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April 1986, Vol 140, No. 4 >
Article | April 1986

Large-Airway Collapse due to Acquired Tracheobronchomalacia in Infancy FREE

Juan L. Sotomayor, MD; Rudolfo I. Godinez, MD; Spencer Borden, MD; Robert W. Wilmott, MD
[+] Author Affiliations

Accepted for publication Nov 26, 1985.

Reprint requests to Department of Allergy/Immunology/Pulmonary, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 (Dr Sotomayor).


Am J Dis Child. 1986;140(4):367-371. doi:10.1001/archpedi.1986.02140180101035.
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• Seven infants with wheezing and cyanotic spells were diagnosed as having tracheobronchomalacia by bronchoscopy or fluoroscopy. These studies demonstrated narrowing of the central airways by 75% or more on exhalation. Five patients were premature infants who had been ventilated for hyaline membrane disease. The mean time from onset of symptoms to diagnosis was six months. Determination of the optimal positive end-expiratory pressure (PEEP) during fluoroscopy facilitated subsequent management. Six of the seven patients required PEEP of 8 to 18 cm H2O for at least three months, and five of the seven still require mechanical ventilation. All patients improved, with decreased cyanotic spells and a reduced requirement for ventilatory support. Tracheostomy without PEEP did not appear to be helpful. Tracheobronchomalacia may be more frequent than usually appreciated; the treatment of choice appears to be long-term PEEP.

(AJDC 1986;140:367-371)

REFERENCES

1 +
Cogbill TH, Moore FA, Accurso FJ, et al:  Primary tracheomalacia . Ann Thorac Surg 1983;; 35:538-541.
2 +
Gupta TG, Goldberg SJ, Lewis E, et al:  Congenital bronchomalacia . AJDC 1968;;115:88-90.
3 +
Agosti E, DeFilippi G, Fior R, et al:  Generalized familial bronchomalacia . Acta Paediatr Scand 1974;;63:616-618.
4 +
Mitchell RE, Bury RG:  Congenital bronchiectasis due to deficiency of bronchial cartilage (Williams-Campbell syndrome) . J Pediatr 1975;; 87:230-232.
5 +
Benjamin B, Cohen D, Glasson M:  Tracheomalacia in association with congenital tracheoesophageal fistula . Surgery 1976;;79:504-508.
6 +
Toyama WM:  Esophageal atresia and tracheoesophageal fistula in association with bronchial and pulmonary anomalies . J Pediatr Surg 1972;;7:302-307.
7 +
Godfrey S:  Association between pectus excavatum and segmental bronchomalacia . J Pediatr 1980;;96:649-652.
8 +
Jokinen K, Palva T, Sutinen S, et al:  Acquired tracheobronchomalacia . Ann Clin Res 1977;;9:52-57.
9 +
Nuutinen J:  Acquired tracheobronchomalacia . Ann Clin Res 1977;;9:350-355.
10 +
Feist JH, Johnson TH, Wilson RJ:  Acquired tracheomalacia: Etiology and differential diagnosis . Chest 1975;;68:340-345.
11 +
Johnson TH, Mikita JJ, Wilson RJ, et al:  Acquired tracheomalacia . Radiology 1973;;109: 577-590.
12 +
Cochran ST, Gyepes MT, Smith LE:  Obstruction of the airways by the heart and pulmonary vessels in infants . Pediatrics 1977;;6:81-87.
13 +
Couvreur J, Grimfeld A, Tournier G, et al:  La dyskinesie trachéale (trachéomalacia) chez l'enfant . Semin Hop Paris 1981;;57:688-697.
14 +
Temtamy SA, Miller JD:  Extending the scope of the VATER association: Definition of a VATER syndrome . J Pediatr 1974;;85:345-349.
15 +
Lees MH:  Cyanosis of the newborn infant . J Pediatr 1970;;77:484-498.
16 +
Cogbill TH, Moore FA, Accurso FJ, et al:  Primary tracheomalacia . Ann Thorac Surg 1983;; 35:538-541.
17 +
Nakayama DK, Harrison MR, de Lorimier AA, et al:  Reconstructive surgery for obstructing lesions of the intrathoracic trachea in infants and small children . J Pediatr Surg 1982;;17:854-866.
18 +
Neijens HJ, Kerrebijn KF, Smalhout B:  Successful treatment with CPAP of two infants with bronchomalacia . Acta Paediatr Scand 1978;; 67:293-296.
19 +
Kanter RK, Pollack MM, Wright WW, et al:  Treatment of severe tracheobronchomalacia with continuous positive airway pressure (CPAP) . Anesthesiology 1982;;57:54-56.
20 +
Filler RM, Buck JR, Bahoric A, et al:  Treatment of segmental tracheomalacia and bronchomalacia by implantation of an airway splint . J Pediatr Surg 1982;;17:597-603.
21 +
Nakayama DK, Harrison MR, de Lorimier AA, et al:  Reconstructive surgery for obstructing lesions of the intrathoracic trachea in infants and small children . J Pediatr Surg 1982;;17:854-866.
22 +
Wiseman NE, Duncan PG, Cameron CB:  Management of tracheobronchomalacia with continuous positive airway pressure . J Pediatr Surg 1985;;20:489-493.
23 +
Wittenborg MH, Gyepes MT, Crocker D:  Tracheal dynamics in infants with respiratory distress, stridor and collapsing trachea . Radiology 1967;;88:653-662.
24 +
Kao LC, Warburton D, Cheng MH, et al:  Effect of oral diuretics or pulmonary mechanics in infants with chronic bronchopulmonary dysplasia: Results of a double-blind crossover sequential trial . Pediatrics 1984;;74:37-44.
25 +
Northway WH, Rosan RC, Porter DY:  Pulmonary disease following respiratory therapy of hyaline membrane disease: Bronchopulmonary dysplasia . N Engl J Med 1967;;276:357-368.
26 +
Landing BH:  Congenital malformation and genetic disorders of the respiratory tract . Am Rev Respir Dis 1979;;120:151-185.
27 +
Bhutani VK, Rubenstein SD, Shaffer TH:  Pressure-volume relationships of tracheae in fetal newborn and adult rabbits . Respir Physiol 1981;;43:227-231.
28 +
Bhutani VK, Rubenstein D, Shaffer TH:  Pressure-induced deformation in immature airways . Pediatr Res 1981;;15:829-832.
29 +
Bhutani VK, Shaffer TH:  Time-dependent tracheal deformation in fetal neonatal and adult rabbits . Pediatr Res 1982;;16:830-833.
30 +
Johner CA, Szanto PA:  Polychondritis in a newborn presenting as tracheomalacia . Ann Otol Rhinol Laryngol 1970;;79:1114-1116.
31 +
Cochran ST, Gyepes MT, Smith LE:  Obstruction of the airways by the heart and pulmonary vessels in infants . Pediatrics 1977;;6: 81-87.
32 +
MacDonald NE, Hall BH, Suffin SC, et al:  Respiratory syncytial virus (RSV) infection in infants with congenital heart disease . N Engl J Med 1982;;307:397-400.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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References

1 +
Cogbill TH, Moore FA, Accurso FJ, et al:  Primary tracheomalacia . Ann Thorac Surg 1983;; 35:538-541.
2 +
Gupta TG, Goldberg SJ, Lewis E, et al:  Congenital bronchomalacia . AJDC 1968;;115:88-90.
3 +
Agosti E, DeFilippi G, Fior R, et al:  Generalized familial bronchomalacia . Acta Paediatr Scand 1974;;63:616-618.
4 +
Mitchell RE, Bury RG:  Congenital bronchiectasis due to deficiency of bronchial cartilage (Williams-Campbell syndrome) . J Pediatr 1975;; 87:230-232.
5 +
Benjamin B, Cohen D, Glasson M:  Tracheomalacia in association with congenital tracheoesophageal fistula . Surgery 1976;;79:504-508.
6 +
Toyama WM:  Esophageal atresia and tracheoesophageal fistula in association with bronchial and pulmonary anomalies . J Pediatr Surg 1972;;7:302-307.
7 +
Godfrey S:  Association between pectus excavatum and segmental bronchomalacia . J Pediatr 1980;;96:649-652.
8 +
Jokinen K, Palva T, Sutinen S, et al:  Acquired tracheobronchomalacia . Ann Clin Res 1977;;9:52-57.
9 +
Nuutinen J:  Acquired tracheobronchomalacia . Ann Clin Res 1977;;9:350-355.
10 +
Feist JH, Johnson TH, Wilson RJ:  Acquired tracheomalacia: Etiology and differential diagnosis . Chest 1975;;68:340-345.
11 +
Johnson TH, Mikita JJ, Wilson RJ, et al:  Acquired tracheomalacia . Radiology 1973;;109: 577-590.
12 +
Cochran ST, Gyepes MT, Smith LE:  Obstruction of the airways by the heart and pulmonary vessels in infants . Pediatrics 1977;;6:81-87.
13 +
Couvreur J, Grimfeld A, Tournier G, et al:  La dyskinesie trachéale (trachéomalacia) chez l'enfant . Semin Hop Paris 1981;;57:688-697.
14 +
Temtamy SA, Miller JD:  Extending the scope of the VATER association: Definition of a VATER syndrome . J Pediatr 1974;;85:345-349.
15 +
Lees MH:  Cyanosis of the newborn infant . J Pediatr 1970;;77:484-498.
16 +
Cogbill TH, Moore FA, Accurso FJ, et al:  Primary tracheomalacia . Ann Thorac Surg 1983;; 35:538-541.
17 +
Nakayama DK, Harrison MR, de Lorimier AA, et al:  Reconstructive surgery for obstructing lesions of the intrathoracic trachea in infants and small children . J Pediatr Surg 1982;;17:854-866.
18 +
Neijens HJ, Kerrebijn KF, Smalhout B:  Successful treatment with CPAP of two infants with bronchomalacia . Acta Paediatr Scand 1978;; 67:293-296.
19 +
Kanter RK, Pollack MM, Wright WW, et al:  Treatment of severe tracheobronchomalacia with continuous positive airway pressure (CPAP) . Anesthesiology 1982;;57:54-56.
20 +
Filler RM, Buck JR, Bahoric A, et al:  Treatment of segmental tracheomalacia and bronchomalacia by implantation of an airway splint . J Pediatr Surg 1982;;17:597-603.
21 +
Nakayama DK, Harrison MR, de Lorimier AA, et al:  Reconstructive surgery for obstructing lesions of the intrathoracic trachea in infants and small children . J Pediatr Surg 1982;;17:854-866.
22 +
Wiseman NE, Duncan PG, Cameron CB:  Management of tracheobronchomalacia with continuous positive airway pressure . J Pediatr Surg 1985;;20:489-493.
23 +
Wittenborg MH, Gyepes MT, Crocker D:  Tracheal dynamics in infants with respiratory distress, stridor and collapsing trachea . Radiology 1967;;88:653-662.
24 +
Kao LC, Warburton D, Cheng MH, et al:  Effect of oral diuretics or pulmonary mechanics in infants with chronic bronchopulmonary dysplasia: Results of a double-blind crossover sequential trial . Pediatrics 1984;;74:37-44.
25 +
Northway WH, Rosan RC, Porter DY:  Pulmonary disease following respiratory therapy of hyaline membrane disease: Bronchopulmonary dysplasia . N Engl J Med 1967;;276:357-368.
26 +
Landing BH:  Congenital malformation and genetic disorders of the respiratory tract . Am Rev Respir Dis 1979;;120:151-185.
27 +
Bhutani VK, Rubenstein SD, Shaffer TH:  Pressure-volume relationships of tracheae in fetal newborn and adult rabbits . Respir Physiol 1981;;43:227-231.
28 +
Bhutani VK, Rubenstein D, Shaffer TH:  Pressure-induced deformation in immature airways . Pediatr Res 1981;;15:829-832.
29 +
Bhutani VK, Shaffer TH:  Time-dependent tracheal deformation in fetal neonatal and adult rabbits . Pediatr Res 1982;;16:830-833.
30 +
Johner CA, Szanto PA:  Polychondritis in a newborn presenting as tracheomalacia . Ann Otol Rhinol Laryngol 1970;;79:1114-1116.
31 +
Cochran ST, Gyepes MT, Smith LE:  Obstruction of the airways by the heart and pulmonary vessels in infants . Pediatrics 1977;;6: 81-87.
32 +
MacDonald NE, Hall BH, Suffin SC, et al:  Respiratory syncytial virus (RSV) infection in infants with congenital heart disease . N Engl J Med 1982;;307:397-400.

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