Erik B Hysinger1,2,3, Catherine K Hart3,4,5, Gregory Burg6,7, Alessandro De Alarcon3,4,5, Dan Benscoter1,2,3. 1. Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, U.S.A. 2. Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, U.S.A. 3. Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, U.S.A. 4. Department of Otolaryngology, University of Cincinnati, College of Medicine, Cincinnati, OH, U.S.A. 5. Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, U.S.A. 6. Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A. 7. Division of Pulmonary Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: Both flexible and rigid bronchoscopy can be used to assess tracheomalacia; however, there is limited evidence comparing the two techniques. The objective of this study was to compare flexible and rigid bronchoscopy for evaluating the location and severity of tracheomalacia in children. STUDY DESIGN: Retrospective case series. METHODS: This was a retrospective study of children with both flexible and rigid bronchoscopy under the same sedation. All bronchoscopies were reviewed by three bronchoscopists for the location and severity of tracheomalacia. The location of collapse was defined as upper, middle, or lower trachea, and the severity of collapse was defined as none (0%-25% collapse), mild/moderate (26%-75% collapse), and severe (>75% collapse). RESULTS: Twenty-one patients were recruited for this study with a variety of neonatal respiratory diseases. There was 94% agreement (κ = 0.64) for assessment of tracheomalacia in the upper trachea. However, agreement was only 75% (κ = 0.50) in the middle trachea and 76% (κ = 0.52) in the lower trachea. In the subset of patients without tracheostomy, agreement improved to 100%, 88%, and 82% for the upper, middle, and lower trachea, respectively. There was poor correlation for tracheomalacia severity in the middle trachea (ρ = 0.30, P = .2) and moderate in the lower trachea (ρ = 0.63, P = .002). CONCLUSIONS: Although there is moderate agreement between flexible and rigid bronchoscopy for evaluating the presence of tracheomalacia, there can be differences in the two techniques, particularly when assessing severity of airway collapse. Future studies will be needed to understand factors that result in the discordance of flexible and rigid bronchoscopy for assessing airway dynamics. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:201-204, 2021.
OBJECTIVES/HYPOTHESIS: Both flexible and rigid bronchoscopy can be used to assess tracheomalacia; however, there is limited evidence comparing the two techniques. The objective of this study was to compare flexible and rigid bronchoscopy for evaluating the location and severity of tracheomalacia in children. STUDY DESIGN: Retrospective case series. METHODS: This was a retrospective study of children with both flexible and rigid bronchoscopy under the same sedation. All bronchoscopies were reviewed by three bronchoscopists for the location and severity of tracheomalacia. The location of collapse was defined as upper, middle, or lower trachea, and the severity of collapse was defined as none (0%-25% collapse), mild/moderate (26%-75% collapse), and severe (>75% collapse). RESULTS: Twenty-one patients were recruited for this study with a variety of neonatal respiratory diseases. There was 94% agreement (κ = 0.64) for assessment of tracheomalacia in the upper trachea. However, agreement was only 75% (κ = 0.50) in the middle trachea and 76% (κ = 0.52) in the lower trachea. In the subset of patients without tracheostomy, agreement improved to 100%, 88%, and 82% for the upper, middle, and lower trachea, respectively. There was poor correlation for tracheomalacia severity in the middle trachea (ρ = 0.30, P = .2) and moderate in the lower trachea (ρ = 0.63, P = .002). CONCLUSIONS: Although there is moderate agreement between flexible and rigid bronchoscopy for evaluating the presence of tracheomalacia, there can be differences in the two techniques, particularly when assessing severity of airway collapse. Future studies will be needed to understand factors that result in the discordance of flexible and rigid bronchoscopy for assessing airway dynamics. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:201-204, 2021.
Authors: A Ioana Cristea; Clement L Ren; Reshma Amin; Laurie C Eldredge; Jonathan C Levin; Parevi P Majmudar; Anne E May; Rebecca S Rose; Michael C Tracy; Karen F Watters; Julian Allen; Eric D Austin; Mary E Cataletto; Joseph M Collaco; Robert J Fleck; Andrew Gelfand; Don Hayes; Marcus H Jones; Sheila S Kun; Erica W Mandell; Sharon A McGrath-Morrow; Howard B Panitch; Rizwana Popatia; Lawrence M Rhein; Alejandro Teper; Jason C Woods; Narayan Iyer; Christopher D Baker Journal: Am J Respir Crit Care Med Date: 2021-12-15 Impact factor: 21.405