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Mariussi M, Amaral PT, Kaiser Ururahy Nunes Fonseca E, Teles G, Falsarella PM, Caruso R, Jacomelli M, Garcia RG. Multidetector computed tomography imaging planning for bronchoscopy stent and valve placement in the treatment of COPD, air leaks, and airway stenosis. Curr Probl Diagn Radiol 2025; 54:159-166. [PMID: 39168765 DOI: 10.1067/j.cpradiol.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/24/2024] [Accepted: 08/08/2024] [Indexed: 08/23/2024]
Abstract
Bronchoscopy using a flexible bronchoscope is considered a safe procedure and has been used for diagnosing and treating airway and parenchymal lung diseases. Bronchoscopic interventions in selected patients with emphysema, airway stenosis, and air leaks provide new treatment options. The application of multidetector computed tomography (MDCT) planning prior to bronchoscopy is comprehensively addressed. Using MDCT scan for pre-procedural planning, ensures precise navigation and device placement during bronchoscopy, ultimately improving patient outcomes. Radiological features can be correlated with bronchoscopy findings, linking MDCT images with direct bronchoscopy observations. This educational statement provides a comprehensive overview of the integration of computed tomography and bronchoscopy in managing different pulmonary conditions treated with endobronchial valve and airway stent placement, focusing on key aspects to enhance understanding and application in clinical practice. Emphasis is placed on their role in treating airway stenosis (AS), air leaks, and chronic obstructive pulmonary disease (COPD), highlighting the conditions under which these procedures are most beneficial. It explores how MDCT imaging contributes to the diagnosis and treatment planning of these conditions and the correct interpretation of MDCT image findings during follow-up after the procedure.
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Affiliation(s)
- Miriana Mariussi
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Paula Terra Amaral
- Department of Diagnostic Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Gustavo Teles
- Department of Diagnostic Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Rodrigo Caruso
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcia Jacomelli
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Gobbo Garcia
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Chitilian HV, Bao X. Anesthetic Management for Tracheal Resection and Reconstruction. Thorac Surg Clin 2025; 35:11-16. [PMID: 39515889 DOI: 10.1016/j.thorsurg.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Tracheal resection and reconstruction (TRR) surgery presents unique challenges to the anesthesiologist. These challenges include the induction of anesthesia and establishment of an airway in a patient with tracheal stenosis; airway management during the open tracheal phase of the operation; and emergence from anesthesia and extubation at the end of the case. A number of approaches to the safe conduct of these anesthetics have been described in the literature. Ultimately the successful anesthetic management of TRR hinges on an understanding of the surgical procedure, as well as close communication with the surgeon.
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Affiliation(s)
- Hovig V Chitilian
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Xiaodong Bao
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Little BP, Walker CM, Bang TJ, Brixey AG, Christensen JD, De Cardenas J, Hobbs SB, Klitzke A, Madan R, Maldonado F, Marshall MB, Moore WH, Rosas E, Chung JH. ACR Appropriateness Criteria® Tracheobronchial Disease. J Am Coll Radiol 2024; 21:S518-S533. [PMID: 39488358 DOI: 10.1016/j.jacr.2024.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 08/31/2024] [Indexed: 11/04/2024]
Abstract
A variety of thoracic imaging modalities and techniques have been used to evaluate diseases of the trachea and central bronchi. This document evaluates evidence for the use of thoracic imaging in the evaluation of tracheobronchial disease, including clinically suspected tracheal or bronchial stenosis, tracheomalacia or bronchomalacia, and bronchiectasis. Appropriateness guidelines for initial imaging evaluation of tracheobronchial disease and for pretreatment planning or posttreatment evaluation are included. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | | | - Anupama G Brixey
- Portland VA Healthcare System and Oregon Health & Science University, Portland, Oregon
| | | | - Jose De Cardenas
- University of Michigan, Ann Arbor, Michigan; American College of Chest Physicians
| | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York; Commission on Nuclear Medicine and Molecular Imaging
| | - Rachna Madan
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American Thoracic Society
| | - M Blair Marshall
- Harvard Medical School, Boston, Massachusetts; American Association for Thoracic Surgery
| | - William H Moore
- New York University Langone Medical Center, New York, New York
| | - Edwin Rosas
- University of Chicago, Chicago, Illinois, Primary care physician
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Gulilat D, Genetu A, Kejela S, Kassa S, Bekele A, Tizazu A. Nonmalignant tracheal stenosis: presentation, management and outcome in limited resources setting. J Cardiothorac Surg 2024; 19:21. [PMID: 38263174 PMCID: PMC10804803 DOI: 10.1186/s13019-024-02480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Nonmalignant tracheal stenosis is a potentially life threatening conditions that develops as fibrotic healing from intubation, tracheostomy, caustic injury or chronic infection processes like tuberculosis. This is a report of our experience of its management with tracheostomy, rigid bronchoscopic dilation and surgery. METHODS Retrospective study design was used. 60 patients treated over five years period were included. RESULTS Mean age was 26.9 ± 10.0 with a range of 10-55 years. Majority (56 patients (93.3%)) had previous intubation as a cause for tracheal stenosis. Mean duration of intubation was 13.8 days (range from 2 to 27 days). All patients were evaluated with neck and chest CT (Computed Tomography) scan. Majority of the stenosis was in the upper third trachea - 81.7%. Mean internal diameter of narrowest part was 5.5 ± 2.5 mm, and mean length of stenosed segment was 16.9 ± 8 mm. Tracheal resection and end to end anastomosis (REEA) was the most common initial modality of treatment followed by bronchoscopic dilation (BD) and primary tracheostomy (PT). The narrowest internal diameter of the tracheal stenosis (TS) for each initial treatment category group was 4.4 ± 4.3 mm, 5.1 ± 1.9 mm and 6.7 ± 1.6 mm for PT, tracheal REEA and BD respectively, and the mean difference achieved statistical significance, F (10,49) = 2.25, p = 0.03. Surgery resulted in better outcome than bronchoscopic dilation (89.1% vs. 75.0%). DISCUSSION AND CONCLUSION Nonmalignant tracheal stenosis mostly develops after previous prolonged intubation. Surgical resection and anastomosis offers the best outcome.
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Affiliation(s)
- Dereje Gulilat
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abraham Genetu
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Segni Kejela
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seyoum Kassa
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda
| | - Ayalew Tizazu
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Razmjoo S, Shahbazian H, Hosseini SM, Feli M, Mohammadian F, Bagheri A. Therapeutic and prophylactic effects of radiation therapy in the management of recurrent granulation tissue induced tracheal stenosis: a review on the role of Endobronchial brachytherapy and external beam radiation therapy. Brachytherapy 2023; 22:389-399. [PMID: 36922243 DOI: 10.1016/j.brachy.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Granulation tissue-induced tracheal stenosis (mainly secondary to intubation or lung transplantation) is one of the most common etiologies of benign airway obstructions. Recurrence rates after standard treatment options (surgical resection and/or endobronchial interventions) can inadvertently worsen the stricture through the stimulation of more granulation tissue generation (via increased fibroblast activity and roliferation). Low-dose radiotherapy could be a promising tool to prevent granulation tissue formation after surgery and/or endobronchial interventions regarding its established role in the treatment of keloids or hypertrophic scars, two benign diseases with similar a pathophysiology to tracheal stenosis. This study reviews case reports and small series that used endobronchial brachytherapy (EBBT) or external beam radiotherapy (EBRT) for the management of refractory granulation tissue-induced tracheal stenosis after surgery and/or endobronchial interventions. METHODS AND MATERIALS Case reports and series (published up to October 2022) that reported outcomes of patients with recurrent granulation tissue-induced tracheal stenosis (after surgery and/or endobronchial interventions) treated by EBBT or EBRT (in definitive or prophylactic settings) were eligible. RESULTS Sixteen studies (EBBT: nine studies including 69 patients, EBRT: seven studies including 32 patients) were reviewed. The pooled success rate across all studies was 74% and 97% for EBBT and EBRT, respectively. CONCLUSIONS Radiation therapy appears to be effective in the management of selected patients with recurrent/refractory tracheal stenosis. Response to this treatment is usually good, but further studies with a larger number of patients and long-term followup are necessary to determine the optimal technique, dose, and timing of radiation therapy, late complications, the durability of response, and criteria for patient selection.
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Affiliation(s)
- Sasan Razmjoo
- Department of Clinical Oncology and Clinical Research Development Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hodjatollah Shahbazian
- Department of Clinical Oncology and Clinical Research Development Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed-Mohammad Hosseini
- Department of Clinical Oncology and Clinical Research Development Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Feli
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Mohammadian
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Bagheri
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Huang CY, Chang TS, Alice Hwang L, Lin YS. Novel airway-cartilage combined model for medialization laryngoplasty and laryngotracheal reconstruction surgery planning. J Chin Med Assoc 2022; 85:1076-1082. [PMID: 35947024 DOI: 10.1097/jcma.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The clinical outcomes of surgical treatments for vocal cord paralysis and tracheal stenosis, such as medialization laryngoplasty and laryngotracheal reconstruction, vary owing to the complex anatomy and physiology of the human upper airway. However, advances in three-dimensional (3D) simulation and printing ushered its use on an office-based workstation to aid in several surgical areas. METHODS The preoperation neck computed tomography image was loaded into the InVesalius 3.0 software for manual segmentation of airway and nearby important anatomic landmarks including hyoid bone, thyroid cartilage, and cricoid cartilage. The 3D model of the desired anatomy structure was manufactured and used for presurgical planning and rehearsal of the surgery. RESULTS We review cases of four patients: two cases of unilateral vocal palsy undergoing medialization laryngoplasty and two cases of tracheal stenosis patients who used the air-cartilage combined model. CONCLUSION Preoperation planning of the medialization thyroplasty could be more precise by prevision of the paralyzed vocal cord plane. Tracheal surgery could benefit from a preoperative design of segmented length. The novel airway-cartilage combined model offers new insight into vocal cord and trachea surgery.
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Affiliation(s)
- Chien-Yu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- College of Artificial Intelligence, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Lisa Alice Hwang
- Department of Oral and Maxillofacial Surgery, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Department of Stomatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, ROC
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An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management. CURRENT PULMONOLOGY REPORTS 2022; 11:29-38. [PMID: 35261874 PMCID: PMC8892813 DOI: 10.1007/s13665-022-00286-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/27/2022]
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Alem N, Alsufiani H, Alsaadi A, Aljohani S, Arkoubi M. The utility of CT virtual bronchoscopy in the esophageal lung diagnosis: A case report. Respir Med Case Rep 2022; 37:101658. [PMID: 35585904 PMCID: PMC9108735 DOI: 10.1016/j.rmcr.2022.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
The esophageal lung is a variant of the communicating bronchopulmonary foregut malformation (CBPFM). It needs a high index of suspicion for diagnosis because it is a rare condition and does not have specific symptoms. A CT scan or an esophageal contrast study, showing direct communication between the airways and the esophagus or stomach, confirms the diagnosis. Patients with esophageal lung need flexible bronchoscopy for evaluating tracheobronchial anomalies. We present a three-month-old boy with a right esophageal lung in which the CT virtual bronchoscopy showed an absence of the right main bronchus at the carina level. This case report highlights the importance of CT virtual bronchoscopy as an alternative to flexible bronchoscopy for the diagnosis of tracheobronchial anomalies associated with CBPFM.
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Sahin MF, Beyoglu MA, Yazicioglu A, Yekeler E. Analysis of 40 patients who underwent tracheal resection due to benign complex tracheal stenosis. Asian J Surg 2022; 45:213-219. [PMID: 34052083 DOI: 10.1016/j.asjsur.2021.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Benign tracheal stenosis is a common complication in patients followed up in intensive care units. We aimed to analyze the etiology, diagnostic approaches, treatment methods for benign tracheal stenosis, and the predicting factors for complications after tracheal resection for benign stenosis. MATERIAL-METHOD Forty patients who underwent tracheal resection reconstruction due to benign tracheal stenosis were analyzed retrospectively. Predictive factors for complications were determined by statistical analysis. RESULTS There were 23 patients (57.5%) in the intubation group, 11 patients (27.5%) in the tracheostomy group, and 6 patients (15%) in the subsequent tracheostomy group. Preoperatively, rigid dilatation was applied to all patients between 2 and 6 sessions (median = 3). Tracheal resections were performed in all patients after rigid dilatations. The mean of the resected segment lengths is 32.1 ± 8.8 mm. There was a statistically significant difference between preoperative bronchoscopic measurements, preoperative tomography measurements, and intraoperative measurements of the stenosis segment (ꭓ2 (2) = 71,500; p < 0.001). The patients' mean follow-up period was 27.4 ± 21.7 months (3-84). Mortality due to tracheal surgery and major anastomotic complications were not observed. The minor anastomotic complication rate was 12.5%, the non-anastomotic complication rate was 17.5%. The effect of resection length and surgical experience were found to be statistically significant risk factors for anastomotic complications. CONCLUSIONS Rigid dilatation does not provide significant palliation in complex stenosis. Bronchoscopic measurements give closer results than CT measurements in the preoperative estimation of resection length. The risk of anastomotic complications increases when the length of the resection increases and when the surgical experience is less.
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Affiliation(s)
- Mehmet Furkan Sahin
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Muhammet Ali Beyoglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Alkin Yazicioglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Erdal Yekeler
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
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Godoy MCB, Truong MT, Jimenez CA, Shroff GS, Vlahos I, Casal RF. Imaging of therapeutic airway interventions in thoracic oncology. Clin Radiol 2021; 77:58-72. [PMID: 34736758 DOI: 10.1016/j.crad.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Tracheobronchial obstruction, haemoptysis, and airway fistulas caused by airway involvement by primary or metastatic malignancies may result in dyspnoea, wheezing, stridor, hypoxaemia, and obstructive atelectasis or pneumonia, and can lead to life-threatening respiratory failure if untreated. Complex minimally invasive endobronchial interventions are being used increasingly to treat cancer patients with tracheobronchial conditions with curative or, most often, palliative intent, to improve symptoms and quality of life. The selection of the appropriate treatment strategy depends on multiple factors, including tumour characteristics, whether the lesion is predominately endobronchial, shows extrinsic compression, or a combination of both, the patient's clinical status, the urgency of the clinical scenario, physician expertise, and availability of tools. Pre-procedure multidetector computed tomography (MDCT) imaging can aid in the most appropriate selection of bronchoscopic treatment. Follow-up imaging is invaluable for the early recognition and management of any potential complication. This article reviews the most commonly used endobronchial procedures in the oncological setting and illustrates the role of MDCT in planning, assisting, and follow-up of endobronchial therapeutic procedures.
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Affiliation(s)
- M C B Godoy
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - C A Jimenez
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - R F Casal
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Bourdillon AT, Hajek MA, Wride M, Lee M, Lerner M, Kohli N. Correlations of Radiographic and Endoscopic Observations in Subglottic Stenosis. Ann Otol Rhinol Laryngol 2021; 131:724-729. [PMID: 34459264 DOI: 10.1177/00034894211042768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE(S) Subglottic stenosis (SGS) represents a constellation of diverse pathologic processes that ultimately lead to narrowing of the subglottic region and can produce significant morbidity. Existing endoscopic and radiographic assessments may not be consistent in practice. METHODS Severity of stenosis was evaluated and reported using the Cotton-Myer classification system from 33 endoscopic procedures from 32 unique subjects. Radiographic imaging within the preceding 3 month period was subsequently reviewed and narrowing was measured by a blinded radiologist. Degree of stenosis was reported as a percentage in 30 out of 33 endoscopic evaluations and subsequently compared to radiographically determined percentage of stenosis. Statistical analyzes were conducted to evaluate concordance between endoscopic and radiographic assessments. RESULTS About 45.5% (15/33) of the evaluations were in agreement using Cotton-Myer scoring, while 27.3% (9/33) were discrepant by 1 grade and 27.3% (9/33) by 2 grades. Correlation of degree of stenosis as a percentage using Spearman (coefficient: 0.233, P-value: .214) and Pearson (coefficient: 0.138, P-value: .466) methods demonstrated very weak relationships. Radiographic scoring did not predict endoscopic classification to a significant degree using mixed effects regression. CONCLUSIONS Radiographic and endoscopic grading of subglottic stenosis may not be reliably concordant in practice.
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Affiliation(s)
| | - Michael A Hajek
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mitchel Wride
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mike Lee
- Department of Radiology and Biomedical Imaging Diagnostic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Michael Lerner
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Nikita Kohli
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
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Farghaly S, El-Abdeen AZ, Shaaban LH, El-Malah HEDGM, Kamal M. Ultrasound as a bedside tool for diagnosis of post-intubation tracheal stenosis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Screening of post-intubation stenosis can allow early diagnosis, early management of stenosis, and possible prevention of progress. Fiberoptic bronchoscope is the gold standard for diagnosis of tracheal stenosis. Other imaging modalities as computed tomography can be considered but are not available in intensive care unit.
Purpose of the study
To evaluate the validity of ultrasound (US) as a bedside test for early diagnosis of post-intubation stenosis compared to multidetector computed tomography (MDCT) and fiberoptic bronchoscope (FOB).
Results
Out of the 50 included patients, 12 patients were found to have definite stenosis by FOB. Compared to CT, significant positive correlation was found between all ultrasound parameters (laryngeal width, tracheal diameter) and corresponding CT parameters (r = 0.798, p < 0.001; r = 0.714, p < 0.001 respectively). Compared to FOB results, the yield of MDCT chest for diagnosis of stenosis had 91.6% sensitivity and 100% specificity, while the yield of US detected by mucosal irregularity as a diagnostic tool for tracheal stenosis had comparable sensitivity (91.6%) but lower specificity (88.9%).
Conclusion
Due to its high sensitivity, US could help in detection of possible post-intubation laryngotracheal stenosis in critically ill MV patients.
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13
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Alrabiah A, Almohanna S, Aljasser A, Zakzouk A, Habib SS, Almohizea M, Bukhari M, Alammar A. Utility of Spirometry Values for Evaluating Tracheal Stenosis Patients Before and After Balloon Dilation. EAR, NOSE & THROAT JOURNAL 2020; 101:NP62-NP67. [PMID: 32692288 DOI: 10.1177/0145561320936968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Tracheal stenosis is defined as a narrowing of the airway distal to the lower edge of the cricoid cartilage. It is initially diagnosed based on clinical presentation and then confirmed using direct laryngobronchoscopy. Other adjunctive diagnostic methods, including spirometry, have been proposed. This study aimed to evaluate the relationship between tracheal stenosis severity and pre- and post-balloon dilatation spirometry parameters in order to assess for significant changes in spirometry values and to evaluate for the effects of stenosis-associated factors on post-dilation spirometry values, including vertical length and grade of the stenosis, as well as the role of wound-modifying agents. METHODS This retrospective study included adults (>18 years of age) with isolated tracheal stenosis who underwent endoscopic balloon dilations at King Saud University Medical City from June 2015 to May 2019, with detailed documentation of operative findings and valid spirometry measurements pre- and post-balloon dilation. Basic demographic data and operative note details, including information about the percentage of tracheal stenosis, distance of tracheal stenosis from vocal cords, vertical length of stenotic segment, and use of wound-modifying agents (topical mitomycin C or triamcinolone injections), were extracted. RESULTS Fourteen patients with spirometry measurements obtained on 50 occasions (25 pre-balloon dilation and 25 post-balloon dilation) were included. Each 1-unit increase in the vertical length of the stenosis showed a statistically significant negative relationship (-1.47 L/s) with pre-balloon dilation peak expiratory flow (PEF; P = .034). Post-balloon dilation spirometric values showed statistically significant improvements for most variables. CONCLUSIONS The vertical length of an isolated tracheal stenosis can be predicted before surgical interventions using PEF values and may be a significant indicator of anticipated post-balloon dilation surgical success. Our study suggested that spirometry is a very useful technique for evaluating patients with tracheal stenosis due to its noninvasiveness, cost-effectiveness, with a good clinical value.
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Affiliation(s)
- Abdulaziz Alrabiah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Shahad Almohanna
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Syed Shahid Habib
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Almohizea
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Manal Bukhari
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Joffe MR, Tan CJ, Boland LA, Pilton JL, Hickey MC. Successful tracheoscopy-assisted reconstruction of traumatic tracheal avulsion in a cat. J Vet Emerg Crit Care (San Antonio) 2020; 30:467-473. [PMID: 32584513 DOI: 10.1111/vec.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To outline the clinical findings, surgical management, complications, and outcomes in a case of intrathoracic, traumatic, tracheal avulsion. CASE SUMMARY A 2-year-old domestic shorthair cat presented with respiratory distress 18 days after a motor vehicle accident. A tracheal avulsion was diagnosed and treated by surgical anastomosis. The initial anastomosis failed. The subsequent tracheoscopic-assisted tracheal anastomosis was successful. The cat had no further episodes of respiratory distress following the second surgery in a 9-month follow-up period. UNIQUE INFORMATION PROVIDED This communication describes a complication of intrathoracic, traumatic, tracheal avulsion repair that has not previously been described and the use of tracheoscopy during the subsequent surgical procedure to ensure accurate suture placement.
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Affiliation(s)
- Michelle R Joffe
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Tan
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Lara A Boland
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Joanna L Pilton
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Mara C Hickey
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
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Aljathlany Y, Aljasser A, Alhelali A, Bukhari M, Almohizea M, Khan A, Alammar A. Proposing an Endotracheal Tube Selection Tool Based on Multivariate Analysis of Airway Imaging. EAR, NOSE & THROAT JOURNAL 2020; 100:629S-635S. [PMID: 31914813 DOI: 10.1177/0145561319900390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate endotracheal tube (ETT) size chart. STUDY DESIGN Retrospective chart review. SETTING Tertiary care center. MATERIALS AND METHODS The data for patients aged >18 years who underwent neck computed tomography were screened. Patients with existing tumors, trauma, or any pathology that can alter the normal airway anatomy and those with intubation, tracheostomy, or nasogastric tubes were excluded. Computed tomography software was used to measure the anteroposterior diameter (APD), transverse diameter (TD), and cross-sectional area (CSA) at the glottic, proximal subglottic, distal subglottic, and tracheal levels. Multiple regression analysis was used to identify the predictors of the airway size. RESULTS One hundred patients were reviewed. The TD was consistently smaller than or equal to the APD at each level in all but 3 patients. The mean CSA and TD (170 mm2 and 11.3 mm, respectively) of the glottis indicated that the glottis was most often the narrowest level, followed by the proximal subglottis where the mean CSA and TD were 192.1 mm2 and 12.7 mm, respectively. Moreover, the mean APD was the smallest at the level of the trachea (20.1 mm). Multiple regression analysis confirmed that height and sex were the predominant predictors of measurements for the 4 airway segments. In addition, age was associated with the TD and CSA of the distal subglottic and tracheal segments, respectively. CONCLUSION One-third of our participants exhibited a proximal subglottic diameter that was equal to or smaller than the glottic diameter. Our findings also suggested that the height and sex of the patients are important variables for the selection of an appropriate ETT size.
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Affiliation(s)
- Yousef Aljathlany
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alhelali
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Manal Bukhari
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed Almohizea
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Adeena Khan
- Department of Radiology, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
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Aljathlany Y, Alamari K, Aljasser A, Alhelali A, Bukhari M, Almohizea M, Khan A, Alammar A. Comparison Between Mathematical and Software Calculation Methods for the Measurement of the Cross-sectional Area in Upper Airway Imaging. Cureus 2019; 11:e6106. [PMID: 31886046 PMCID: PMC6901374 DOI: 10.7759/cureus.6106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aimed to compare the results of a software calculation method (SCM) and the mathematical calculation method (MCM) in measuring the cross-sectional area (CSA) at four different upper airway segments. Methods The data from the retrospective chart reviews of patients older than 18 years who had undergone computed tomography (CT) of the neck at our tertiary care center between September 2014 and September 2018 were reviewed. Data of patients who were intubated, tracheostomized, had nasogastric tubes, tumors, craniofacial anomalies, trauma, or any pathology that may affect the normal airway anatomy were excluded. We measured the anteroposterior (APD) and transverse diameter (TD) utilizing the CT software. CSA was calculated using both the mathematical formula (MCM) and software (SCM) at the glottis, proximal subglottis, distal subglottis, and tracheal levels. A paired sample t-test was used to determine the significant difference between SCM and MCM at each level. Results The data of 100 patients (59% female) were reviewed. There was a significant difference between the SCM and MCM at all four levels. The mean differences between the SCM and MCM were -33.63 mm2, -24.20 mm2, 6.04 mm2 (p < 0.001) at the glottis, proximal subglottis, and trachea, respectively. The mean difference at the distal subglottis was -4.08 mm2 (p = 0.01). Conclusion Our study found a significant difference between the SCM and MCM in measuring the CSA of the four airway segments. Theoretically, the SCM is more accurate and precise than MCM in measuring CSA; however, we could not prove the superiority of either method.
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Affiliation(s)
- Yousef Aljathlany
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Kholoud Alamari
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Abdullah Aljasser
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Abdullah Alhelali
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Manal Bukhari
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Mohammed Almohizea
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Adeena Khan
- Radiology, King Saud University Medical City, Riyadh, SAU
| | - Ahmed Alammar
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
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Bourinet V, Thiam K, Guinde J, Laroumagne S, Dutau H, Astoul P. [Trans-vocal cord prostheses - preliminary experience treating benign laryngotracheal stenosis in adults]. Rev Mal Respir 2018; 36:49-56. [PMID: 30337136 DOI: 10.1016/j.rmr.2018.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/25/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Benign laryngotracheal stenosis is a rare pathology with multiple etiologies, the management of which is complex. This is because of the configuration and proximity of the larynx and the difficulty with surgical approaches, which are potentially mutilating, especially for the management of a benign disease. When surgery is challenging, iterative dilatations of the stricture or the fashioning of a definitive tracheotomy are therapeutic alternatives. Advances in rigid bronchoscopy and the evolution of prosthetic silicone material allow a new approach in the management of benign laryngotracheal stenosis, by placing flexible silicone prostheses which cover all the stenosis from the arytenoids to the trachea. This preliminary work aims to evaluate the feasibility, effectiveness, tolerance and complications of the implementation of this type of prosthesis. PATIENTS AND METHODS This is a retrospective single-centre study which analyzed the records of patients with symptomatic benign laryngotracheal stenosis who underwent placement of a transcordial prosthesis over a period of three years. The prosthesis used, inserted under general anesthesia during a rigid tube interventional bronchoscopy, was either a straight silicone prosthesis or a Montgomery T-tube for those with a pre-existing tracheotomy. RESULTS Six patients were included. Five are still alive, one patient died from a cause unrelated to the placement of the prosthesis. Four have no tracheostomy and two now have no transcordal prosthesis. The data collected on tolerance found, for three patients, two cases of minor aspiration and one case of transient cough. All patients had whispered voice dysphonia. We did not observe prosthesis migration or obstruction. CONCLUSION These preliminary results are encouraging. Transcordal prostheses in benign laryngotracheal stenosis have a complementary or alternative role compared to surgery with a palliative or even curative objective.
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Affiliation(s)
- V Bourinet
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - K Thiam
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France; Service de pneumo-oncologie, université Cheikh-Anta-Diop, CHU Fann, Dakar, Sénégal
| | - J Guinde
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - S Laroumagne
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - H Dutau
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France.
| | - P Astoul
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France; Aix-Marseille université, 13000 Marseille, France
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The evaluation and surgical management of post-intubation tracheal strictures at a thoracic surgery referral centre in South Africa. Afr J Thorac Crit Care Med 2018; 24. [PMID: 34541505 PMCID: PMC8432930 DOI: 10.7196/sarj.2018.v24i2.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 11/08/2022] Open
Abstract
Background The surgical treatment of tracheal stenosis following endotracheal intubation or tracheostomy is well described in the developed world. Objectives To describe our surgical experience with this pathology, and highlight the nuances of its diagnosis and management in South Africa. Methods We reviewed the clinical records and archived imaging of all patients who underwent tracheal resection and reconstruction for post-intubation tracheal stenosis between 1 July 2003 and 31 July 2014 in the Department of Cardiothoracic Surgery at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Results During the study period, 42 patients underwent tracheal resection. We evaluated the preoperative bronchoscopic characteristics of the tracheal stricture in all patients, and computed tomography (CT) was used as an adjunct in 28 (66%) patients. The stricture lengths determined by CT and intraoperative measurement were strongly correlated (r (27)=0.506, p=0.006), and the stricture lengths determined by bronchoscopy and intraoperative measurement were weakly correlated (r (41)=0.201, p=0.209). A total of 36 patients (85.7%) underwent surgery via a cervical approach and 6 (14.3%) via a right thoracotomy approach. There was no early mortality, and surgery was complicated by vocal cord palsy in 4 cases, restenosis in 2 cases, infection in 1 case and paraparesis in 1 case. Conclusion Tracheal resection for the treatment of post-intubation tracheal stenosis can be undertaken safely with minimal complications in the developing world, with the vast majority of lesions approached via a cervical approach. A preoperative evaluation of the stricture using CT is an accurate technique for planning tracheal resection and reconstruction.
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Advanced Technologies for Imaging and Visualization of the Tracheobronchial Tree. Thorac Surg Clin 2018; 28:127-137. [DOI: 10.1016/j.thorsurg.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Vallés J, Millán S, Díaz E, Castanyer E, Gallardo X, Martín-Loeches I, Andreu M, Prenafeta M, Saludes P, Lema J, Batlle M, Bacelar N, Artigas A. Incidence of airway complications in patients using endotracheal tubes with continuous aspiration of subglottic secretions. Ann Intensive Care 2017; 7:109. [PMID: 29098448 PMCID: PMC5668230 DOI: 10.1186/s13613-017-0331-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 10/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneumonia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions. METHODS In consecutive adult patients with continuous aspiration of subglottic secretions, we prospectively recorded clinical airway complications during the period after extubation. A multidetector computed tomography of the neck was performed during the period of 5 days following extubation to classify subglottic and tracheal lesions as mucosal thickening, cartilage thickening or deep ulceration. RESULTS In the 86 patients included in the study, 6 (6.9%) had transient dyspnea, 7 (8.1%) had upper airway obstruction and 18 (20.9%) had dysphonia at extubation. Univariate analysis identified more attempts required for intubation (2.3 ± 1.1 vs. 1.2 ± 0.5; p = 0.001), difficult intubation (71.4 vs. 10.1%, p = 0.001) and Cormack score III-IV (71.4 vs. 8.8%; p < 0.001) as risk factors for having an upper airway obstruction at extubation. The incidence of failed extubation among patients after planned extubation was 18.9% and 11 patients (12.7%) required tracheostomy. A multidetector computed tomography was performed in 37 patients following extubation, and injuries were observed in 9 patients (24.3%) and classified as tracheal injuries in 2 patients (1 cartilage thickening and 1 mild stenosis with cartilage thickening) and as subglottic mucosal thickenings in 7 patients. CONCLUSIONS The incidence of upper airway obstruction after extubation in patients with continuous aspiration of subglottic secretions was 8.1%, and the injuries observed by computed tomography were not severe and located mostly in subglottic space.
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Affiliation(s)
- Jordi Vallés
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain. .,Universitat Autonoma Barcelona, Sabadell, Spain. .,CIBERES Enfermedades Respiratorias, Valladolid, Spain.
| | - Susana Millán
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Emili Díaz
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain.,CIBERES Enfermedades Respiratorias, Valladolid, Spain
| | - Eva Castanyer
- UDIAT, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Ignacio Martín-Loeches
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain.,CIBERES Enfermedades Respiratorias, Valladolid, Spain
| | - Marta Andreu
- UDIAT, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Paula Saludes
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Jorge Lema
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Montse Batlle
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Néstor Bacelar
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Antoni Artigas
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain.,Universitat Autonoma Barcelona, Sabadell, Spain.,CIBERES Enfermedades Respiratorias, Valladolid, Spain
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Current and future approaches to large airways imaging in adults and children. Clin Radiol 2017; 72:356-374. [DOI: 10.1016/j.crad.2017.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/07/2017] [Accepted: 01/23/2017] [Indexed: 01/04/2023]
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Popov TM, Marinov T, Rangachev J, Konov D, Belitova M. Cricotracheal Resection in a Patient with Severe Subglottic Stenosis - Advantages of a Temporary Non-Cannulated Tracheostomy. Balkan Med J 2017; 34:165-167. [PMID: 28418345 PMCID: PMC5394299 DOI: 10.4274/balkanmedj.2016.0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Stenosis in the area of the cricotracheal segment is still a challenging problem to be dealt with. Post-intubational cases mark an increase in recent years due to the advances in intensive care, thoracic surgery and neurosurgery departments. Case Report: This paper describes a case report of a patient with severe subglottic stenosis (grade III according to the Cotton-Myer scale), introduces a new option in cricotracheal resections - postoperative temporary non-cannulated tracheostomy and describes its advantages. Conclusion: This variation of classical operative techniques provides additional fixation of the trachea, thus relieving any transitory tension on the anastomosis; acts as a valve and decreases the air-pressure in the upper airways during coughing and sneezing in the post-operative period; and is an easy access point for video tracheoscopy of the anastomosis.
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Affiliation(s)
| | - Tzvetomir Marinov
- Department of Anesthesiology and Intensive Care, Medical University of Sofia, Sofia, Bulgaria
| | - Julian Rangachev
- Department of Otolaryngology, Medical University of Sofia, Sofia, Bulgaria
| | - Dimitar Konov
- Department of Otolaryngology, Medical University of Sofia, Sofia, Bulgaria
| | - Maya Belitova
- Department of Anesthesiology and Intensive Care, Medical University of Sofia, Sofia, Bulgaria
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Little BP, Duong PAT. Imaging of Diseases of the Large Airways. Radiol Clin North Am 2016; 54:1183-1203. [PMID: 27719983 DOI: 10.1016/j.rcl.2016.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Imaging of the large airways is key to the diagnosis and management of a wide variety of congenital, infectious, malignant, and inflammatory diseases. Involvement can be focal, regional, or diffuse, and abnormalities can take the form of masses, thickening, narrowing, enlargement, or a combination of patterns. Recognition of the typical morphologies, locations, and distributions of large airways disease is central to an accurate imaging differential diagnosis.
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Affiliation(s)
- Brent P Little
- Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Clinic Building A, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA.
| | - Phuong-Anh T Duong
- Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Clinic Building A, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA
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Dalar L, Karasulu L, Abul Y, Özdemir C, Sökücü SN, Tarhan M, Altin S. Bronchoscopic Treatment in the Management of Benign Tracheal Stenosis: Choices for Simple and Complex Tracheal Stenosis. Ann Thorac Surg 2016; 101:1310-7. [DOI: 10.1016/j.athoracsur.2015.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/26/2015] [Accepted: 10/01/2015] [Indexed: 12/20/2022]
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Jugpal TS, Garg A, Sethi GR, Daga MK, Kumar J. Multi-detector computed tomography imaging of large airway pathology: A pictorial review. World J Radiol 2015; 7:459-474. [PMID: 26753061 PMCID: PMC4697120 DOI: 10.4329/wjr.v7.i12.459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
The tracheobronchial tree is a musculo-cartilagenous framework which acts as a conduit to aerate the lungs and consequently the entire body. A large spectrum of pathological conditions can involve the trachea and bronchial airways. These may be congenital anomalies, infections, post-intubation airway injuries, foreign body aspiration or neoplasms involving the airway. Appropriate management of airway disease requires an early and accurate diagnosis. In this pictorial essay review, we will comprehensively describe the various airway pathologies and their imaging findings by multi-detector computed tomography.
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Godoy MCB, Saldana DA, Rao PP, Vlahos I, Naidich DP, Benveniste MF, Erasmus JJ, Marom EM, Ost D. Multidetector CT evaluation of airway stents: what the radiologist should know. Radiographics 2015; 34:1793-806. [PMID: 25384279 DOI: 10.1148/rg.347130063] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Airway stents are increasingly used to treat symptomatic patients with obstructive tracheobronchial diseases who are not amenable to surgical resection or who have poor performance status, precluding them from resection. The most common conditions that are treated with tracheobronchial stents are primary lung cancer and metastatic disease. However, stents have also been used to treat patients with airway stenosis related to a variety of benign conditions, such as tracheobronchomalacia, relapsing polychondritis, postintubation tracheal stenosis, postoperative anastomotic stenosis, and granulomatous diseases. Additionally, airway stents can be used as a barrier method in the management of esophagorespiratory fistulas. Many types of stents are available from different manufacturers. Principally, they are classified as silicone; covered and uncovered metal; or hybrid, which are made of silicone and reinforced by metal rings. The advantages and disadvantages of each type of airway stent are carefully considered when choosing the most appropriate stent for each patient. Multidetector computed tomography plays an important role in determining the cause and assessing the location and extent of airway obstruction. Moreover, it is very accurate in its depiction of complications after airway stent placement.
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Affiliation(s)
- Myrna C B Godoy
- From the Departments of Diagnostic Radiology (M.C.B.G., D.A.S., M.F.B., J.J.E., E.M.M.) and Pulmonary Medicine (D.O.), University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 371, Houston, TX 77030; Department of Radiology, St George's Hospital NHS Trust, London, England (P.P.R., I.V.); and Department of Radiology, Langone Medical Center, New York University, New York, NY (D.P.N.)
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Abumossalam A, Elshafeey M, Abdelsalam E. Tracheoechography versus CT tracheography for assessment of idiopathic pulmonary fibrosis related tracheopathy. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Okuda N, Nakataki E, Itagaki T, Onodera M, Imanaka H, Nishimura M. Complete bronchial obstruction by granuloma in a paediatric patient with translaryngeal endotracheal tube: a case report. J Med Case Rep 2014; 8:260. [PMID: 25060137 PMCID: PMC4112840 DOI: 10.1186/1752-1947-8-260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/02/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Although continuous or frequent stimuli in tracheostomized patients may cause tracheal granulomas, little is known about management of patients with translaryngeal intubation. Case presentation A 1-month-old Japanese boy, weighing 3.5kg, was admitted to our hospital owing to cardiac failure caused by an atrial septal defect and intractable arrhythmia. To treat his unstable cardiovascular status, surgery was performed to close his atrial septal defect. After the operation, stenosis was detected by auscultation and flow limitation worsened. A bronchoscopy revealed granulomas completely obstructing his right bronchus and partially obstructing his left bronchus. Dexamethasone infusion partially reduced the mass, after which removal by yttrium aluminium garnet laser was tried. The airway obstruction was not resolved, however, because of granuloma reproliferation. Budesonide (aerosol liquid) inhalation was started, and tissue was reduced using an yttrium aluminium garnet laser and physically removed using forceps. After continued budesonide inhalation, he was successfully liberated from the ventilator. Conclusions Life-threatening airway obstruction by granulomas developed in a translaryngeally intubated paediatric patient. The granuloma was detected after a couple of weeks of intubation. A bronchial granuloma is rare in paediatric patients. It should be suspected with evidence of bronchial obstruction. Treatment with corticosteroids and surgery using a laser maybe indicated.
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Barros Casas D, Fernández-Bussy S, Folch E, Flandes Aldeyturriaga J, Majid A. Non-malignant central airway obstruction. Arch Bronconeumol 2014; 50:345-54. [PMID: 24703501 DOI: 10.1016/j.arbres.2013.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/23/2013] [Accepted: 12/28/2013] [Indexed: 02/07/2023]
Abstract
The most common causes of non-malignant central airway obstruction are post-intubation and post-tracheostomytracheal stenosis, followed by the presence of foreign bodies, benign endobronchial tumours and tracheobronchomalacia. Other causes, such as infectious processes or systemic diseases, are less frequent. Despite the existence of numerous classification systems, a consensus has not been reached on the use of any one of them in particular. A better understanding of the pathophysiology of this entity has allowed us to improve diagnosis and treatment. For the correct diagnosis of nonspecific clinical symptoms, pulmonary function tests, radiological studies and, more importantly, bronchoscopy must be performed. Treatment must be multidisciplinary and tailored to each patient, and will require surgery or endoscopic intervention using thermoablative and mechanical techniques.
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Affiliation(s)
- David Barros Casas
- Servicio de Neumología, Hospital Universitario La Paz, Madrid, España; Unidad de broncoscopias, Servicio de Neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - Sebastian Fernández-Bussy
- Servicio de Neumología Intervencionista, Clínica Alemana-Universidad del Desarrollo de Chile, Santiago de Chile, Chile
| | - Erik Folch
- Division of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston. Estados Unidos
| | | | - Adnan Majid
- Division of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston. Estados Unidos.
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Rubikas R, Matukaitytė I, Jelisiejevas JJ, Račkauskas M. Surgical treatment of non-malignant laryngotracheal stenosis. Eur Arch Otorhinolaryngol 2014; 271:2481-7. [PMID: 24652116 DOI: 10.1007/s00405-014-2981-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/21/2014] [Indexed: 11/25/2022]
Abstract
The objectives of this study were the following: (1) to analyze the results of surgical treatment of non-malignant subglottic laryngeal and tracheal stenosis, (2) to evaluate the feasibility and technical aspects of the video mediastinoscopy for the mobilization of the mediastinal trachea, (3) to evaluate the influence of the early internal condition of the anastomosis on the development of restenosis. From 1996 up to 2013, 75 patients aged 11-78 years underwent surgery for post-intubation/tracheostomy (71 patients), post-traumatic (3 patients), and idiopathic (1 patient) subglottic laryngeal and tracheal stenosis. Twenty-three (30.7 %) patients with subglottic laryngeal and upper tracheal stenosis underwent cricotracheal resection and thyrotracheal anastomosis (group A), while 52 (69.3 %) patients with tracheal stenosis underwent tracheal resection and cricotracheal or tracheotracheal anastomosis (group B). The length of the resected segment in patients of groups A and B was 28-55 (42 ± 11) mm and 18-65 (36 ± 14) mm, respectively, (p = 0.22). Perioperative complications within 30 days occurred in eight (34.8 %) patients of group A, and in six (11.5 %) patients of group B (p = 0.04). There was one intraoperative and one postoperative death on the third day due to heart failure. The excellent results were achieved in 63 (86.3 %), satisfactory in 8 (11.0 %), and unsatisfactory in 2 (2.7 %) patients. The incidence rate of perioperative complications is related to the location of the stenosis and the type of the resection and anastomosis. Video mediastinoscopy simplifies the mobilization of the mediastinal trachea, which allows for carrying out the anastomosis with minimal tension. Early internal abnormalities of the anastomosis predict its restenosis.
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Affiliation(s)
- Romaldas Rubikas
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian Health Sciences University , Eivenių 2, 5009, Kaunas, Lithuania,
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Jamaati HR, Shadmehr MB, Aloosh O, Radmand G, Mohajerani SA, Hashemian SM. Evaluation of plethysmography for diagnosis of postintubation tracheal stenosis. Asian Cardiovasc Thorac Ann 2014; 21:181-6. [PMID: 24532617 DOI: 10.1177/0218492312454537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Post-intubation tracheal stenosis is a serious disease caused by cuff pressure during tracheal intubation. The reported prevalence of post-intubation tracheal stenosis is 10%-22% in intubated patients. Invasive diagnostic methods based on fiberoptic or rigid bronchoscopy are suggested for initial assessment and treatment. This study aimed to evaluate plethysmography as an alternative diagnostic tool for post-intubation tracheal stenosis. We also assessed the relationship between plethysmography and bronchoscopy findings in patients with post-intubation tracheal stenosis. METHODS The sample included 30 patients who were admitted to our intensive care unit or surgical ward during the course of a year, and diagnosed with post-intubation tracheal stenosis. All patients underwent plethysmography and rigid bronchoscopy. The relationship between the plethysmography and bronchoscopy findings was examined. RESULTS Stricture intensity had the strongest correlation with upper airway resistance (p = 0.001). The relationship of length of stricture to forced expiratory volume in 1 s and maximum expiratory flow 50 and 75 was significant in univariate analysis, and to reserve volume and total lung capacity in multivariate analysis. CONCLUSION Significant relationships were found between plethysmography variables and rigid bronchoscopy findings in patients with post-intubation tracheal stenosis, and some formulas were developed to give an alternative estimate of stricture severity, without bronchoscopy.
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Affiliation(s)
- Hamid Reza Jamaati
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shweel M, Shaban Y. Radiological evaluation of post-traumatic tracheal stenosis using multidetector CT with multiplanar reformatted imaging and virtual bronchoscopy: Comparison with intraoperative findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Nair A, Godoy MC, Holden EL, Madden BP, Chua F, Ost DE, Roos JE, Naidich DP, Vlahos I. Multidetector CT and postprocessing in planning and assisting in minimally invasive bronchoscopic airway interventions. Radiographics 2013; 32:E201-32. [PMID: 22977038 DOI: 10.1148/rg.325115133] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A widening spectrum of increasingly advanced bronchoscopic techniques is available for the diagnosis and treatment of various bronchopulmonary diseases. The evolution of computed tomography (CT)-multidetector CT in particular-has paralleled these advances. The resulting development of two-dimensional and three-dimensional (3D) postprocessing techniques has complemented axial CT interpretation in providing more anatomically familiar information to the pulmonologist. Two-dimensional techniques such as multiplanar recontructions and 3D techniques such as virtual bronchoscopy can provide accurate guidance for increasing yield in transbronchial needle aspiration and transbronchial biopsy of mediastinal and hilar lymph nodes. Sampling of lesions located deeper within the lung periphery via bronchoscopic pathways determined at virtual bronchoscopy are also increasingly feasible. CT fluoroscopy for real-time image-guided sampling is now widely available; electromagnetic navigation guidance is being used in select centers but is currently more costly. Minimally invasive bronchoscopic techniques for restoring airway patency in obstruction caused by both benign and malignant conditions include mechanical strategies such as airway stent insertion and ablative techniques such as electrocauterization and cryotherapy. Multidetector CT postprocessing techniques provide valuable information for planning and surveillance of these treatment methods. In particular, they optimize the evaluation of dynamic obstructive conditions such as tracheobronchomalacia, especially with the greater craniocaudal coverage now provided by wide-area detectors. Multidetector CT also provides planning information for bronchoscopic treatment of bronchopleural fistulas and bronchoscopic lung volume reduction for carefully selected patients with refractory emphysema.
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Affiliation(s)
- Arjun Nair
- Department of Radiology, St George's Hospital, London SW17 0QT, England.
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Surgical management of scleromatous laryngotracheal stenosis. Auris Nasus Larynx 2013; 40:388-93. [PMID: 23276716 DOI: 10.1016/j.anl.2012.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/09/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Scleroma is a chronic specific granulomatous disease of the upper respiratory tract caused by Klebsiella Rhinoscleromatis. It usually affects the subglottic region and upper trachea resulting in various degrees of stenosis. Patients with laryngotracheal stenosis may present with stridor, shortness of breath or exercise intolerance and may be tracheostomy dependent. In this work, we presented the experience of our Institute in the management of patients with scleromatous laryngotracheal stenosis using the already designed procedures for traumatic laryngotracheal stenosis. PATIENTS AND METHODS The study was a non controlled prospective study. It was conducted in Oto-Rhino-Laryngology and Head and Neck Surgery Department of Zagazig University Hospitals, Egypt. It included 38 patients with scleromatous subglottic stenosis and/or upper tracheal stenosis. The patients were classified into four grades according to Myer-Cotton's scale. The surgical treatment modalities included endoscopic CO2 laser surgery with dilatation, laryngotracheal reconstruction, and partial cricotracheal resection with thyrotracheal anastomosis. RESULTS The average follow-up period was 32.1 months. Twenty four patients (63%) had an excellent outcome. Nine patients (24%) had a good outcome. Five patients (13%) were still tracheostomy dependent. Eleven patients (29%) developed postoperative granulation tissue. The overall success rate was 87%. CONCLUSION Scleromatous laryngotracheal stenosis is considered a challenging surgical problem. It requires a multidisciplinary approach by well-trained personnel. The surgical techniques designed for cases of laryngotracheal stenosis of a traumatic etiology can be applied for cases of scleroma with approximately the same success rates.
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Adali F, Uysal A, Bayramoglu S, Guner NT, Yilmaz G, Cimilli T. Virtual and fiber-optic bronchoscopy in patients with indication for tracheobronchial evaluation. Ann Thorac Med 2011; 5:104-9. [PMID: 20582176 PMCID: PMC2883192 DOI: 10.4103/1817-1737.62474] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Accepted: 03/10/2010] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the results of virtual bronchoscopy (VB) images in defining tracheobronchial pathologies with those of fiber-optic bronchoscopy (FOB) in patients with clinical indication for bronchoscopy. METHODS Twenty-two patients with bronchoscopy indication were evaluated with FOB and VB. The VB results were evaluated blindly, independent of the FOB results. RESULTS In 19 of the 22 patients, tracheobronchial abnormalities were present on FOB, whereas 3 patients had normal findings on FOB. In 17 of 19 patients, VB demonstrated the FOB diagnosis of tracheobronchial abnormality. While FOB detected 11 endoluminal lesions, VB detected 6. While FOB detected 20 obstructive lesions, VB detected 26. In evaluating external compression, FOB detected 2 lesions and VB detected 15. CONCLUSIONS VB is a non-invasive, uncomplicated, and reproducible examination method in patients with an indication for thorax examination. Virtual bronchoscopy could find a clinically broader field of application in the future.
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Affiliation(s)
- Fulya Adali
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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Coordes A, Rademacher G, Knopke S, Todt I, Ernst A, Estel B, Seidl RO. Selection and placement of oral ventilation tubes based on tracheal morphometry. Laryngoscope 2011; 121:1225-30. [PMID: 21557233 DOI: 10.1002/lary.21752] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 01/14/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVE/HYPOTHESIS Evidence-based guidelines for the selection of appropriately sized ventilation tubes as well as their placement do not exist, although iatrogenic injuries to the trachea and larynx following endotracheal intubation are not infrequent. Our objective was to provide selection recommendations for ventilation tubes based on anatomic criteria. STUDY DESIGN Prospective cross-sectional study at a tertiary care hospital. METHODS From January 2010 to June 2010 all patients more than 16 years who underwent computer tomography of the neck were included. Contraindications were intubation, tracheotomy, fractures of the lower jaw, tumors, and head or neck deformities. Radiologic data was used to determine the distance between the lower incisors and cricoid cartilage and the smallest laryngotracheal diameter. The results were correlated with patient characteristics and compared with properties of ventilation tubes. RESULTS One hundred fifty-nine patients were included in the study. The laryngotracheal constriction was subcricoidal with a mean diameter of 15.5 ± 3.2 mm coronal and 17.1 ± 2.6 mm sagittal. The mean distance between lower incisors and cricoid cartilage was 176.5 ± 14.8 mm. Patient height correlated significantly with the coronal subcricoid tracheal diameter (r = .51; P < .001) as well as with the distance between lower incisors and cricoid cartilage (r = .64; P < .001). No statistically significant gender or age-related correlations were found. Despite having the same specifications, tubes from different manufacturers differed considerably in their dimensions. CONCLUSIONS Selection of size and placement of ventilation tubes can be based on patient height. Considerable differences in the dimensions of ventilation tubes necessitate a height-based nomogram for evidence-based tube selection and placement. A uniform system of tube labeling based on biometric data is required.
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Affiliation(s)
- Annekatrin Coordes
- Department of Otolaryngology at UKB, Charité Medical School, Berlin, Germany.
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Morshed K, Trojanowska A, Szymański M, Trojanowski P, Szymańska A, Smoleń A, Drop A. Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings. Eur Arch Otorhinolaryngol 2010; 268:591-7. [PMID: 20848120 PMCID: PMC3052474 DOI: 10.1007/s00405-010-1380-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 09/01/2010] [Indexed: 11/29/2022]
Abstract
The aim of the study was to evaluate and compare various helical CT display modes [virtual endoscopy (VE)] and multiplanar reformations (MPR), conventional flexible tracheobronchoscopy (FT) and intra-operative (IO) findings in patients with tracheal stenosis and to analyze the advantage of MPR and VE in diagnosis and treatment planning and in postoperative follow-up. Thirty-seven patients with tracheal stenosis underwent standard neck and chest CT followed by MPR and VE. Results were correlated with the results of FT and IO findings. Thirty-three of the 37 stenoses were correctly graded and measured adequately using VE. Complete correlation among CT, fiberoptic tracheoscopy, and surgery of stenosis grading, stenosis length and length of planned resection segment of the trachea was noted between 33 of 37 patients with tracheal stenosis. Correlation between VE and IO was noted in 35 of 37 patients and between FT and VE was noted in 33 of 37 patients with tracheal stenosis. The sensitivity of VE was 94–97%, specificity was 100% with comparison to IO findings. The sensitivity and accuracy of MPR was 86–89% and specificity was 100% with comparison to FT findings. The results of the study indicate that VE is an excellent, consistent, and objective technique. VE with MPR is very useful in diagnostic evaluation and treatment planning in patients with tracheal stenosis.
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Affiliation(s)
- Kamal Morshed
- Department of Otolaryngology Head and Neck Surgery, Medical University of Lublin, Jaczewskiego 8 str., 20-090, Lublin, Poland.
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Abstract
Recent advances in multidetector computed tomography (MDCT) technology have transformed the imaging evaluation of the trachea and bronchi. Multiplanar 2-dimensional and 3-dimensional volume reconstruction techniques, including external rendering and virtual bronchoscopy, can be generated in mere minutes, thereby complementing conventional axial CT imaging in the depiction of various central airway disease processes including airway stenoses, central airway neoplasms, and congenital airway disorders. Paired inspiratory and dynamic expiratory MDCT imaging, along with newer cine CT imaging methods, have enhanced the assessment of tracheobronchomalacia in both adults and the pediatric population. In addition, MDCT imaging plays an essential complementary role to conventional bronchoscopy, facilitating planning and guidance of bronchoscopic interventions, and providing a noninvasive method for postprocedural surveillance.
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