Interventions for primary (intrinsic) tracheomalacia in children

Goyal, Vikas, Masters, I. Brent and Chang, Anne B. (2012) Interventions for primary (intrinsic) tracheomalacia in children. Cochrane Database of Systematic Reviews, 10 10: CD005304-1-CD005304-30. doi:10.1002/14651858.CD005304.pub3

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Author Goyal, Vikas
Masters, I. Brent
Chang, Anne B.
Title Interventions for primary (intrinsic) tracheomalacia in children
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2012-01
Year available 2012
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD005304.pub3
Volume 10
Issue 10
Start page CD005304-1
End page CD005304-30
Total pages 30
Place of publication Oxford, United Kingdom
Publisher John Wiley and Sons
Collection year 2013
Language eng
Formatted 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 apnoea to common respiratory symptoms such as chronic cough and wheeze. Current practice following diagnosis of tracheomalacia includes 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 calibre 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 Airways Group searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Group's Specialised Register, MEDLINE and EMBASE databases. The Cochrane Airways Group performed the latest searches in March 2012
Selection criteria :
All randomised controlled trials (RCTs) of therapies related to symptoms associated with primary or intrinsic tracheomalacia.
Data collection and analysis :
Two reviewers extracted data from the included study independently and resolved disagreements by consensus.
Main results :
We included one RCT that compared nebulised recombinant human deoxyribonuclease (rhDNase) with placebo in 40 children with airway malacia and a respiratory tract infection. We assessed it to be a RCT with overall low risk of bias. Data analysed in this review showed that there was no significant difference between groups for the primary outcome of proportion cough-free at two weeks (odds ratio (OR) 1.38; 95% confidence interval (CI) 0.37 to 5.14). However, the mean change in night time cough diary scores significantly favoured the placebo group (mean difference (MD) 1.00; 95% CI 0.17 to 1.83, P = 0.02). The mean change in daytime cough diary scores from baseline was also better in the placebo group compared to those on nebulised rhDNase, but the difference between groups was not statistically significant (MD 0.70; 95% CI -0.19 to 1.59). Other outcomes (dyspnoea, and difficulty in expectorating sputum scores, and lung function tests at two weeks also favoured placebo over nebulised rhDNase but did not reach levels of significance.
Authors' conclusions :
There is currently an absence of evidence to support any of the therapies currently utilised for management of intrinsic tracheomalacia. It remains inconclusive whether the use of nebulised rhDNase in children with airway malacia and a respiratory tract infection worsens recovery. 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 on interventions such as antibiotics and chest physiotherapy are clearly needed. Outcomes of these RCTs should include measurements of the trachea and physiological outcomes in addition to clinical outcomes.
Keyword Trachea
Tracheal Diseases
Adolescent
Tracheoesophageal Fistula
Surgical-Treatment
Flexible Bronchoscopy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
 
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