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Tracheal disease

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Tracheomalacia, stenosis & vascular compression

Aetiology

Tracheomalacia

Most commonly associated with:
- oesophageal atresia
- TOF
- vascular anomalies

Vascular compression

- double aortic arch
- complex of R sided aortic arch + left ductus arteriosus + aberrant L subclavian artery
- anomalous innominate artery

Management

- division of vascular ring or ligation or repositioning of aberrant artery does not immediately restore normal airway dimensions or stability: symptoms may persist for years
- tracheomalacia can sometimes be stabilized by prolonged period of nasotracheal intubation or tracheostomy with CPAP
- tracheopexy (suspends anterior tracheal wall from post sternal surface and great vessels occasionally useful)

Tracheal stenosis in children

Subglottic

- occurs in 2-8% of surviving intubated infants with very low birth weight (<1.5 kg)
- following are potential causative factors:

  • physical damage to airway during intubation
  • ETT which is too large
  • ETT of inadequate shape
  • inadequate humidification
  • movement of ETT in piston-like manner during ventilation
  • physiologic activity of larynx and trachea during coughing or swallowing
  • infection
  • systemic illness
  • prolonged intubation
  • frequent ETT changes
  • patient activity while intubated

- treatment has included:

  • local and systemic steroids
  • tracheal dilatation
  • tracheal resection and anastamosis
  • tracheal split with insertion of a cartilaginous graft
  • simply waiting for patient to "outgrow" the problem

- tracheostomy performed to secure ventilation while awaiting resolution of tracheal stenosis associated with a high complication rate with an estimated mortality rate as high as 8% in infants <1 yr


© Charles Gomersall December 1999

 

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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