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

Intensive Care Med. 2001 Apr;27(4):722-9. doi: 10.1007/s001340000822.


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

Design: Retrospective review.

Setting: Tertiary paediatric intensive care unit.

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

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

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

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

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchial Diseases / diagnostic imaging
  • Bronchial Diseases / mortality*
  • Bronchial Diseases / therapy*
  • Bronchography
  • Female
  • Humans
  • Infant
  • Intensive Care Units, Pediatric*
  • Male
  • Predictive Value of Tests
  • Regression Analysis
  • Respiration, Artificial
  • Retrospective Studies
  • Survival Rate
  • Time Factors
  • Tracheal Stenosis / diagnostic imaging
  • Tracheal Stenosis / mortality*
  • Tracheal Stenosis / therapy*
  • Treatment Outcome