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Title of Journal: Intensive Care Med

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Abbravation: Intensive Care Medicine

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Springer-Verlag

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10.1016/0166-3615(93)90010-x

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1432-1238

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Current management and outcome of tracheobronchial malacia and stenosis presenting to the paediatric intensive care unit

Authors: David P. Inwald, Derek Roebuck, Martin J. Elliott, Quen Mok,

Publish Date: 2001/02/16
Volume: 27, Issue:4, Pages: 722-729
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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: Forty-eight cases admitted to our PICU over a 5-year period in whom a diagnosis of tracheobronchial malacia or stenosis was made by dynamic contrast bronchography (1994–1999). Interventions: Conservative management, tracheostomy and long-term 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), ex-premature infants (n=11), vascular rings (n=9), complex cardiac and/or syndromic pathology (n=17) and tracheo-oesophageal 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=0.039 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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