Balloon dilatation for paediatric airway stenosis: evidence from the UK Airway Intervention Registry

Balloon dilatation for paediatric airway stenosis: evidence from the UK Airway Intervention Registry:

Abstract

Objectives

To assess the safety and efficacy in routine clinical practice of balloon dilatation procedures in the treatment of paediatric airway stenosis.

Design

Observational data collection in prospective online research database

Setting

Acute NHS Trusts with ENT department undertaking complex paediatric airway work

Participants: Children (<18) undergoing balloon dilatation treatment for airway stenosis.

Main outcome measures

airway diameter, complications, hospital resource usage.

Results

59 patients had 133 balloon procedures during 128 visits to 10 hospitals. 69 (52%) of balloon procedures were conducted with a tracheostomy. Intra‐operative Cotton‐Myer grade decreased in 43 (57%). The mean pre‐balloon subglottic diameter was 4.2 [95% CI: 3.8 to 4.5] mm and its rate of increase was 0.8 [0.5 to 1.2] mm per year modelled on 30 patients’ long term data. As the primary treatment of stenosis, the procedural success rate of balloon dilatation (n=52) was 65% (22% with tracheostomy, 88% without tracheostomy), and 71% as an adjunct to open reconstructive surgery (n=7). In the 64 hospital visits where a balloon procedure was conducted with a tracheostomy in place only 1 in‐hospital complication (lower respiratory tract infection) occurred. For those without a tracheostomy in place, in‐hospital complications occurred in 7 of 64 balloon hospital visits, all related to ongoing or worsening stenosis. 6 out‐of‐hospital complications were deemed related to ongoing or worsening stenosis following the procedure and 2 complications were a combination of lower respiratory infection and ongoing or worsening stenosis.

Conclusions

Balloon dilation increases the size of the airway intraoperatively, and is associated with long term increase in airway diameter. Safety outcomes mostly relate to ongoing or worsening stenosis and are more common in patients without a tracheostomy.