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Lower airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Kimberley R. Kaspy, Sara M. Zak
TracheomalaciaThis is a condition of excessive dynamic collapse of the trachea during the respiratory cycle. There is no standardized classification system of the degree of tracheomalacia seen, though it is often described when the airway lumen is reduced by > 50%, with severe tracheomalacia generally associated with > 90% reduction in the lumen.19–21 The presence of tracheomalacia on bronchoscopy can be very dependent on the level of anesthesia and how forcefully the patient is breathing during the procedure.In patients with tracheomalacia, the tracheal rings do not extend for the normal ~300 degrees and are often shorter and/or flattened. This results in a broader, posterior tracheal wall, which will then protrude into the airway with expiration, leading to narrowing of the tracheal lumen, as shown in Video 5.2. This will worsen with more forceful exhalation and coughing.Tracheomalacia can be localized to a small section of the trachea or extend for nearly the entire length of the trachea. It is most commonly seen near the end of the trachea before it branches into the mainstem bronchi and is often associated with bronchomalacia.
Congenital Disorders of the Larynx, Trachea and Bronchi
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Tracheomalacia is a condition in which there is reduced stiffness of the tracheal wall, resulting in abnormal collapse of the trachea during expiration which, if severe, can produce symptoms of airway obstruction. Bronchomalacia is the equivalent condition affecting the bronchi. There is, however, no association between tracheobronchomalacia and laryngomalacia, although because the latter is a common condition it may sometimes coexist.
Cleft lip and palate: developmental abnormalities of the face, mouth and jaws
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In many craniofacial conditions, the airway can be affected and either fully or partially obstructed due to a retropositioned hypoplastic maxilla with the tongue falling back to close off the upper airway, often compounded by a hypoplastic mandible. The trachea itself may also be abnormal and tracheomalacia can also lead to respiratory problems. Neonates are obligate nasal breathers and some forms of nasal obstruction can also precipitate airway symptoms. In the most severe cases intubation is not possible as a result of the abnormal anatomy and a tracheostomy may be necessary. In emergency situations it may be helpful to nurse the baby prone, allowing the tongue to fall forward.
The impact of early surgical treatment of tracheal stenosis on neurorehabilitation outcome in patients with severe acquired brain injury
Published in Brain Injury, 2023
R. Formisano, M. D’Ippolito, M. Giustini, C. Della Vedova, L. Laurenza, M. Matteis, C. Menna, E. A. Rendina
Tracheostomy can be performed through an open surgical or percutaneous technique. Complications related to tracheostomies include: (1) early complications: pneumothorax, pneumomediastinum, bleeding, tracheal wall perforation, blood and/or mucus clots, accidental decannulation: (2) later complications: infections, tracheomalacia, granulation tissue formation, tracheal stenosis, tracheoesophageal fistula, vocal cord dysfunction (injury of recurrent laryngeal nerve), stomal granulation, persistent tracheal fistula, and scarring. The incidence of late complications is estimated to be as high as 65% of patients (7). The incidence of tracheostomy in patients with sABI is reported to be from 50% to 70%, even though the ideal timing for performing tracheostomy in patients with sABI has not been clearly established, and it is still controversial (8,9). In literature, the definition of early tracheostomy ranges from 3 days to < 21 days, depending mainly on patient population (10). However, although the definition of early tracheostomy remains to be agreed upon, there is a growing consensus among researchers that suggests > 21 days are to be considered as late tracheostomy (11).
Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children
Published in Journal of Asthma, 2021
Stephanie Woodward, Michael Mundorff, Cindy Weng, David G. Gamboa, Michael D. Johnson
2: A 15-month-old previously healthy 11 kg Caucasian male with tracheomalacia presented to his primary care physician’s office after 3 days of coughing and one day of respiratory distress. After no improvement with nebulized budesonide and albuterol, he was sent to a local general ED where respiratory distress was treated with IV methylprednisolone, inhaled racemic epinephrine, and 2.5 mg of inhaled albuterol. He was given IV ceftriaxone to treat pneumonia, suggested by a large left-sided opacity on chest radiography. He was admitted to the general hospital ward at the general hospital and continued on intermittent nebulized albuterol and racemic epinephrine, receiving five doses over 48 h without improvement. On the day after admission tachycardia at 262 bpm was diagnosed as SVT by EKG. This resolved spontaneously after IV fluid bolus; no vagal maneuvers or adenosine were used. He was transferred to the ICU at PCH where he received further evaluation and treatment for what was determined to be a mediastinal lymphatic malformation, treated with flovent to reduce airway inflammation, sclerotherapy, and continued intermittent doses of levalbuterol and albuterol. He had a second episode of SVT in the hospital two weeks later unrelated to any dosing of SABA which resolved with adenosine 1.1 mg. With no ventricular pre-excitation on EKG, he was then started on oral digoxin, and had another episode of SVT three weeks later during a crying episode which resolved without intervention. He stopped taking digoxin after two years, and had no subsequent episodes of SVT. He was never diagnosed with asthma.
Stents for small airways: current practice
Published in Expert Review of Respiratory Medicine, 2020
Paul Zarogoulidis, Konstantinos Sapalidis, Christoforos Kosmidis, Kosmas Tsakiridis, Haidong Huang, Chong Bai, Wolfgang Hohenforst-Schmidt, Stavros Tryfon, Anastasios Vagionas, Konstantinos Drevelegas, Eleni-Isidora Perdikouri, Lutz Freitag
Airway obstruction can be induced either by cancer or benign causes. Benign bronchus stenosis is being caused by: tuberculosis, sarcoidosis, vasculitis, and chronic inflammation due to smoking in chronic obstructive pulmonary disease patients or lung transplantation [1]. Tracheomalacia can be caused by infection, and stent placement could be used if surgery is not possible. Moreover, due to malignancies (lung cancer or metastatic cancer in the bronchus), after treatment with radiotherapy or surgical intervention such as sleeve resection can lead to atelectasis and impairment of lung function [2]. The ideal airway stent should: (a) be easy to place and remove, (b) be large enough to maintain position, (c) be flexible enough to mimic airway physiology but have sufficient radial force to resist airway compression, (d) yet not too large and as congruent as possible to avoid granulation tissue reactions, and (e) not impair mucociliary clearance. The time to insert the stent is also very important; in benign inflammatory diseases we should wait until the inflammation stops, unless it is absolutely necessary for the respiration of the patient. In any case, the main purpose of stent placement is the improvement of quality of life.