title: Tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants.
abstract: BACKGROUND
  Tracheobronchomalacia prevalence in premature infants on prolonged mechanical ventilation is high.
  
  
  OBJECTIVE
  To examine the prevalence of tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants, and describe the demographic, clinical and dynamic airway characteristics of those infants with tracheobronchomalacia.
  
  
  METHODS
  This retrospective review studies 198 tracheobronchograms performed from 1998 to 2011 in a cohort of 158 ventilator-dependent infants <2 years of age. Dynamic airway assessment during tracheobronchography determined the optimal positive end-expiratory pressure to maintain airway patency at expiration in those infants with tracheobronchomalacia.
  
  
  RESULTS
  Tracheobronchograms were performed at a median age of 52 weeks post menstrual age. The primary diagnoses in these infants were bronchopulmonary dysplasia (53%), other causes of chronic lung disease of infancy (28%) and upper airway anomaly (13%). Of those with bronchopulmonary dysplasia, 48% had tracheobronchomalacia. Prematurity (P=0.01) and higher baseline - pre-tracheobronchogram positive end-expiratory pressure (P=0.04) were significantly associated with tracheobronchomalacia. Dynamic airway collapse during tracheobronchography showed statistically significant airway opening at optimal positive end-expiratory pressure (P < 0.001). There were no significant complications noted during and immediately following tracheobronchography.
  
  
  CONCLUSIONS
  The overall prevalence of tracheobronchomalacia in this cohort of ventilator-dependent infants is 40% and in those with bronchopulmonary dysplasia is 48%. Infants born prematurely and requiring high pre-tracheobronchogram positive end-expiratory pressure were likely to have tracheobronchomalacia. Tracheobronchography can be used to safely assess the dynamic function of the airway and can provide the clinician the optimal positive end-expiratory pressure to maintain airway patency.
authors.affiliation: Division of Neonatology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. wmmanimtim@cmh.edu.|University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. wmmanimtim@cmh.edu.
authors.forename: Winston M
authors.initials: WM
authors.lastname: Manimtim
authors.affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.|Division of Radiology, Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Rivard
authors.affiliation: Department of Research, Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Ashley K
authors.initials: AK
authors.lastname: Sherman
authors.affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.|Division of Radiology, Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Brent E
authors.initials: BE
authors.lastname: Cully
authors.affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.|Division of Radiology, Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Brenton D
authors.initials: BD
authors.lastname: Reading
authors.affiliation: Division of Neonatology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.|University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors.forename: Charisse I
authors.initials: CI
authors.lastname: Lachica
authors.affiliation: Division of Neonatology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.|University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Gratny
mesh_terms: D001995:Bronchography / Q000379:methods*; D001997:Bronchopulmonary Dysplasia / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012121:Respiration, Artificial; D012189:Retrospective Studies; D055089:Tracheobronchomalacia / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Airway; Bronchopulmonary dysplasia; Infants; Neonatology; Respiratory; Tracheobronchography; Tracheobronchomalacia