Tracheo/Bronchomalacia in Children: Clinical Presentation, Diagnostic Tests, Surgical Treatments, Follow Up and Respiratory Assistance

Background: In pediatric age, the central airways are more flexible and mobile, with tracheal and bronchial walls easly tending to collapse, allowing partial or complete occlusion of the lumen: a situation described as tracheobronchomalacia (TBM). Any condition that causes an increase in intrathoracic pressure are situations in which airway collapse is accentuated and biphasic or barking cough appears. Objectives: Although the situation of TBM is relatively frequent in pediatric age, the diagnostic criteria and subsequent treatment do not follow well-standardized criteria, and often vary from pediatric center to center. Therefore, there is a real need to standardize diagnostic procedures and the resulting medical or surgical treatments. Methods: We therefore organized a day of meeting to talk about TBM, inviting from all Italy pediatricians and pediatric surgeons that diagnose and treat patients with this pathology on daily basis. Results: This work, collecting all the meeting interventions, is a compendium that truly deals with TBM in all its aspects, emphasizing above all the most correct criteria to diagnose and therefore best treat each individual pediatric patient with such clinical condition. We give particular emphasis to the need to perform static and dynamic videobronchoscopy (S/DVBS) to verify the patency of the tracheal lumen, so as to evaluate the severity of TBM, when the patient increases intrathoracic pressure. Conclusion: this work deals with TBM in all its diagnostic and treatment aspects and can be a valid help for all pediatricians who treat this pathology.