of participants, patients underwent PPT during EA repair had lower chance of repeated intubation and decreased risk of RTI requiring admissions within one year.
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Affiliation(s)
- Chonggao Zhou
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Jie Dong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha 410007, China
| | - Bo Li
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Ming Li
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Chanjuan Zou
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Yong Xiao
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Guang Xu
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Bixiang Li
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha 410007, China
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Chang AB, Oppenheimer JJ, Dunlap W, Lieberman JA, Irwin RS. Yardstick for managing cough. Part 2: in children. Ann Allergy Asthma Immunol 2023; 130:681-689. [PMID: 36736723 DOI: 10.1016/j.anai.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
Nationwide statistics in the United States and Australia reveal that cough of undifferentiated duration is the most common complaint for which patients of all ages seek medical care in the ambulatory setting. Management of chronic cough is one of the most common reasons for new patient visits to respiratory specialists. Because symptomatic cough is such a common problem and so much has been learned about how to diagnose and treat cough of all durations but especially chronic cough, this 2-part yardstick has been written to review in a practical way the evidence-based guidelines most of which have been developed from high-quality systematic reviews on how best to manage cough of all durations in adults, adolescents, and children. Chronic cough in children is often benign and self-limiting. Using established and validated protocols and specific pointers (clues in history, findings on examination) can aid the clinician in identifying causes when present and improve outcomes. In this manuscript, part 2 of the 2-part series, we provide evidence-based, expert opinion recommendations on the management of chronic cough in the pediatric patient (<14 years of age).
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology, and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia; Menzies School of Health Research, Darwin, Australia.
| | | | - Whitney Dunlap
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts; Northeast Allergy, Asthma, and Immunology, Worcester, Massachusetts
| | - Jay Adam Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
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Anterior and posterior tracheopexy for severe tracheomalacia. JTCVS Tech 2022; 17:159-163. [PMID: 36820339 PMCID: PMC9938389 DOI: 10.1016/j.xjtc.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/17/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives Congenital tracheomalacia can be the cause of respiratory failure in young children. Although the indication for surgical treatment has already been discussed vigorously, no clear guidelines about the modality are available. Methods Through a sternotomy approach, a combination of posterior pexy and anterior tracheopexy using a tailored ringed polytetrafluoroethylene prosthesis is performed. Patient demographic characteristics, as well as operative details and postoperative outcomes, are included in the analysis. Results Between 2018 and 2022, 9 children underwent the operation under review. All patients showed severe clinical symptoms of tracheomalacia, which was confirmed on bronchoscopy. The median age was 9 months. There was no operative mortality. Eight patients could be weaned from the ventilator. One patient died because of interstitial lung disease with bronchomalacia and concomitant severe cardiac disease. The longest follow-up now is 4 years, and shows overall excellent clinical results, without any reintervention. Conclusions Surgical treatment of tracheomalacia through a combination of posterior and anterior pexy is feasible, with acceptable short- and midterm results.
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Heterogenous Disease Course and Long-Term Outcome of Children's Interstitial Lung Disease Related to Filamin A Gene Variants. Ann Am Thorac Soc 2022; 19:2021-2030. [PMID: 35767027 DOI: 10.1513/annalsats.202202-142oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Variable disease course and outcomes have been reported in children's interstitial lung disease associated with FLNA (Filamin A gene) variants. Objectives: To further delineate long-term respiratory outcomes and identify potential contributing factors to severe disease course. Methods: We retrospectively collected longitudinal data from three centers on nine cases (one male) with FLNA variants and early respiratory disease onset (within the first 24 mo of life). Clinical, radiographic, and histopathologic data were analyzed, focusing on cardiorespiratory disease course. Results: All required early respiratory support (three invasive ventilation, three noninvasive ventilation, three supplemental oxygen), and all experienced frequent severe infective respiratory exacerbations. Three died in infancy from refractory respiratory failure and pulmonary hypertension (PH). The six surviving individuals were 3, 10, 11, 15, 18, and 33 years old at time of reporting. The extent of functional respiratory impairment decreased with age; at last follow-up, there were no individuals on home invasive ventilation, one on nocturnal noninvasive ventilation, four on oxygen, and one on no respiratory support. Spirometry consistently demonstrated moderate to severe obstructive defects (forced expiratory volume in 1 s/forced vital capacity [FVC] z-score, -3.76 to -1.77; percent predicted FVC, 31.5% to 92.1%). Seven required PH treatment in early childhood (7/9), and three of the survivors (3/6) still receive treatment. Radiologic and histopathologic findings were consistent among cases. Conclusions: Early mortality was common, but many survivors stabilized even after severe symptoms in infancy. All survivors had persistent obstructive defects on spirometry, and half have persistent or recurrent PH. These typical findings are suggestive of this rare diagnosis and should prompt consideration of genetic testing.
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Guerin S, Blanchon S, de Halleux Q, Bayon V, Ferry T. Long term NIV in an infant with Hallermann-Streiff syndrome: A case report and overview of respiratory morbidity. Front Pediatr 2022; 10:1039964. [PMID: 36405833 PMCID: PMC9669373 DOI: 10.3389/fped.2022.1039964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Hallermann-Streiff syndrome (HSS) is a rare congenital syndrome with different anomalies including midface hypoplasia, beak nose and micrognathia. The upper airways narrowness can lead to severe respiratory complications such as obstructive sleep apnoea syndrome (OSAS), particularly in infancy. The management of these severe OSAS is difficult and poorly documented in literature. We report the case of an infant with HSS complicated by severe and early OSAS successfully managed with non-invasive ventilation (NIV), provide an overview of respiratory morbidities and discuss treatment options for HSS-related OSAS.
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Affiliation(s)
- S Guerin
- Unité de Pneumologie et Mucoviscidose Pédiatrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse
| | - S Blanchon
- Unité de Pneumologie et Mucoviscidose Pédiatrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse
| | - Q de Halleux
- Unité de Physiothérapie Pédiatrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse
| | - V Bayon
- Centre d’Investigation et de Recherche sur le Sommeil, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse
| | - T Ferry
- Soins Intensifs Pédiatriques, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse
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Paediatric tracheobronchomalacia: Incidence, patient characteristics, and predictors of surgical intervention. J Pediatr Surg 2022; 57:543-549. [PMID: 35718546 DOI: 10.1016/j.jpedsurg.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Tracheobronchomalacia (TBM), a condition where an abnormality of the tracheal walls causes collapse during the respiratory cycle, is a common cause of airway obstruction in childhood. TBM can present with a large spectrum of disease severity and underlying pathologies that may be managed medically and surgically, and it is not always clear which patients would most benefit from surgical intervention. We aim to describe the incidence, patient characteristics, and predictors of surgical intervention in a large cohort of paediatric patients. METHODS We performed a retrospective review of all children diagnosed with TBM to a paediatric Otolaryngology unit in the west of Scotland between 2010 and 2020. Odds ratios for clinical predictors of surgery were calculated using logistic regression with uni- and multivariate analysis. RESULTS 249 patients were identified of which 219 proceeded to data collection. Primary malacia was noted in 161 (73.5%) and secondary in 58 (26.5%). Causes of secondary malacia included compression by the innominate artery (11%) and vascular rings (7.8%). Surgical interventions were performed in 28 patients (12.8%) including division of vascular ring, aortopexy, and surgical tracheostomy. Multivariate analysis showed secondary TBM, acute life-threatening events, and difficulty weaning from mechanical ventilation were independent risk factors for surgical intervention. CONCLUSIONS TBM can present with a myriad of airway symptoms and is frequently associated with other airway and mediastinal pathologies necessitating multiple interventions. Children aged <1 year present with a more severe form of the disease and the presence of particular independent risk factors may indicate a need for surgical intervention.
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Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Thomas RJ, Masters IB, Chang AB. Pulmonary function of children with tracheomalacia and associated clinical factors. Pediatr Pulmonol 2022; 57:2437-2444. [PMID: 35785487 PMCID: PMC9796637 DOI: 10.1002/ppul.26054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/01/2022] [Accepted: 06/25/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Spirometry is easily accessible yet there is limited data in children with tracheomalacia. Availability of such data may inform clinical practice. We aimed to describe spirometry indices of children with tracheomalacia, including Empey index and flow-volume curve pattern, and determine whether these indices relate with bronchoscopic features. METHODS From the database of children with tracheomalacia diagnosed during 2016-2019, we reviewed their flexible bronchoscopy and spirometry data in a blinded manner. We specially evaluated several spirometry indices and tracheomalacia features (cross-sectional lumen reduction, malacic length, and presence of bronchomalacia) and determined their association using multivariable regression. RESULTS Of 53 children with tracheomalacia, the mean (SD) peak expiratory flow (PEF) was below the normal range [68.9 percent of predicted value (23.08)]. However, all other spirometry parameters were within normal range [Z-score forced expired volume in 1 s (FEV1 ) = -1.18 (1.39), forced vital capacity (FVC) = -0.61 (1.46), forced expiratory flow between 25% and 75% of vital capacity (FEF25%-75% ) = -1.43 (1.10), FEV1 /FVC = -1.04 (1.08)], Empey Index = 8.21 (1.59). The most common flow-volume curve pattern was the "knee" pattern (n = 39, 73.6%). Multivariable linear regression identified the presence of bronchomalacia was significantly associated with lower flows: FEV1 [coefficient (95% CI) -0.78 (-1.54, -0.02)], FEF25%-75% [-0.61 (-1.22, 0)], and PEF [-12.69 (-21.13, -4.25)], all p ≤ 0.05. Other bronchoscopic-defined tracheomalacia features examined (cross-sectional lumen reduction, malacic length) were not significantly associated with spirometry indices. CONCLUSION The "knee" pattern in spirometry flow-volume curve is common in children with tracheomalacia but other indices, including Empey index, cannot be used to characterize tracheomalacia. Spirometry indices were not significantly associated with bronchoscopic tracheomalacia features but children with tracheobronchomalacia have significantly lower flow than those with tracheomalacia alone.
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Affiliation(s)
- Wicharn Boonjindasup
- Menzies School of Health Research, Child Health Division, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Charles Darwin University, Casuarina, Northern Territory, Australia.,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Menzies School of Health Research, Child Health Division, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Charles Darwin University, Casuarina, Northern Territory, Australia.,Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rahul J Thomas
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Ian B Masters
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Menzies School of Health Research, Child Health Division, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Charles Darwin University, Casuarina, Northern Territory, Australia.,Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Gunatilaka CC, Hysinger EB, Schuh A, Xiao Q, Gandhi DB, Higano NS, Ignatiuk D, Hossain MM, Fleck RJ, Woods JC, Bates AJ. Predicting tracheal work of breathing in neonates based on radiological and pulmonary measurements. J Appl Physiol (1985) 2022; 133:893-901. [PMID: 36049059 PMCID: PMC9529254 DOI: 10.1152/japplphysiol.00399.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022] Open
Abstract
Tracheomalacia is an airway condition in which the trachea excessively collapses during breathing. Neonates diagnosed with tracheomalacia require more energy to breathe, and the effect of tracheomalacia can be quantified by assessing flow-resistive work of breathing (WOB) in the trachea using computational fluid dynamics (CFD) modeling of the airway. However, CFD simulations are computationally expensive; the ability to instead predict WOB based on more straightforward measures would provide a clinically useful estimate of tracheal disease severity. The objective of this study is to quantify the WOB in the trachea using CFD and identify simple airway and/or clinical parameters that directly relate to WOB. This study included 30 neonatal intensive care unit subjects (15 with tracheomalacia and 15 without tracheomalacia). All subjects were imaged using ultrashort echo time (UTE) MRI. CFD simulations were performed using patient-specific data obtained from MRI (airway anatomy, dynamic motion, and airflow rates) to calculate the WOB in the trachea. Several airway and clinical measurements were obtained and compared with the tracheal resistive WOB. The maximum percent change in the tracheal cross-sectional area (ρ = 0.560, P = 0.001), average glottis cross-sectional area (ρ = -0.488, P = 0.006), minute ventilation (ρ = 0.613, P < 0.001), and lung tidal volume (ρ = 0.599, P < 0.001) had significant correlations with WOB. A multivariable regression model with three independent variables (minute ventilation, average glottis cross-sectional area, and minimum of the eccentricity index of the trachea) can be used to estimate WOB more accurately (R2 = 0.726). This statistical model may allow clinicians to estimate tracheal resistive WOB based on airway images and clinical data.NEW & NOTEWORTHY The work of breathing due to resistance in the trachea is an important metric for quantifying the effect of tracheal abnormalities such as tracheomalacia, but currently requires complex dynamic imaging and computational fluid dynamics simulation to calculate it. This study produces a method to predict the tracheal work of breathing based on readily available imaging and clinical metrics.
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Affiliation(s)
- Chamindu C Gunatilaka
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erik B Hysinger
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Andreas Schuh
- Department of Computing, Imperial College London, London, United Kingdom
| | - Qiwei Xiao
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Deep B Gandhi
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nara S Higano
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Daniel Ignatiuk
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Md M Hossain
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio
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40
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Park YJ, Kim E, Jung HS. Successful management of a tracheomalacia patient with active endotracheal bleeding due to intraoperative innominate artery injury: A case report. Medicine (Baltimore) 2022; 101:e30797. [PMID: 36181007 PMCID: PMC9524874 DOI: 10.1097/md.0000000000030797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Intraoperative innominate artery injury is life-threatening in tracheomalacia patients with prolonged tracheostomy. Anesthetic management is challenging in cases with massive hemorrhage into the endotracheal tube. We report a case in which we successfully managed a tracheomalacia patient with acute endotracheal bleeding due to innominate artery injury. PATIENT CONCERNS A 24-year-old patient with tracheomalacia was scheduled to undergo exploratory thoracotomy for the treatment of intermittent bleeding at the tracheostomy site. During exploration, sudden active bleeding due to innominate artery injury was observed in the endotracheal lumen. DIAGNOSES The patient was diagnosed with tracheomalacia. INTERVENTIONS We immediately used the bronchoscope to place the tip of the endotracheal tube at the bleeding site and hyperinflated the cuff. OUTCOMES The ballooned cuff compressed the active bleeding site, so no additional bleeding was detected by bronchoscopy, and no additional massive bleeding was observed in the operative field. LESSONS Immediate and appropriate overinflation of the endotracheal tube cuff by an anesthesiologist may provide improved surgical field visibility and time for critical surgical procedures in cases of massive hemorrhaging.
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Affiliation(s)
- Yoo Jung Park
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunji Kim
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hong Soo Jung
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Hong Soo Jung, Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea (e-mail: )
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41
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Liszewski MC, Ciet P, Winant AJ, Lee EY. Pediatric large airway imaging: evolution and revolution. Pediatr Radiol 2022; 52:1826-1838. [PMID: 35536417 DOI: 10.1007/s00247-022-05377-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 12/14/2022]
Abstract
Infants and children often present with respiratory symptoms referable to the airway. For these pediatric patients, airway imaging is frequently performed to evaluate for underlying disorders of the large airway. Various imaging modalities have been used to evaluate the pediatric large airway, and pediatric airway imaging techniques have continued to evolve. Therefore, clear understanding of the status and new advances in pediatric large airway imaging is essential for practicing radiologists to make timely and accurate diagnoses, which can lead to optimal pediatric patient management.
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Affiliation(s)
- Mark C Liszewski
- Departments of Radiology and Pediatrics, Montefiore Medical Center and Albert Einstein College of Medicine, 111 East 210th St., Bronx, NY, 10467, USA.
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Pediatric Respiratory Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, University Hospital of Cagliari, Cagliari, Italy
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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42
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Hysinger EB, Higano NS, Critser PJ, Woods JC. Imaging in neonatal respiratory disease. Paediatr Respir Rev 2022; 43:44-52. [PMID: 35074281 PMCID: PMC10439744 DOI: 10.1016/j.prrv.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022]
Abstract
The purpose of this review is to describe the current state of the art in clinical imaging for NICU patients, divided into major areas that correspond to likely phenotypes of neonatal respiratory disease: airway abnormalities, parenchymal disease, and pulmonary vascular disease. All common imaging modalities (ultrasound, X-ray, CT, and MRI) are discussed, with an emphasis on modalities that are most relevant to the individual underlying aspects of disease. Some promising aspects of dynamic and functional imaging are included, where there may be future clinical applicability.
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Affiliation(s)
- E B Hysinger
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, United States.
| | - N S Higano
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, United States
| | - P J Critser
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, United States
| | - J C Woods
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, United States
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43
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Durward A, Macrae D. Long term outcome of babies with pulmonary hypertension. Semin Fetal Neonatal Med 2022; 27:101384. [PMID: 36031529 DOI: 10.1016/j.siny.2022.101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Neonatal pulmonary hypertension (PH) is associated with many severe congenital abnormalities (congenital diaphragmatic hernia) or acquired cardiorespiratory diseases such as pneumonia, meconium aspiration and bronchopulmonary dysplasia (BPD). If no cause is found it may be labelled idiopathic persistent pulmonary hypertension of the newborn. Although PH may result in life threatening hypoxia and circulatory failure, in the majority of cases, it resolves in the neonatal period following treatment of the underlying cause. However, in some cases, neonatal PH progresses into infancy and childhood where symptoms include failure to thrive and eventually right heart failure or death if left untreated. This chronic condition is termed pulmonary vascular hypertensive disease (PHVD). Although classification and diagnostic criteria have only recently been proposed for pediatric PHVD, little is known about the pathophysiology of chronic neonatal PH, or why pulmonary vascular resistance may remain elevated well beyond infancy. This review explores the many factors involved in chronic PH and what implications this may have on long term outcome when the disease progresses beyond the neonatal period.
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Affiliation(s)
- Andrew Durward
- ECMO Service, Cardiac Intensive Care Unit, Sidra Medicine, Doha, Qatar.
| | - Duncan Macrae
- Cardiac Intensive Care, Sidra Medicine, Doha, Qatar; Paediatric Intensive Care Medicine, Imperial College, London, UK
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Morante-Valverde R, Usategui A, López M, Grau M, Luna-Paredes MC, Albi S, Alonso-Riaño M, Pablos JL, Antón-Pacheco JL. Histological and structural effects of biodegradable polydioxanone stents in the rabbit trachea. Eur J Cardiothorac Surg 2022; 62:6628586. [PMID: 35781568 DOI: 10.1093/ejcts/ezac380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/03/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the potential biologic effects caused by successive placement of biodegradable polydioxanone (PDO) stents in the rabbit trachea. PDO stents could eventually induce a fibroproliferative reaction in the submucosa that could be beneficial in the treatment of malacia due to an increase in its consistency without impairing the tracheal lumen. METHODS Sixteen adult NZ rabbits were distributed into 3 groups with different survival times according to the number of stents placed: One stent (14 weeks), 2 stents (28 w.), and 3 stents (42 w.). Stent insertion was performed endoscopically in the cervical trachea of the animal. Histopathological studies included Masson's trichrome staining for submucosal fibrosis and Safranin O to assess structural integrity of cartilage. Potential inflammatory changes were analysed by means of immunohistochemistry determining the number of CD45 positive cells. RESULTS Stent placement was successful in every case. Histological studies did not show a statistically significant increase in tracheal wall collagen area and cartilage structure was not modified in those rabbits with one or more PDO stents inserted compared to non-stented tracheal sections. Furthermore, no statistically significant changes in the number of CD45+ cells were observed in stented tracheal segments compared to normal tracheal tissues. CONCLUSIONS According to our data, successive PDO stenting caused mild inflammatory changes in the tracheal wall, no increase in the collagen matrix, and the cartilaginous support was not modified during a long follow-up period (up to 42 weeks). These findings suggest that they may be safe and show good biocompatibility in the long-term.
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Affiliation(s)
- Rocío Morante-Valverde
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain
| | - Alicia Usategui
- Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - María López
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain
| | - Montserrat Grau
- Research Center, Veterinary Unit. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Ma Carmen Luna-Paredes
- Pulmonary Unit, Division of Pediatrics. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Salomé Albi
- Pulmonary Unit, Division of Pediatrics. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Marina Alonso-Riaño
- Division of Pathology. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - José L Pablos
- Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Juan L Antón-Pacheco
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain.,Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U . 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid, 28041, . Spain
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Thomas R, Chang A, Masters IB, Grimwood K, Marchant J, Yerkovich S, Chatfield M, O'Brien C, Goyal V. Association of childhood tracheomalacia with bronchiectasis: a case-control study. Arch Dis Child 2022; 107:565-569. [PMID: 34649867 DOI: 10.1136/archdischild-2021-322578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/27/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Children with tracheomalacia can develop chronic lower airway infection and neutrophilic inflammation. It is plausible children with tracheomalacia are at increased risk of developing bronchiectasis. We hypothesised that compared with controls, tracheomalacia in children is associated with bronchiectasis. DESIGN Single-centre, case-control study. SETTING AND PATIENTS 45 children with chest high-resolution CT (c-HRCT) confirmed bronchiectasis (cases) and enrolled in the Australian Bronchiectasis Registry were selected randomly from Queensland, and 90 unmatched children without chronic respiratory symptoms or radiographic evidence of bronchiectasis (disease controls). Cases and controls had flexible bronchoscopy performed for clinical reasons within 4 weeks of their c-HRCT. INTERVENTIONS The bronchoscopy videos were reviewed in a blinded manner for: (a) any tracheomalacia (any shape deformity of the trachea at end-expiration) and (b) tracheomalacia defined by the European Respiratory Society (ERS) statement (>50% expiratory reduction in the cross-sectional luminal area). MAIN OUTCOME MEASURES AND RESULTS Cases were younger (median age=2.6 years, IQR 1.5-4.1) than controls (7.8 years, IQR 3.4-12.8), but well-balanced for sex (56% and 52% male, respectively). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted OR (ORadj)=13.2, 95% CI 3.2 to 55), while that for ERS-defined tracheomalacia further increased this risk (ORadj=24.4, 95% CI 3.4 to infinity). CONCLUSION Bronchoscopic-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic (>4 weeks) wet cough, the most common symptom of bronchiectasis, which if present should be treated and then investigated if the cough persists or is recurrent.
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Affiliation(s)
- Rahul Thomas
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia .,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anne Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia's Northern Territory, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University Faculty of Health, Gold Coast, Queensland, Australia.,Departments of Infectious Diseases, Gold Coast University Hospital, Southport, Queensland, Australia.,Department of Paediatrics, Gold Coast Health, Southport, Queensland, Australia
| | - Julie Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia's Northern Territory, Australia
| | - Mark Chatfield
- Faculty of Medicine, The University of Queensland Faculty of Health Sciences, Herston, Queensland, Australia
| | - Christopher O'Brien
- Department of Radiology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Department of Paediatrics, Gold Coast Health, Southport, Queensland, Australia
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46
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Yu D, Peng W, Mo X, Zhang Y, Zhang X, He J. Personalized 3D-Printed Bioresorbable Airway External Splint for Tracheomalacia Combined With Congenital Heart Disease. Front Bioeng Biotechnol 2022; 10:859777. [PMID: 35620475 PMCID: PMC9127074 DOI: 10.3389/fbioe.2022.859777] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Severe tracheomalacia (TM) patients with respiratory symptoms need surgical intervention, including aortopexy, internal stents or external splint. While some patients continue to have respiratory symptoms after tracheal relief, and there is no evidence to support any one surgery therapy over another. Here we introduce a clinical safety and efficacy of the three-dimensional (3D)-printed bioresorbable airway external splints in treating congenital heart disease (CHD) patients with severe TM. From May 2019 to September 2020, nine patients with severe TM were enrolled. The median age was 5 months (range, 3–25 months), and the median weight was 7.5 kg (range, 3–15 kg). All patients had wheezing, and two patients were assisted by machine ventilation (MV) preoperatively. The median length of TM was 1.5 cm (range, 1.0–3.0 cm). All patients underwent suspension of a “C”-shaped lumen airway external splint, which were designed in SOLIDWORKS and made of polycaprolactone (PCL). The airway external splint could provided effective support for at least 6 months and was completely degraded into carbon dioxide and water within 2–3 years. The median time of postoperative machine assisted ventilation was 23.7 h (range, 3.3–223.4 h), and the median time of ICU stay was 9 days (range, 4–25 days). The median follow-up time was 18 months (range, 12–24 months). Respiratory symptoms were all relieved, and no external splint-associated complications occurred. The 3D computed tomography reconstruction showed no airway stenosis. Personalized 3D-printed bioresorbable airway external splint can not only limit external compression and prevent airway collapse but also ensure the growth potential of the airway, which is a safe, reliable and effective treatment for CHD with TM.
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Affiliation(s)
- Di Yu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Peng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yuxi Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jiankang He
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, China
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47
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Guo Q, Fu W, Du J, Dai J, Geng G, Yan L, Yang T, Li Y, Liu J, Chen J, Liu Z, Yuan X, Deng D, Tian D. Reassessing the role of tracheobronchomalacia in persistent wheezing. Pediatr Pulmonol 2022; 57:976-981. [PMID: 35040289 DOI: 10.1002/ppul.25833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tracheobronchomalacia (TBM) is often manifested as wheezing. Reassessing the role of TBM in persistent wheezing in children is essential. METHODS We selected children who were diagnosed with TBM by bronchoscopy and who underwent bronchoscopic reexamination for persistent wheezing or chronic cough between January 2009 and July 2019. The clinical and bronchoscopy data were collected and retrospectively reviewed. For statistical analysis, we used the Kaplan-Meier method, Kruskal-Wallis test, and Fisher exact test. RESULTS A total of 79 patients (57 males and 22 females) were included. The median age of the first TBM diagnosis was 7 (interquartile [IQR] 4-11) months. The median age of the first wheezing episode was 4 (IQR 3-7) months. During the time interval between the two bronchoscopies, malacia lesions resolved in 50 patients (63.3%), improvement was seen in 14 patients (17.7%), no change was observed in 11 patients (13.9%), and the condition was aggravated in 4 patients (5.1%). The malacia lesions in 37 patients resolved before 2 years of age. Among the 50 resolved patients, 22 patients (44.0%) reported wheezing three times or more between bronchoscopy evaluations, and 13 of these 22 patients (59.1%) with atopy or family history of allergic diseases were ultimately diagnosed with bronchial asthma. CONCLUSIONS In children with persistent wheezing, the role of TBM should be reassessed, especially in those with atopy or family history of allergic diseases, and bronchial asthma should be considered early.
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Affiliation(s)
- Qian Guo
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Wenlong Fu
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jielin Du
- Epidemiology and Health Statistics, School of Public Health and Management, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Jihong Dai
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Gang Geng
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Li Yan
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Ting Yang
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Ying Li
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jingyue Liu
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jianchuan Chen
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Zheng Liu
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Xiaoping Yuan
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Dan Deng
- Epidemiology and Health Statistics, School of Public Health and Management, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Daiyin Tian
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
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48
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Higano NS, Bates AJ, Gunatilaka CC, Hysinger EB, Critser PJ, Hirsch R, Woods JC, Fleck RJ. Bronchopulmonary dysplasia from chest radiographs to magnetic resonance imaging and computed tomography: adding value. Pediatr Radiol 2022; 52:643-660. [PMID: 35122130 PMCID: PMC8921108 DOI: 10.1007/s00247-021-05250-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 12/31/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a common long-term complication of preterm birth. The chest radiograph appearance and survivability have evolved since the first description of BPD in 1967 because of improved ventilation and clinical strategies and the introduction of surfactant in the early 1990s. Contemporary imaging care is evolving with the recognition that comorbidities of tracheobronchomalacia and pulmonary hypertension have a great influence on outcomes and can be noninvasively evaluated with CT and MRI techniques, which provide a detailed evaluation of the lungs, trachea and to a lesser degree the heart. However, echocardiography remains the primary modality to evaluate and screen for pulmonary hypertension. This review is intended to highlight the important findings that chest radiograph, CT and MRI can contribute to precision diagnosis, phenotyping and prognosis resulting in optimal management and therapeutics.
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Affiliation(s)
- Nara S Higano
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Chamindu C Gunatilaka
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erik B Hysinger
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul J Critser
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Russel Hirsch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert J Fleck
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Radiology, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA.
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49
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Stepien KM, Bentley A, Chen C, Dhemech MW, Gee E, Orton P, Pringle C, Rajan J, Saxena A, Tol G, Gadepalli C. Non-cardiac Manifestations in Adult Patients With Mucopolysaccharidosis. Front Cardiovasc Med 2022; 9:839391. [PMID: 35321113 PMCID: PMC8935042 DOI: 10.3389/fcvm.2022.839391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/10/2022] [Indexed: 12/12/2022] Open
Abstract
Mucopolysaccharidoses (MPS) are a heterogeneous group of disorders that results in the absence or deficiency of lysosomal enzymes, leading to an inappropriate storage of glycosaminoglycans (GAGs) in various tissues of the body such as bones, cartilage, heart valves, arteries, upper airways, cornea, teeth, liver and nervous system. Clinical manifestations can become progressively exacerbated with age and affect their quality of life. Developments in advanced supportive treatment options such as enzyme replacement therapy (ERT), hematopoietic stem cell transplantation (HSCT) may have improved patients' life span. Adult MPS patients require specialist clinical surveillance long-term. In many cases, in addition to the MPS-related health problems, they may develop age-related complications. Considering the complexity of their clinical manifestations and lack of guidelines on the management of adult MPS disorders, multispecialty and multidisciplinary teams' care is essential to diagnose and treat health problems that are likely to be encountered. This review presents non-cardiac clinical manifestations, their pathophysiology, management and long-term outcomes in adult MPS patients.
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Affiliation(s)
- Karolina M. Stepien
- Adult Inherited Metabolic Diseases, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Andrew Bentley
- Northwest Ventilation Unit and Sleep Department, Wythenshawe Hospital, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
- Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Intensive Care & Respiratory Medicine, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Cliff Chen
- Clinical Neuropsychology, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - M. Wahab Dhemech
- Northwest Ventilation Unit and Sleep Department, Wythenshawe Hospital, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Edward Gee
- Trauma and Orthopaedic Surgery, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Peter Orton
- Trauma and Orthopaedic Surgery, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Catherine Pringle
- Neurosurgery, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Jonathan Rajan
- Manchester and Salford Pain Centre, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Ankur Saxena
- Neurosurgery, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Govind Tol
- Anaesthetics Department, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Chaitanya Gadepalli
- Ear, Nose and Throat, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
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50
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Guedes F, Branquinho MV, Sousa AC, Alvites RD, Bugalho A, Maurício AC. Central airway obstruction: is it time to move forward? BMC Pulm Med 2022; 22:68. [PMID: 35183132 PMCID: PMC8858525 DOI: 10.1186/s12890-022-01862-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/14/2022] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Central airway obstruction (CAO) represents a pathological condition that can lead to airflow limitation of the trachea, main stem bronchi, bronchus intermedius or lobar bronchus. MAIN BODY It is a common clinical situation consensually considered under-diagnosed. Management of patients with CAO can be difficult and deciding on the best treatment approach represents a medical challenge. This work intends to review CAO classifications, causes, treatments and its therapeutic limitations, approaching benign and malign presentations. Three illustrative cases are further presented, supporting the clinical problem under review. CONCLUSION Management of CAO still remains a challenge. The available options are not always effective nor free from complications. A new generation of costume-tailored airway stents, associated with stem cell-based therapy, could be an option in specific clinical situations.
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Affiliation(s)
- Fernando Guedes
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
- Pulmonology Department, Bronchology Unit, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
| | - Mariana V Branquinho
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
| | - Ana C Sousa
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
| | - Rui D Alvites
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
| | - António Bugalho
- CUF Tejo Hospital e CUF Descobertas Hospital, Lisbon, Portugal
- Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Lisbon, Portugal
| | - Ana Colette Maurício
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal.
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.
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