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Case report
Tracheal opening manoeuvre (PEEP-20) in a patient with bronchopulmonary dysplasia and severe tracheobronchomalacia with neurally adjusted ventilatory assist (NAVA)
  1. Maite Olguin Ciancio1,
  2. Francisco José Cambra2,3 and
  3. Martí Pons-Odena2,3
  1. 1 Department of Pediatric Kinesiology, Clinica Zabala, Caba, Argentina
  2. 2 Pediatric Intensive Care Unit, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
  3. 3 Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57. 08950 Esplugues de Llobregat, Spain
  1. Correspondence to Dr Martí Pons-Odena; mpons{at}


Bronchopulmonary dysplasia (BPD) is occasionally associated with tracheobronchomalacia, and it is this combination that can lead to serious outcomes. The most severe cases require tracheostomies, ventilatory support and eventually even tracheal stents or surgery. Ventilation in patients with tracheomalacia is complicated without a good patient-ventilator synchrony; the neurally adjusted ventilatory assist (NAVA) mode is potentially beneficial in these cases. This case report presents a patient affected by BPD and severe tracheobronchomalacia who was tracheostomised and ventilated 24 hours a day and who suffered from episodes of airway collapse despite using the NAVA mode. It was necessary to increase the positive end-expiratory pressure to 20 cmH2O (the PEEP-20 manoeuvre) for several minutes during an episode; this allowed the trachea to remain open and allowed us to optimise the patient’s ventilation. This strategy has previously been described in a patient with tracheomalacia, reducing the frequency and need for sedation in the following episodes.

  • mechanical ventilation
  • paediatric intensive care
  • paediatrics

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  • Contributors MP-O and MOC conceived the case report, acquired the data and contributed to writing the manuscript. FJC contributed to writing the manuscript. All authors read, reviewed and approved the final version of this case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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