Tracheobronchomalacia: When Aortopexy / Anterior Tracheobronchopexy Has Not Achieved Adequate Airway Patency
Clinical Scenario
This protocol applies to patients with tracheobronchomalacia who have undergone anterior surgical support of the airway and have not met the required patency threshold — indicating that a further line of management is needed.
Previous Line — Failure Condition
The prior approach — aortopexy and anterior tracheobronchopexy (supporting and suturing the anterior wall of the trachea and/or main bronchi to the sternum and anterior chest wall, under direct bronchoscopic guidance) — did not achieve greater than 50% airway patency at −50 mmHg suction (Munoz maneuver). Non-achievement of this target is the criterion for escalation to the current protocol.
Next-Line Approach (Partial Overview)
The next step involves a definitive airway procedure that addresses both airway mechanics and secretion clearance. It is reserved for patients in whom prior interventions have been exhausted and the risk–benefit assessment supports its use. The full structured regimen is available via the protocol.
References
DOI: 10.1016/j.sempedsurg.2021.151062
- In the past, tracheostomy and long-term medical ventilation was the mainstay surgical approach in patients with severe TBM.
- The utility of the tracheostomy is to provide a mechanism for the delivery of positive airway pressure, secretion suctioning and removal, and a degree of airway stenting.
- Thus, this approach should be avoided if possible and reserved as a last resort in highly selected patients with life-threatening airway obstruction who have failed other therapeutical strategies or in whom the risk-benefit analysis points to tracheostomy placement.
View source ↗