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Bronchoscopic interventions for plastic bronchitis in children without structural heart disease

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Plastic bronchitis (PB) is a rare and life-threatening complication encountered in several disease states that leads to airway obstruction by branching casts. PB is most often reported in children with cyanotic congenital heart disease where recurrence is common, and mortality is high. There is limited data on optimal management strategies or recurrence of non-structural heart disease–related PB in children. We describe the clinical features, management, and outcomes in our cohort of children with non-structural heart disease-related PB. Among the 12 identified patients, asthma was the most common (67%) diagnosis. Ventilatory requirements ranged from room air to one patient who required extracorporeal membrane oxygenation (ECMO). Most patients (92%) required bronchoscopy, and cryotherapy was successfully utilized in two patients to relieve refractory obstructive airway casts. All patients received chest physiotherapy, and 11 patients were treated with two or more medications. There was one mortality despite ECMO, and one-third had recurrent PB, all of whom had asthma.

Conclusion: Asthma is a risk factor for recurrent PB. Bronchoscopic interventions including cryotherapy are safe and effective treatment options in patients with refractory PB.

What is Known:

• Plastic bronchitis is a rare but life-threatening cause of airway obstruction caused by branching casts that are generally reported in patients with congenital heart disease.

What is New:

• In children without structural heart disease, asthma is a risk factor for recurrent plastic bronchitis. Cryotherapy via bronchoscopy is a safe and effective intervention in patients with refractory plastic bronchitis.

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Bronchoalveolar lavage


Congenital heart disease


Extracorporeal membrane oxygenation


Endotracheal tube


Flexible bronchoscopy


High flow nasal cannula oxygen


Mechanical ventilation


Noninvasive positive pressure ventilation


Plastic bronchitis


Polymerase chain reaction


Rigid bronchoscopy


Sickle cell acute chest syndrome


Tissue plasminogen activator


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Authors and Affiliations



EFK: data collection, data analysis, manuscript writing; ASK: data analysis, manuscript writing; RP: data collection, manuscript writing; GLS: data collection, analysis; DMS: data analysis, manuscript writing; SL: data analysis, manuscript writing; LG: study design, data collection, data analysis, manuscript writing.

Corresponding author

Correspondence to Lokesh Guglani.

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Ethics approval

The study was approved by the Children’s Healthcare of Atlanta Institutional Review Board. In view of the retrospective nature of this study, all procedures performed were part of routine clinical care.

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Not applicable since this was a retrospective chart review.

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All authors have consented for the publication of the current version of this manuscript.

Conflict of interest

The authors declare no competing interests.

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Communicated by: Daniele De Luca

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Kallam, E.F., Kasi, A.S., Patki, R. et al. Bronchoscopic interventions for plastic bronchitis in children without structural heart disease. Eur J Pediatr 180, 3547–3554 (2021).

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