Document Detail


Airway stents in children.
MedLine Citation:
PMID:  18286550     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Airway obstruction in children is a rare, but difficult clinical problem, with no clear agreement on optimal therapeutic approach. Stenting of the airway has been used successfully in adults, and is an attractive alternative in children. Fundamental differences of pediatric compared to adult use include the benign nature of most stenoses, the narrow and soft airways of children, the required long-term tolerance and adaptation to growth. These differences may significantly alter the therapeutic balance, calling into question the precise role stents play in the treatment of airway obstruction in children. Stent placement can be technically demanding but is not exceedingly difficult. Experience is necessary to select the proper size and type of stent. Metal stents usually achieve airway patency and clinical improvement in the majority of cases, while this is less frequently the case with silicone stents. Some complications such as granulation and secretion retention seem to occur in most children after stent implantation. Unfortunately, severe complications including death have been reported in a significant proportion of children. Stent related mortality can be estimated at 12.9% from published data, but these include complication centered reports. The initial euphoria for airway stents in children has largely abated and most authors agree that they should only be employed in circumstances with no good alternatives. It is crucial that all surgical and medical alternatives are considered and the decision to place a stent is not made because other options are overlooked or not available locally. Stent use in a palliative setting has also been reported and is probably reasonable. Stents will only allow limited adaptation for the growth of pediatric airways by balloon dilatation. All metal stents should be considered as potentially permanent, and removal sometimes may only be possible through a surgical and sometimes risky approach.
Authors:
T Nicolai
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Pediatric pulmonology     Volume:  43     ISSN:  1099-0496     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-04     Completed Date:  2008-06-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  330-44     Citation Subset:  IM    
Affiliation:
Dr. v. Haunersches Kinderspital, University Childrens Hospital, Munich, Germany. tnicolai@med.uni-muenchen.de
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MeSH Terms
Descriptor/Qualifier:
Airway Obstruction / surgery*
Bronchial Diseases / surgery
Child
Child, Preschool
Constriction, Pathologic / surgery
Equipment Design
Humans
Infant
Stents*
Tracheal Diseases / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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