Treatment of Bilateral Severe Bronchomalacia with 3-Dimensionally Printed Patient-Specific External Bronchial Splints

Abstract

Objectives:

(1) Describe the treatment options for severe bronchomalacia. (2) Learn about a novel technology for treatment of severe bronchomalacia using a 3-dimensionally (3D) printed patient-specific external bronchial splint.

Methods:

A 16-month-old patient previously underwent tracheostomy for severe bronchomalacia but had been unable to be discharged home since birth because of persistent high ventilatory requirements (PEEP 20). Despite high ventilatory settings and intravenous sedatives, respiratory events required prolonged intensive care unit (ICU) care and intermittent comas. Endoscopic examination demonstrated focal bilateral mainstem bronchomalacia. DICOM CT images of the patient’s airway were imported into a computer-aided modeling program and custom 3D external bronchial splints were created utilizing image-based Boolean design. The splints were 3D printed using poly-L-caprolactone. Institutional Review Board and Food and Drug Administration emergency-use exemption was granted and the patient was implanted with the custom devices.

Results:

Subsequent bronchoscopy revealed patency of both mainstem bronchi and normal ventilatory variation in both lungs. Peak end-expiratory pressure (PEEP) was immediately weaned from 20 to 10 mm Hg and tidal volumes immediately improved from 5 to 10 cc/kg. The patient is actively being weaned from ventilator support. Respiratory parameters, endoscopy, and dynamic imaging are being actively studied during the patient’s recovery.

Conclusions:

This patient demonstrates a clinical scenario of bilateral bronchomalacia who had exhausted conventional treatment options but necessitated prolonged ICU-level support. The creation of 3D-printed external bronchial splints has alleviated the critical nature of the bronchomalacia and represents the first time this technology has been used in a patient with bilateral disease.