title: Current management and outcome of tracheobronchial malacia and stenosis presenting to the paediatric intensive care unit.
abstract: 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.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary paediatric intensive care unit.
  
  
  METHODS
  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).
  
  
  METHODS
  Conservative management, tracheostomy and long-term ventilation, surgical correction, internal or external airway stenting.
  
  
  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.
authors.affiliation: Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. D.Inwald@ich.ucl.ac.uk
authors.forename: D P
authors.initials: DP
authors.lastname: Inwald
authors.forename: D
authors.initials: D
authors.lastname: Roebuck
authors.forename: M J
authors.initials: MJ
authors.lastname: Elliott
authors.forename: Q
authors.initials: Q
authors.lastname: Mok
mesh_terms: D001982:Bronchial Diseases / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D001995:Bronchography; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014135:Tracheal Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome