Tracheobronchial malacia and stenosis in children in intensive care: bronchograms help to predict oucome
Robert J Burden, Frank Shann, Warwick Butt, Michael Ditchfield
Paediatric Intensive
Care Unit, Royal Children's Hospital, Parkville, Victoria 3052, Australia
Correspondence to: Professor F Shann.
Received 2 June 1998; Returned to authors 27 July 1998; Revised version received 22 December 1998; Accepted for publication 1 February 1999
BACKGROUND
Severe
tracheobronchial malacia and stenosis are important causes of morbidity
and mortality in children in intensive care, but little is known about
how best to diagnose these conditions or determine their prognosis.
METHODSThe records of
all 62 children in whom one or both of these conditions had been
diagnosed by contrast cinetracheobronchography in our intensive care
unit in the period 1986-95 were studied.
RESULTSSeventy four
per cent of the 62 children had congenital heart disease; none was a
preterm baby with airways disease associated with prolonged
ventilation. Fifteen of the children had airway stenosis without
malacia; three died because of the stenosis and two died from other
causes. Twenty eight of the 47 children with malacia died; only eight
children survived without developmental or respiratory handicap. All
children needing ventilation for malacia for longer than 14 consecutive
days died if their bronchogram showed moderate or severe malacia of
either main bronchus (15 cases), or malacia of any severity of both
bronchi (three additional cases); all children needing ventilation for
malacia for longer than 21 consecutive days died if their bronchogram
showed malacia of any severity of the trachea or a main bronchus (three
additional cases). These findings were strongly associated with a fatal
outcome (p<0.00005); they were present in 21 children (all of whom
died) and absent in 26 (of whom seven died, six from non-respiratory causes). They had a positive predictive value for death of 100%, but
the lower limit of the 95% confidence interval was 83.9% so up to
16% of patients meeting the criteria might survive.
CONCLUSIONIn this
series the findings on contrast cinetracheobronchography combined with
the duration of ventilation provided a useful guide to the prognosis of
children with tracheobronchomalacia. The information provided by
bronchoscopy was less useful.
Keywords: bronchography; tracheobronchomalacia; children; tracheal stenosis
© 1999 by Thorax
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