[Tracheobronchomalacia in pediatric patients: clinical experience].

BACKGROUND

Tracheobronchomalacia is characterized by a deficiency in the cartilaginous support of the trachea and bronchi and hypotony in the myoelastic elements, that lead to different levels of airway obstruction.

OBJECTIVE

To report our experience in the treatment of traqueobronchomalacia.

METHODS

Retrospective review of 24 patients with tracheomalacia of different levels (3 tracheobronchomalacia, 3 laryngotracheomalacia) and 8 patients with bronchomalacia.

RESULTS

The age at diagnosis ranged from 9 days to 9 years. Clinical presentation was recurrent wheezing in 19 patients, stridor in 6 and atelectasis in 4. The associated factors were neurological impairment in 8, congenital heart disease in 10 and prolonged mechanical ventilation in 4. The diagnosis was done by flexible bronchoscopy in all patients, using sedation and allowing spontaneous breathing. At the moment of diagnosis, treatment consisted in oxygen supply in 14 patients, physiotherapy in 21, beta 2 adrenergic agonists in 27, racemic epinephrine in 8, mechanical ventilation in 12, ipratropium bromide in 5 and inhaled steroids in 13. After diagnosis, 24 patients received bronchodilator therapy with ipratropium bromide, 15 received racemic epinephrine and 22 received inhaled steroids. In 21, beta 2 adrenergic agonists were discontinued. Thirteen patients required ventilation support and home oxygen. Twenty two patients showed a satisfactory clinical evolution and 6 patients died.

CONCLUSIONS

The clinical presentation of tracheobronchomalacia is varied and diagnosis is done by flexible bronchoscopy. Treatment will depend on the severity of the disease, but beta 2 adrenergic agonists should be excluded.