{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T16:02:48Z","timestamp":1782316968997,"version":"3.54.5"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T00:00:00Z","timestamp":1636329600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Plastic bronchitis (PB) is a condition characterized by the formation of thick airway casts leading to acute and often life\u2010threatening airway obstruction. PB occurs mainly in pediatric patients with congenital heart disease (CHO) who have undergone staged surgical palliation (Glenn, Fontan), but can also occur after chemical inhalation, H1N1, severe COVID\u201019, sickle cell disease, severe asthma, and other diseases. Mortality risk from PB can be up to 40%\u201360%, and no treatment guideline\u00a0exist. The objectives herein are to develop a standardized evaluation, classification, and treatment guideline for PB patients presenting with tracheobronchial casts, based on our experience with PB at the Children's Hospital of Colorado in Denver.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We describe 11 patients with CHO\u2010associated PB (post\u2010Fontan [<jats:italic>n<\/jats:italic>\u2009=\u20099], pre\u2010Fontan [<jats:italic>n<\/jats:italic>\u2009=\u20092]) who presented with their initial episodes. We utilized histopathological analysis of tracheobronchial casts to guide treatment in these patients, utilizing our hospital\u2010wide guideline document and classification system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found that 100% of post\u2010Fontan PB patients had fibrinous airway casts, while pre\u2010Fontan PB casts were fibrinous only in one of two patients (50%). Utilizing histopathology as a guide to therapy, PB patients with fibrin airway casts were treated with airway\u2010delivered fibrinolytics and anticoagulants, as well as aggressive airway clearance and other supportive care measures. These therapies resulted in successful cast resolution and improved survival in post\u2010Fontan PB patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We have shown an improved outcome in PB patients whose treatment plan was based on Denver's PB classification schema and standardized treatment guideline\u00a0based on tracheobronchial cast histopathology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.25746","type":"journal-article","created":{"date-parts":[[2021,10,29]],"date-time":"2021-10-29T10:31:25Z","timestamp":1635503485000},"page":"529-537","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Fibrin airway cast obstruction: Experience, classification, and treatment guideline from Denver"],"prefix":"10.1002","volume":"57","author":[{"given":"Deborah R.","family":"Liptzin","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Section of Pulmonary and Sleep Medicine University of Colorado Denver (Primary Research Site) Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"McGraw","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Pulmonary and Sleep Medicine University of Colorado Denver (Primary Research Site) Aurora Colorado USA"},{"name":"Division of Pediatric Pulmonology, Department of Pediatrics University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Houin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Pulmonary and Sleep Medicine University of Colorado Denver (Primary Research Site) Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4981-9634","authenticated-orcid":false,"given":"Livia A.","family":"Veress","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Pulmonary and Sleep Medicine University of Colorado Denver (Primary Research Site) Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,11,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.109.4.e67"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-008-9312-2"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-011-0058-x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PCC.0000149320.06424.1D"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.10179"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.155.1.9001337"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.100.1.139"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-2883"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e318068b60e"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/toxsci\/kfu225"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.23043"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2020.02.010"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202004-0945LE"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2005.09.001"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201209-080OC"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.03.050"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-012-0430-5"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951109990357"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/2150135112438107"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.01.063"},{"issue":"2","key":"e_1_2_9_22_1","first-page":"157","article-title":"Treatment of plastic bronchitis using serial flexible bronchoscopy and aerosolized heparin therapy","volume":"23","author":"Walker PA","year":"2013","journal-title":"Eur\u00a0J\u00a0Pediatr\u00a0Surg\u00a0Off\u00a0J\u00a0Austrian Assoc\u00a0Pediatr\u00a0Surg\u00a0[et al] = Zeitschrift fur Kinderchirurgie"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-003-0529-9"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-011-1288-z"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951101000385"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)33719-5"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.23793"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1745-7254.2006.00418.x"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.10196"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.05.067"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004630-199805000-00004"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951112002089"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-005-0913-8"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.07.004"},{"issue":"2","key":"e_1_2_9_35_1","first-page":"47","article-title":"Successful treatment of plastic bronchitis with low fat diet and subsequent thoracic duct ligation in child with Fontan physiology","volume":"45","author":"Parikh K","year":"2012","journal-title":"Lymphology"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.43"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.96.09030612"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.10.042"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.04.015"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pupt.2009.10.009"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1R690"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1165\/rcmb.2012-0177OC"}],"container-title":["Pediatric Pulmonology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.25746","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ppul.25746","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.25746","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T07:09:03Z","timestamp":1693206543000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ppul.25746"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,8]]},"references-count":41,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1002\/ppul.25746"],"URL":"https:\/\/doi.org\/10.1002\/ppul.25746","archive":["Portico"],"relation":{},"ISSN":["8755-6863","1099-0496"],"issn-type":[{"value":"8755-6863","type":"print"},{"value":"1099-0496","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,8]]},"assertion":[{"value":"2020-09-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}