Paediatric Tracheomalacia

Abstract

Intrathoracic tracheomalacia is characterized by increased compliance of the central airway within the thorax. This leads to excessive dynamic collapse during exhalation or periods of increased intrathoracic pressure such as crying. Extrathoracic tracheomalacia involves dynamic collapse of the airway between the glottis and sternal notch that occurs during inhalation rather than exhalation. The tone of the posterior membrane of the trachea increases throughout development and childhood, as does the rigidity of the tracheal cartilage. Abnormalities of airway maturation result in congenital tracheomalacia. Acquired tracheomalacia occurs in the normally developed trachea due to trauma, external compression, or airway inflammation. Although tracheomalacia can be suspected by history, physical examination, and supportive radiographic findings, flexible fiberoptic bronchoscopy remains the "gold standard" for diagnosis. Current treatment strategies involve pharmacotherapy with cholinergic agents, positive pressure ventilation, and surgical repair.

Paediatric tracheomalacia - A review of clinical features and comparison of diagnostic imaging techniques

“…In neonates clinical features include harsh cough, central wheeze, dyspnoea, gasping, stridor, feeding difficulties and blue spells. In older infants expiratory wheeze, chronic cough, apnoeic episodes and recurrent respiratory tract infections due to impaired clearance of secretions are common symptoms [5,[9][10][11]. The nonspecific nature of this clinical picture makes an accurate clinical diagnosis very difficult.…”

“…This can affect a single or multiple segments of the trachea but most commonly occurs in its distal third [2] [3] [4]. While it can occur on it's own, primary tracheomalacia has been shown to be associated with many comorbidities, commonly tracheoesophageal fistula / oesophageal atresia (TOF/OA), craniofacial abnormalities and chromosomal abnormalities [5]. Secondary tracheomalacia is degeneration of normal cartilage as a result of localised compression of the trachea.…”

Airway obstruction during general anesthesia in a premature infant suspecting bronchospasm and/or airway malacia -A case report-

“…The presence and extent of central airway collapse depends on how rigid the airway is, the magnitude of pressure applied across it, or the transmural pressure across the tracheal wall [9]. Airway obstruction can occur during any phase of respiration but is most pronounced with expiration, because cartilaginous rings of airway fail to provide the necessary rigidity to resist the external force and prevent airway collapse [10].…”

Can high flow nasal cannula be used in a pediatric patient with tracheomalacia?

“…Thus, respiratory impairment likely results from a combination of the dynamic properties of the extrathoracic and the intrathoracic airway. 6 Hypoxemia as well as hypercapnia may be seen in these patients. In a recently published study by Testa et al, HFNC did not effectively reduce increased carbon dioxide levels.…”