Interventions for primary (intrinsic) tracheomalacia in children
Abstract
Background
Tracheomalacia, a disorder of the large airways where the trachea is deformed or malformed during respiration is commonly seen in tertiary paediatric practice. It is associated with a wide spectrum of respiratory symptoms from life threatening recurrent apnea to common respiratory symptoms such as chronic cough and wheeze. Current practice following diagnosis of tracheomalacia include medical approaches aimed at reducing associated symptoms of tracheomalacia, ventilation modalities of continuous positive airway pressure (CPAP) and bi‐level positive airway pressure (BiPAP) and, surgical approaches aimed at improving the caliber of the airway (airway stenting, aortopexy, tracheopexy).
Objectives
To evaluate the efficacy of medical and surgical therapies for children with intrinsic (primary) tracheomalacia.
Search methods
The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE and EMBASE databases were searched by the Cochrane Airways Group. The latest searches were performed in February 2008.
Selection criteria
All randomised controlled trials of therapies related to symptoms associated with primary or intrinsic tracheomalacia.
Data collection and analysis
Results of searches were reviewed against pre‐determined criteria for inclusion. No eligible trials were identified and thus no data were available for analysis.
Main results
No randomised controlled trials (RCTs) that examined therapies for intrinsic tracheomalacia were found. Eight of the more recent (last 11 years) non randomised controlled trials reported a benefit from the various surgical interventions. The success was however not universal and in some studies severe adverse events occurred.
Authors' conclusions
There is currently an absence of evidence to support any of the therapies currently utilised for management of intrinsic tracheomalacia. It is unlikely that any RCT on surgically based management will ever be available for children with severe life threatening illness associated with tracheomalacia. For those with less severe disease, RCTs are clearly needed. Outcomes of these RCTs should include measurements of the trachea and physiological outcomes in addition to clinical outcomes.
PICOs
Plain language summary
Interventions for primary (intrinsic) tracheomalacia in children
The clinical spectrum of tracheomalacia in children ranges from minimal symptoms to severe life threatening disease. Available medical and surgical approaches to treat symptoms associated with tracheomalacia range from simple medical therapies, ventilation , tracheostomy and stents to direct surgical approaches such as aorta/tracheopexy. Using the standard search module of the Cochrane Airways Group, no randomised controlled trials that assessed any therapy for intrinsic tracheomalacia were found. With the lack of evidence, the routine use of any therapies for intrinsic tracheomalacia cannot be assessed. The decision to subject a child to any surgical or medical based therapies will have to be made on an individual basis, with careful consideration of the risk‐benefit ratio for each individual situation.
