Using Airway Resistance Trends to Evaluate Bronchodilator Therapies for Pediatric Patients With Malacia

Background: Since malacia is primarily assessed through bronchoscopy it has previously been difficult to determine the best therapies for these patients. We have had to rely on clinical assessments such as work of breathing, ventilator waveforms, and vital signs. This has often been challenging since many patients with malacia also have comorbidities such as BPD, CLD, PHTN, asthma, or neuromuscular conditions that can also affect their clinical assessment. Since malacia affects the shape of the airways, it can cause an increase in airway resistance (Raw). Bronchodilators can be used to help control the effect of malacia on the shape of the airway. Methods: This quality improvement study examined tracheostomy and ventilator dependent pediatric patients with malacia who were treated with bronchodilators. Using an NM3 we recorded the patient’s Raw once per minute for the duration of the study. These Raw readings are plotted in relation to the times when bronchodilators are given (see attached graph). We are then able to evaluate the patient’s Raw pre and post treatment. Looking at the trend of Raw readings pre and post bronchodilator treatment we can see if their Raw increases or decreases. If Raw decreases, we know the therapy was effective. We can also look at the Raw trends from one treatment to the next. If the Raw is increasing before the next treatment is given, we can increase our treatment frequency to provide better control. Since there is limited data on pediatric Raw, we do not target specific Raw ranges. We instead look at the trends for each patient individually. Results: 9 patients were evaluated in the study. Patients required anywhere from 1 to 4 studies each to titrate optimal medications and medication frequencies. We were able to observe changes in Raw in relation to the treatment times. Conclusions: Using Raw trends we were able to establish that these patients benefited from more frequent treatments than the previous standard of BID Atrovent. All of the patients showed decreased Raw readings at Q8 or Q6 therapy. The use of Raw trends may be beneficial in titrating bronchodilator therapy for pediatric patients with malacia. (Fig 1: example of 1 patient) Disclosures: None of the authors have any industry or commercial relationships to disclose.