Abstract Introduction Tracheomalacia and bronchomalacia or tracheobronchomalacia (TBM) typically refers to pathological narrowing of the proximal large airways. There can be dynamic or structural issues which lead to abnormal narrowing. TBM is commonly identified in neonates with bronchopulmonary dysplasia (BPD), with a reported incidence of 10-85%. However, given the lack of clear guidelines for diagnosis or management of TBM in BPD, we hypothesized high inter-center and provider practice variability based on diagnostic modality and TBM definition. Methods A survey characterizing providers’ practice in diagnosing and managing TBM was sent to physicians practicing flexible or rigid bronchoscopy at BPD Collaborative centers. The survey was administered using REDCap® platform and included questions to assess reader’s understanding of TBM and its management, including deidentified videos of bronchoscopy procedures to answer targeted clinical scenario questions. Results A total of 71 physicians from 34 centers completed the survey with multiple respondents from 16 centers. The majority were pulmonologists (78.9%) with 14.1% otolaryngologists; the median years in practice among all respondents were 11 years. Most providers reported screening for airway abnormalities (71.4%) most commonly for patients with BPD spells (97.1%) or inability to wean support (87.1%). Definitions of TBM varied, with 42.3% defining it as any airway narrowing and 40.8% defining it as dynamic narrowing only. Criteria defining TBM varied between providers with most variability in mild TBM (Table). Bronchoscopy (rigid or flexible) was the most common diagnostic method. Flexible bronchoscopy (FB) without an artificial airway (66.2%) under spontaneous breathing “light” sedation (95.8%) regarded as the gold standard. Combined pulmonary and ENT scopes were preferred (66.7%). Few centers endorsed having a written protocol for TBM diagnosis (11.3%). Anesthesia considerations (40.3%) topped challenges. Most were not comfortable in making recommendations for posterior tracheopexy due to lack of experience (52.2%). Video based scenarios reflected significant variability in diagnosis and management of TBM. Conclusions There is lack of consensus for defining malacia, especially mild TBM. Flexible bronchoscopy under light sedation was considered the gold standard, interpretation and management practices differed widely. This variability also alludes to potential issues with any research involving airway malacia unless clear standardization definitions are used. Standardized definitions, diagnostic criteria, and multidisciplinary collaboration are essential to improve consistency and optimize outcomes for children with BPD-associated TBM. This abstract is funded by: None
Bansal et al. (Fri,) studied this question.