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{{short description|Tracheal disease}}
{{short description|Tracheal disease}}
{{use mdy dates|date=April 2024}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Tracheomalacia
| name = Tracheomalacia
| image =
| image = Tracheomalacia.jpg
| caption = (A) Tracheal structure with normal C-shape rings. (B) U-shaped rings with a wider posterior membrane, demonstrating posterior intrusion. (C) Bow-shaped rings with a broad posterior membrane and severe posterior intrusion.|
| caption = |
| pronounce = "tray·kee·oh·muh·lay·shuh"
| pronounce = {{IPAc-en|ˌ|t|r|eɪ|k|i|oʊ|m|ə|ˈ|l|eɪ|ʃ|ə}} {{respell|TRAY|kee|oh|mə|LAY|shə}}
| field =
| field =
| synonyms =
| synonyms =
| symptoms = wheezing, dyspnea and fatigue upon exertion; infants may show signs of cyanosis
| symptoms = Wheezing, dyspnea and fatigue upon exertion <br/>Infants may show signs of cyanosis
| complications = inability to propel secretions, leading to repeated cases of pneumonia
| complications = Inability to propel secretions, leading to repeated cases of pneumonia
| onset =
| onset =
| duration =
| duration =
| types = Congenital (heart/great vessel malformations or tracheal anomalies); Acquired (secondary to trauma or tracheostomy)<ref name="CHUV2020">{{cite web |title=Tracheomalacia / Bronchomalacia information |url=https://www.chuv.ch/en/voies-aeriennes/orva-home/patients-and-families/conditions-we-treat/tracheomalacia-bronchomalacia-information |website=CHUV}}</ref>
| types = Congenital (heart/great vessel malformations or tracheal anomalies)<br/>Acquired (secondary to trauma or tracheostomy)<ref name="CHUV2020">{{cite web |title=Tracheomalacia / Bronchomalacia information |url=https://www.chuv.ch/en/voies-aeriennes/orva-home/patients-and-families/conditions-we-treat/tracheomalacia-bronchomalacia-information |website=CHUV}}</ref>
| causes =
| causes =
| risks =
| risks =
| diagnosis = endoscopy (diagnostic); flexible laryngobronchoscopy (confirmation)<ref name="CHUV2020"/>
| diagnosis = Endoscopy (diagnostic); flexible laryngobronchoscopy (confirmation)<ref name="CHUV2020"/>
| differential =
| differential =
| prevention = Avoiding hard throat impacts
| prevention = Avoiding hard throat impacts
| treatment = Symptomatic management (PEEP or CPAP) for mild symptoms; Surgery indicated for tracheal compression from large vessel or mass<ref name="CHUV2020"/>
| treatment = Symptomatic management (PEEP or CPAP) for mild symptoms <br/>Surgery indicated for tracheal compression from large vessel or mass<ref name="CHUV2020"/>
| medication =
| medication =
| prognosis = Severe tracheomalacia is associated with significant morbidity and mortality<ref name="McNamara,2004">
| prognosis = Severe tracheomalacia is associated with significant morbidity and mortality<ref name="McNamara2004"/>
| frequency =
| frequency =
| deaths =
| deaths =
| alt =
| alt =
}}
}}
'''Tracheomalacia''' is a condition or incident where the [[cartilage]] that keeps the [[vertebrate trachea|airway (trachea)]] open is soft such that the trachea partly collapses especially during increased airflow. This condition is most commonly seen in infants and young children.<ref name="McNamara,2004">{{cite journal |last1=McNamara |first1=V. M |last2=Crabbe |first2=D. C. G |title=Tracheomalacia |journal=Paediatric Respiratory Reviews |date=1 June 2004 |volume=5 |issue=2 |pages=147–154 |doi=10.1016/j.prrv.2004.01.010 |url=https://www.sciencedirect.com/science/article/pii/S1526054204000247?via%3Dihub |language=en |issn=1526-0542}}</ref> The usual symptom is [[stridor]] when a person [[exhalation|breathes out]]. This is usually known as a collapsed windpipe.
'''Tracheomalacia''' is a condition or incident where the [[cartilage]] that keeps the [[vertebrate trachea|airway (trachea)]] open is soft such that the trachea partly collapses especially during increased airflow. This condition is most commonly seen in infants and young children.<ref name="McNamara2004">{{cite journal |last1=McNamara |first1=V. M |last2=Crabbe |first2=D. C. G |title=Tracheomalacia |journal=Paediatric Respiratory Reviews |date=1 June 2004 |volume=5 |issue=2 |pages=147–154 |doi=10.1016/j.prrv.2004.01.010 |pmid=15135125 |s2cid=241298489 |url=https://www.sciencedirect.com/science/article/pii/S1526054204000247 |language=en |issn=1526-0542}}</ref> The usual symptom is [[stridor]] when a person [[exhalation|breathes out]]. This is usually known as a collapsed windpipe.


The trachea normally opens slightly during [[Inhalation|breathing in]] and narrows slightly during breathing out. These processes are exaggerated in tracheomalacia, leading to airway collapse on breathing out.
The trachea normally opens slightly during [[Inhalation|breathing in]] and narrows slightly during breathing out. These processes are exaggerated in tracheomalacia, leading to airway collapse on breathing out.
Line 32: Line 33:
==Signs and symptoms==
==Signs and symptoms==


Tracheomalacia occurs when the walls of the trachea collapse. This can happen because the walls of the windpipe are weak, or it can happen because something is pressing on it. This may include [[hypotonia]] of the [[trachealis muscle]].<ref>{{Citation|last=Wert|first=Susan E.|title=61 - Normal and Abnormal Structural Development of the Lung|date=2017-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780323352147000615|work=Fetal and Neonatal Physiology (Fifth Edition)|pages=627–641.e3|editor-last=Polin|editor-first=Richard A.|publisher=Elsevier|language=en|isbn=978-0-323-35214-7|access-date=2021-01-23|editor2-last=Abman|editor2-first=Steven H.|editor3-last=Rowitch|editor3-first=David H.|editor4-last=Benitz|editor4-first=William E.}}</ref> The whole windpipe can be affected, or only a short piece of it. If the collapsed part of the windpipe goes past the area where the windpipe branches off into the two lungs, it is called bronchomalacia.{{cn|date=November 2020}}
Tracheomalacia occurs when the walls of the trachea collapse. This can happen because the walls of the windpipe are weak, or it can happen because something is pressing on it. This may include [[hypotonia]] of the [[trachealis muscle]].<ref>{{Citation |last=Wert |first=Susan E. |title=61 - Normal and Abnormal Structural Development of the Lung |date=2017-01-01 |work=Fetal and Neonatal Physiology |pages=627–641.e3 |editor-last=Polin |editor-first=Richard A. |editor-last2=Abman |editor-first2=Steven H. |editor-last3=Rowitch |editor-first3=David H. |editor-last4=Benitz |editor-first4=William E. |url=http://www.sciencedirect.com/science/article/pii/B9780323352147000615 |access-date=2021-01-23 |edition=5th |publisher=Elsevier |language=en |isbn=978-0-323-35214-7}}</ref> The whole windpipe can be affected, or only a short piece of it. If the collapsed part of the windpipe goes past the area where the windpipe branches off into the two lungs, it is called bronchomalacia.{{citation needed|date=November 2020}}


This problem causes noisy or difficult breathing in the first 1 to 2 months after birth. This is called congenital tracheomalacia (it was present at birth). It is not very common. Babies born with tracheomalacia may have other health issues like a heart defect, reflux or developmental delay. Some children get tracheomalacia because of other health issues. Symptoms can be mild to severe.{{cn|date=November 2020}}
This problem causes noisy or difficult breathing in the first 1 to 2 months after birth. This is called congenital tracheomalacia (it was present at birth). It is not very common. Babies born with tracheomalacia may have other health issues like a heart defect, reflux or developmental delay. Some children get tracheomalacia because of other health issues. Symptoms can be mild to severe.{{citation needed|date=November 2020}}


Symptoms inside the lung include noisy breathing that may get better when you change your baby's position or while he or she is asleep. Breathing problems that get worse during coughing, crying, feeding or colds. High-pitched sound during breathing (stridor).
Symptoms inside the lung include noisy breathing that may get better when you change your baby's position or while he or she is asleep. Breathing problems that get worse during coughing, crying, feeding or colds. High-pitched sound during breathing (stridor).
High-pitched cough. Rattling noise or wheezing with breathing.{{cn|date=November 2020}}
High-pitched cough. Rattling noise or wheezing with breathing.<ref>{{Cite web |title=Tracheomalacia |url=https://www.childrenshospital.org/conditions/tracheomalacia |access-date=23 April 2024 |website=Boston Children's Hospital |publisher=Esophageal and Airway Treatment Center}}</ref>


==Diagnosis==
==Diagnosis==
Although current diagnostic approaches include pulmonary function testing which shows a characteristic reduction in [[peak expiratory flow]] (PEF), physical examination, and imaging such as [[computed tomography]] (CT) or [[magnetic resonance imaging]] (MRI), fiberoptic [[bronchoscopy]] (FB) is considered the best diagnostic method because an inserted camera down the throat shows a direct view of the airways and lungs, detecting changes in the size or appearance of the trachea's lumen and [[mucous membrane|mucosa]] and any signs of inflammation, [[fistula]]s, or external compressions to precisely determine the location and severity of the [[malacia]]. <ref>{{cite journal |last1=Snijders |first1=Deborah |last2=Barbato |first2=Angelo |title=An Update on Diagnosis of Tracheomalacia in Children |journal=European Journal of Pediatric Surgery |date=15 August 2015 |volume=25 |issue=04 |pages=333–335 |doi=10.1055/s-0035-1559816 |url=https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0035-1559816.pdf?update=true}}</ref>
There is no standardized, defined set of diagnostic criteria for the diagnosis of tracheomalacia, mainly due to the nonspecific symptoms associated with it.<ref name="fraga2016" >{{cite journal |last1=Fraga |first1=Jose Carlos |last2=Jennings |first2=Russell W. |last3=Kim |first3=Peter C. W. |title=Pediatric tracheomalacia |url=https://www.sciencedirect.com/science/article/pii/S1055858616000226 |journal=Seminars in Pediatric Surgery |pages=156–164 |language=en |doi=10.1053/j.sempedsurg.2016.02.008 |date=1 June 2016|volume=25 |issue=3 |pmid=27301602 }}</ref> Current diagnostic approaches include pulmonary function testing which shows a characteristic reduction in [[peak expiratory flow]] (PEF), physical examination, and imaging such as [[computed tomography]] (CT) or [[magnetic resonance imaging]] (MRI), fiberoptic [[bronchoscopy]] (FB) is considered the best diagnostic method because an inserted camera down the throat shows a direct view of the airways and lungs, detecting changes in the size or appearance of the trachea's lumen and [[mucous membrane|mucosa]] and any signs of inflammation, [[fistula]]s, or external compressions to precisely determine the location and severity of the [[malacia]].<ref>{{cite journal |last1=Snijders |first1=Deborah |last2=Barbato |first2=Angelo |title=An Update on Diagnosis of Tracheomalacia in Children |journal=European Journal of Pediatric Surgery |date=15 August 2015 |volume=25 |issue=4 |pages=333–335 |doi=10.1055/s-0035-1559816 |pmid=26276910 |s2cid=1259529 |url=https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0035-1559816.pdf?update=true}}</ref> Cross-sectional radiological images are important in detecting mediastinal structures involved in TM prior to surgery. Tracheography/[[Bronchography]] is no longer a preferred diagnostic method. Bronchography provides an accurate measurement of the airway lumen with a dynamic and morphological evaluation of the [[tracheobronchial tree]]. However, this requires the injection of contrast material within the narrowed airway. Risks include allergic reaction, airway plugging, or complete airway obstruction.<ref name="fraga2016" />


===Classifications===
===Classifications===
There are three types of tracheomalacia:<ref name="pmid12535032">{{cite journal |vauthors=Austin J, Ali T |title=Tracheomalacia and bronchomalacia in children: pathophysiology, assessment, treatment and anaesthesia management |journal=Paediatr Anaesth |volume=13 |issue=1 |pages=3–11 |date=January 2003 |pmid=12535032 |doi=10.1046/j.1460-9592.2003.00802.x }}</ref>
There are three types of tracheomalacia:<ref name="pmid12535032">{{cite journal |vauthors=Austin J, Ali T |title=Tracheomalacia and bronchomalacia in children: pathophysiology, assessment, treatment and anaesthesia management |journal=Paediatr Anaesth |volume=13 |issue=1 |pages=3–11 |date=January 2003 |pmid=12535032 |doi=10.1046/j.1460-9592.2003.00802.x |s2cid=35135103 }}</ref>
*Type 1&mdash;[[congenital]], sometimes associated with [[tracheoesophageal fistula]] or [[esophageal atresia]]
*Type 1&mdash;[[congenital]], sometimes associated with [[tracheoesophageal fistula]] or [[esophageal atresia]]
*Type 2&mdash;extrinsic compression sometimes due to [[vascular ring]]s
*Type 2&mdash;extrinsic compression sometimes due to [[vascular ring]]s
Line 49: Line 50:


==Treatment==
==Treatment==
According to the 2012 Cochrane review, there is no evidence supporting medical therapy over surgical therapy for significant tracheomalacia, or vice versa. Current recommendations for mild to moderate non-life-threatening tracheomalacia focuses on symptom management.<ref name="fraga2016" />
⚫
Life is usually saved if the airway is opened via a hole in the throat. If a person survives, they may have symptoms, but usually will get better after the airway is reopened. If the symptoms are severe enough, treatment may be needed. These range from medical management over [[mechanical ventilation]] (both [[continuous positive airway pressure]] (CPAP), or [[bi-level positive airway pressure]] (BiPAP) to [[tracheal stenting]] and [[surgery]].{{cn|date=November 2020}}
* Regular use of hypertonic saline nebulizers<ref name="fraga2016" />
* Low dose inhaled steroids may help decrease airway inflammation and swelling<ref name="fraga2016" />
* Inhaled Ipratropium may help decrease secretions and stiffen smaller airways<ref name="fraga2016" />
* Antibiotics during active respiratory infection may decrease severity and length of symptoms<ref name="fraga2016" />
* Continuous Positive Airway Pressure (CPAP) provides additional intraluminal pressure<ref name="fraga2016" />


⚫
Life is usually saved if the airway is opened via a hole in the throat. If a person survives, they may have symptoms, but usually will get better after the airway is reopened. If the symptoms are severe enough, treatment may be needed. These range from medical management over [[mechanical ventilation]] (both [[continuous positive airway pressure]] (CPAP)<ref name=":0">{{Cite web |title=Tracheomalacia - acquired: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/007310.htm |access-date=2024-04-19 |website=medlineplus.gov |language=en}}</ref> or [[bi-level positive airway pressure]] (BiPAP)<ref>{{Cite web |title=What Is tracheobronchomalacia? |url=https://my.clevelandclinic.org/health/diseases/22061-tracheobronchomalacia |access-date=2024-04-28 |website=Cleveland Clinic |language=en}}</ref><ref>{{Cite web |title=BiPAP |url=https://my.clevelandclinic.org/health/treatments/24970-bipap |access-date=2024-04-28 |website=Cleveland Clinic |language=en}}</ref>), to inserting a tracheal [[stent]]<ref name=":0" /> and [[surgery]].<ref name=":0" />
⚫
Surgical techniques include [[aortopexy]], [[tracheopexy]], [[tracheobronchoplasty]], and [[tracheostomy]].<ref name="pmid17356936">{{cite journal |vauthors=van der Zee DC, Bax NM |title=Thoracoscopic tracheoaortopexia for the treatment of life-threatening events in tracheomalacia |journal=Surgical Endoscopy |volume=21 |issue=11 |pages=2024–2025 |year=2007 |pmid=17356936 |doi=10.1007/s00464-007-9250-8|doi-access=free }}</ref><ref name=interventions>{{Cite journal|last=Goyal|first=Vikas|last2=Masters|first2=I. Brent|last3=Chang|first3=Anne B.|date=2012-10-17|title=Interventions for primary (intrinsic) tracheomalacia in children|journal=The Cochrane Database of Systematic Reviews|volume=10|pages=CD005304|doi=10.1002/14651858.CD005304.pub3|issn=1469-493X|pmid=23076914|url=http://espace.library.uq.edu.au/view/UQ:288028/UQ288028_OA.pdf}}</ref> The role of the nebulised recombinant human deoxyribonuclease (rhDNase) remains inconclusive.<ref name="interventions" />

<!--Medical management includes-->
⚫
Surgical techniques include [[aortopexy]], [[tracheopexy]], [[tracheobronchoplasty]], and [[tracheostomy]].<ref name="pmid17356936">{{cite journal |vauthors=van der Zee DC, Bax NM |title=Thoracoscopic tracheoaortopexia for the treatment of life-threatening events in tracheomalacia |journal=Surgical Endoscopy |volume=21 |issue=11 |pages=2024–2025 |year=2007 |pmid=17356936 |doi=10.1007/s00464-007-9250-8|doi-access=free }}</ref><ref name=interventions>{{Cite journal|last1=Goyal|first1=Vikas|last2=Masters|first2=I. Brent|last3=Chang|first3=Anne B.|date=2012-10-17|title=Interventions for primary (intrinsic) tracheomalacia in children|journal=The Cochrane Database of Systematic Reviews|volume=10|pages=CD005304|doi=10.1002/14651858.CD005304.pub3|issn=1469-493X|pmid=23076914|url=http://espace.library.uq.edu.au/view/UQ:288028/UQ288028_OA.pdf}}</ref> The role of the nebulised recombinant human deoxyribonuclease (rhDNase) remains inconclusive.<ref name="interventions" />


==See also==
==See also==
Line 61: Line 70:
== External links ==
== External links ==
{{Medical resources
{{Medical resources
| DiseasesDB = 31858
| DiseasesDB = 31858
| ICD10 = {{ICD10|Q|32|0|q|30}}, {{ICD10|J|39|8|}}
| ICD10 = {{ICD10|Q|32|0|q|30}}, {{ICD10|J|39|8|}}
| ICD9 = {{ICD9|519.19}}, {{ICD9|748.3}}
| ICD9 = {{ICD9|519.19}}, {{ICD9|748.3}}
| ICDO =
| ICDO =
| OMIM =
| OMIM =
| MedlinePlus =
| MedlinePlus =
| eMedicineSubj = med
| eMedicineSubj = med
| eMedicineTopic = 2976
| eMedicineTopic = 2976
| eMedicine_mult = {{eMedicine2|ped|2275}}
| eMedicine_mult = {{eMedicine2|ped|2275}}
| MeshID = D055090
| MeshID = D055090
| SNOMED CT = 95434006
| SNOMED CT = 95434006
}}
}}


Latest revision as of 16:41, 28 April 2024

Tracheomalacia
(A) Tracheal structure with normal C-shape rings. (B) U-shaped rings with a wider posterior membrane, demonstrating posterior intrusion. (C) Bow-shaped rings with a broad posterior membrane and severe posterior intrusion.
Pronunciation
SpecialtyPulmonology Edit this on Wikidata
SymptomsWheezing, dyspnea and fatigue upon exertion
Infants may show signs of cyanosis
ComplicationsInability to propel secretions, leading to repeated cases of pneumonia
TypesCongenital (heart/great vessel malformations or tracheal anomalies)
Acquired (secondary to trauma or tracheostomy)[1]
Diagnostic methodEndoscopy (diagnostic); flexible laryngobronchoscopy (confirmation)[1]
PreventionAvoiding hard throat impacts
TreatmentSymptomatic management (PEEP or CPAP) for mild symptoms
Surgery indicated for tracheal compression from large vessel or mass[1]
PrognosisSevere tracheomalacia is associated with significant morbidity and mortality[2]

Tracheomalacia is a condition or incident where the cartilage that keeps the airway (trachea) open is soft such that the trachea partly collapses especially during increased airflow. This condition is most commonly seen in infants and young children.[2] The usual symptom is stridor when a person breathes out. This is usually known as a collapsed windpipe.

The trachea normally opens slightly during breathing in and narrows slightly during breathing out. These processes are exaggerated in tracheomalacia, leading to airway collapse on breathing out.

If the condition extends further to the large airways (bronchi) (if there is also bronchomalacia), it is termed tracheobronchomalacia. The same condition can also affect the larynx, which is called laryngomalacia. The term is from trachea and the Greek μαλακία, softening

Signs and symptoms

[edit]

Tracheomalacia occurs when the walls of the trachea collapse. This can happen because the walls of the windpipe are weak, or it can happen because something is pressing on it. This may include hypotonia of the trachealis muscle.[3] The whole windpipe can be affected, or only a short piece of it. If the collapsed part of the windpipe goes past the area where the windpipe branches off into the two lungs, it is called bronchomalacia.[citation needed]

This problem causes noisy or difficult breathing in the first 1 to 2 months after birth. This is called congenital tracheomalacia (it was present at birth). It is not very common. Babies born with tracheomalacia may have other health issues like a heart defect, reflux or developmental delay. Some children get tracheomalacia because of other health issues. Symptoms can be mild to severe.[citation needed]

Symptoms inside the lung include noisy breathing that may get better when you change your baby's position or while he or she is asleep. Breathing problems that get worse during coughing, crying, feeding or colds. High-pitched sound during breathing (stridor). High-pitched cough. Rattling noise or wheezing with breathing.[4]

Diagnosis

[edit]

There is no standardized, defined set of diagnostic criteria for the diagnosis of tracheomalacia, mainly due to the nonspecific symptoms associated with it.[5] Current diagnostic approaches include pulmonary function testing which shows a characteristic reduction in peak expiratory flow (PEF), physical examination, and imaging such as computed tomography (CT) or magnetic resonance imaging (MRI), fiberoptic bronchoscopy (FB) is considered the best diagnostic method because an inserted camera down the throat shows a direct view of the airways and lungs, detecting changes in the size or appearance of the trachea's lumen and mucosa and any signs of inflammation, fistulas, or external compressions to precisely determine the location and severity of the malacia.[6] Cross-sectional radiological images are important in detecting mediastinal structures involved in TM prior to surgery. Tracheography/Bronchography is no longer a preferred diagnostic method. Bronchography provides an accurate measurement of the airway lumen with a dynamic and morphological evaluation of the tracheobronchial tree. However, this requires the injection of contrast material within the narrowed airway. Risks include allergic reaction, airway plugging, or complete airway obstruction.[5]

Classifications

[edit]

There are three types of tracheomalacia:[7]

Treatment

[edit]

According to the 2012 Cochrane review, there is no evidence supporting medical therapy over surgical therapy for significant tracheomalacia, or vice versa. Current recommendations for mild to moderate non-life-threatening tracheomalacia focuses on symptom management.[5]

  • Regular use of hypertonic saline nebulizers[5]
  • Low dose inhaled steroids may help decrease airway inflammation and swelling[5]
  • Inhaled Ipratropium may help decrease secretions and stiffen smaller airways[5]
  • Antibiotics during active respiratory infection may decrease severity and length of symptoms[5]
  • Continuous Positive Airway Pressure (CPAP) provides additional intraluminal pressure[5]

Life is usually saved if the airway is opened via a hole in the throat. If a person survives, they may have symptoms, but usually will get better after the airway is reopened. If the symptoms are severe enough, treatment may be needed. These range from medical management over mechanical ventilation (both continuous positive airway pressure (CPAP)[8] or bi-level positive airway pressure (BiPAP)[9][10]), to inserting a tracheal stent[8] and surgery.[8]

Surgical techniques include aortopexy, tracheopexy, tracheobronchoplasty, and tracheostomy.[11][12] The role of the nebulised recombinant human deoxyribonuclease (rhDNase) remains inconclusive.[12]

See also

[edit]

References

[edit]
  1. ^ a b c "Tracheomalacia / Bronchomalacia information". CHUV.
  2. ^ a b McNamara, V. M; Crabbe, D. C. G (June 1, 2004). "Tracheomalacia". Paediatric Respiratory Reviews. 5 (2): 147–154. doi:10.1016/j.prrv.2004.01.010. ISSN 1526-0542. PMID 15135125. S2CID 241298489.
  3. ^ Wert, Susan E. (January 1, 2017), Polin, Richard A.; Abman, Steven H.; Rowitch, David H.; Benitz, William E. (eds.), "61 - Normal and Abnormal Structural Development of the Lung", Fetal and Neonatal Physiology (5th ed.), Elsevier, pp. 627–641.e3, ISBN 978-0-323-35214-7, retrieved January 23, 2021
  4. ^ "Tracheomalacia". Boston Children's Hospital. Esophageal and Airway Treatment Center. Retrieved April 23, 2024.
  5. ^ a b c d e f g h Fraga, Jose Carlos; Jennings, Russell W.; Kim, Peter C. W. (June 1, 2016). "Pediatric tracheomalacia". Seminars in Pediatric Surgery. 25 (3): 156–164. doi:10.1053/j.sempedsurg.2016.02.008. PMID 27301602.
  6. ^ Snijders, Deborah; Barbato, Angelo (August 15, 2015). "An Update on Diagnosis of Tracheomalacia in Children" (PDF). European Journal of Pediatric Surgery. 25 (4): 333–335. doi:10.1055/s-0035-1559816. PMID 26276910. S2CID 1259529.
  7. ^ Austin J, Ali T (January 2003). "Tracheomalacia and bronchomalacia in children: pathophysiology, assessment, treatment and anaesthesia management". Paediatr Anaesth. 13 (1): 3–11. doi:10.1046/j.1460-9592.2003.00802.x. PMID 12535032. S2CID 35135103.
  8. ^ a b c "Tracheomalacia - acquired: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved April 19, 2024.
  9. ^ "What Is tracheobronchomalacia?". Cleveland Clinic. Retrieved April 28, 2024.
  10. ^ "BiPAP". Cleveland Clinic. Retrieved April 28, 2024.
  11. ^ van der Zee DC, Bax NM (2007). "Thoracoscopic tracheoaortopexia for the treatment of life-threatening events in tracheomalacia". Surgical Endoscopy. 21 (11): 2024–2025. doi:10.1007/s00464-007-9250-8. PMID 17356936.
  12. ^ a b Goyal, Vikas; Masters, I. Brent; Chang, Anne B. (October 17, 2012). "Interventions for primary (intrinsic) tracheomalacia in children" (PDF). The Cochrane Database of Systematic Reviews. 10: CD005304. doi:10.1002/14651858.CD005304.pub3. ISSN 1469-493X. PMID 23076914.
[edit]
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