Authors: David P Inwald Derek Roebuck Martin J Elliott Quen Mok
Publish Date: 2001/02/16
Volume: 27, Issue: 4, Pages: 722-729
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 Design Retrospective review Setting Tertiary paediatric intensive care unit Patients Fortyeight cases admitted to our PICU over a 5year period in whom a diagnosis of tracheobronchial malacia or stenosis was made by dynamic contrast bronchography 1994–1999 Interventions Conservative management tracheostomy and longterm ventilation surgical correction internal or external airway stenting Measurements and 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 expremature infants n=11 vascular rings n=9 complex cardiac and/or syndromic pathology n=17 and tracheooesophageal 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=0039 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
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