Significance of the evaluation of tracheal length using a three-dimensional imaging workstation

Matsuoka, Shunichiro; Shimizu, Kimihiro; Koike, Sachie; Takeda, Teiji; Miura, Kentaro; Eguchi, Tadashi; Hamanaka, Kazutoshi

doi:10.21037/jtd-22-595

Cited by 3 publications

(4 citation statements)

References 28 publications

(34 reference statements)

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“…These indications are bene cial for anesthesiologists when deciding the type and xation depth of tracheal tubes. Although this was a single-center study performed in Japan and all patients were Asian, the mean tracheal length was similar to that in other reports from Japan and those from other countries, such as England, New Zealand, and East Asian countries [25][26][27][28][29][30], and the mean tracheal length might be similar across populations. Thus, the characteristics and positional relationships between a tracheal diverticulum and the tracheal tube in this study could be extrapolated to other populations.…”

Section: Discussionsupporting

confidence: 85%

Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study

Mitsuzawa

Kumagai²,

Uchida³

et al. 2023

Preprint

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Background Incomplete sealing of tracheal diverticula by a tracheal tube cuff during positive-pressure ventilation causes barotrauma but the concrete possibility of incomplete sealing has not been indicated. We aimed to assess the possibility of incomplete sealing in a simulated situation of tracheal intubation for patients with tracheal diverticula with tube fixation where the tracheal tube’s vocal cord guide overlaps with the patient’s vocal cord. Methods We retrospectively assessed the characteristics of tracheal diverticula based on thoracic computed tomography data in our institution from January 2018 to July 2020. Then, we assessed the structural parameters of three single-lumen tracheal tubes (Parker Flex-Tip [Parker Medical, Bridgewater, CT, USA], Portex Soft Seal [ICU Medical, San Clemente, CA, USA], and Shiley TaperGuard [Medtronic, Dublin, Ireland]; 6.0–8.0 mm inner diameter size) and simulated the positional relationships between tracheal diverticula and the tracheal tube during tracheal intubation where the vocal cord guide overlaps with the patient’s vocal cord. We assessed each tube product’s possibility of incompletely sealing tracheal diverticula and the possibility of unintended bronchial intubation. Results In 5,854 patients, the prevalence of tracheal diverticula was 5.7%. The mean (SD) length from the vocal cord to the distal end of the tracheal diverticula was 52.2 (12.8) mm. Tracheal tubes with length from the distal end of the tracheal cuff to the vocal cord guide of ≥70 mm had a low risk of incompletely sealing tracheal diverticula (<5%) and length from the distal end of the tube to the vocal cord guide of ≤95 mm had a low risk of unintended bronchial intubation (<5%). No products in this study satisfied both outcomes. Conclusions Tube fixation, where the vocal cord guide overlaps with the patient’s vocal cord, is associated with risk of incompletely sealing of tracheal diverticula depending on the tube’s manufacturer and tube’s inner diameter size, although it was not a high risk. The use of small inner diameter sized tube relative to patient’s body size is high risk of incomplete sealing of tracheal diverticula. Trial registration This trial was prospectively registered at University Hospital Medical Information Network (UMIN). Clinical trial number and registry URL: UMIN000043317 (URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048055)

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Section: Discussionsupporting

confidence: 85%

Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study

Mitsuzawa

Kumagai²,

Uchida³

et al. 2023

Preprint

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“…Unlike Mi et al. who measured directly from coronal CT images, we employed 3D reconstruction technology to assess the central axis length of the tracheobronchial tree airways ( Figure 1B ), minimizing random errors from different starting points and coronal image positions, and reducing systematic errors related to airway curvature and the angles between the trachea and the coronal plane [ 4 ]. In contrast to Ge et al.’s study [ 14 ], which used bronchoscopy to measure central airway lengths in Chinese adults, our study found a shorter tracheal length but a longer main bronchus length.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we utilized 3D reconstruction technology to model the tracheobronchial tree and determined SCA by measuring the angle between the midlines of the main bronchial lumens ( Figure 1A ). This method not only significantly reduces measurement errors inherent in 2D chest CT imaging but also provides more accurate results that reflect clinical realities, such as the actual pathways during the use of airway devices, intubation, or other airway-related surgeries [ 4 , 6 , 7 ]. However, our study did not independently measure RA and LA, which may limit a comprehensive analysis of sex differences.…”

Section: Discussionmentioning

confidence: 99%

“…Three-dimensional (3D) imaging is an accurate and non-invasive assessment tool to effectively evaluate the dimensions of the central airway. For central airway disorders such as tracheal stenosis, trauma, or tumors [ 2 , 3 ], accurate anatomical information is not only crucial for the optimization of therapeutic options such as tracheal resection and reconstruction, bronchial ablation therapy [ 4 , 5 ] but also beneficial for the improvement of the design of medical devices like tracheal stents and double-lumen tubes [ 6 , 7 ]. In addition, reference values for the normal dimensions of the central airway are of great significance to radiologists, anaesthesiologists, and otolaryngologists.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of airway structural parameters in Han Chinese adults: a prospective cross-sectional study

Liu,

Teng,

Mei

et al. 2024

Annals of Medicine

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Introduction Establishing reference ranges for central airway parameters and exploring their influencing factors in Han Chinese non-smoking adults. Methods This prospective cross-sectional study was conducted on Han Chinese non-smoking adults who underwent chest CT scans at the Tongzhou Campus of Dongzhimen Hospital Affiliated with the Beijing University of Chinese Medicine between September 2022 and November 2022. The SYNAPSE 3D image analysis software was utilized, enabling the extraction of critical parameters such as central airway length, airway wall thickness (AWT), airway lumen area (ALA), and subcarinal angle (SCA). Pearson’s correlation coefficient analysis and multiple linear regression analysis methods were employed to evaluate the relationship between central airway parameters and age, sex, weight, and height. Results The study encompassed 888 Han Chinese non-smoking adults, comprising 456 females and 432 males. Significant sex differences were noted in central airway length, AWT, and ALA, with measurements in males exceeding those in females ( p < 0.01) with no significant difference in SCA. Correlation analyses unveiled relationships between central airway parameters and age, sex, weight, and height. During multiple linear regression analyses, no conclusive evidence emerged to demonstrate the independent or combined explanatory or predictive capacity of the aforementioned variables for central airway length and SCA. Although sex has a significant impact on AWT and ALA, its capability in explanation or prediction remains limited. The conclusions drawn from the primary analysis receive reinforcement from the outcomes of sensitivity analyses. Conclusion Establishing the distribution range of central airway parameters in non-smoking Han Chinese adults. It observed significant sex differences in these parameters, except for the SCA. However, the study found that the predictive or explanatory power of age, sex, weight, and height for central airway parameters was either limited or non-significant.

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Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study

Mitsuzawa,

Kumagai,

Uchida

et al. 2023

BMC Anesthesiol

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Background Incomplete sealing of tracheal diverticula by a tracheal tube cuff during positive-pressure ventilation causes barotrauma but the concrete possibility of incomplete sealing has not been indicated. We aimed to assess the possibility of incomplete sealing in a simulated situation of tracheal intubation for patients with tracheal diverticula with tube fixation where the tracheal tube’s vocal cord guide overlaps with the patient’s vocal cord. Methods We retrospectively assessed the characteristics of tracheal diverticula based on thoracic computed tomography data in our institution from January 2018 to July 2020. Then, we assessed the structural parameters of three single-lumen tracheal tubes (Parker Flex-Tip [Parker Medical, Bridgewater, CT, USA], Portex Soft Seal [ICU Medical, San Clemente, CA, USA], and Shiley TaperGuard [Medtronic, Dublin, Ireland]; 6.0–8.0 mm inner diameter size) and simulated the positional relationships between tracheal diverticula and the tracheal tube during tracheal intubation where the vocal cord guide overlaps with the patient’s vocal cord. We assessed each tube product’s possibility of incompletely sealing tracheal diverticula and the possibility of unintended bronchial intubation. Results In 5,854 patients, the prevalence of tracheal diverticula was 5.7%. The mean (SD) length from the vocal cord to the distal end of the tracheal diverticula was 52.2 (12.8) mm. Tracheal tubes with length from the distal end of the tracheal cuff to the vocal cord guide of ≥ 70 mm had a low risk of incompletely sealing tracheal diverticula (< 5%) and length from the distal end of the tube to the vocal cord guide of ≤ 95 mm had a low risk of unintended bronchial intubation (< 5%). No products in this study satisfied both outcomes. Conclusions Tube fixation, where the vocal cord guide overlaps with the patient’s vocal cord, is associated with risk of incompletely sealing of tracheal diverticula depending on the tube’s manufacturer and tube’s inner diameter size, although it was not a high risk. The use of small inner diameter sized tube relative to patient’s body size is high risk of incomplete sealing of tracheal diverticula. Trial registration This trial was prospectively registered at University Hospital Medical Information Network (UMIN). Clinical trial number and registry URL: UMIN000043317 (URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048055).

show abstract

Significance of the evaluation of tracheal length using a three-dimensional imaging workstation

Cited by 3 publications

References 28 publications

Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study

Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study

Analysis of airway structural parameters in Han Chinese adults: a prospective cross-sectional study

Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study

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