Trachea In Children Research Articles

Endotracheal tube cuff position in relationship to the walls of the trachea: A retrospective computed tomography-based analysis.

The use of cuffed endotracheal tubes (ETTs) has become the standard of care in pediatric practice. The rationale for the use of a cuffed ETT is to minimize pressure around the cricoid while providing an effective airway seal. However, safe care requires that the cuff lie distal to the cricoid ring following endotracheal intubation. The current study demonstrates the capability of computed tomography (CT) imaging in identifying the position of the cuff of the ETT in intubated patients. The study included patients ranging in age from 1 month to 10 years who underwent neck and chest CT imaging that required general anesthesia and endotracheal intubation. The location of the ETT and of the cuff within the airway was determined from axial CT images at three levels (proximal, middle, and distal). Anatomical orientations were tabulated, and percent chances of each orientation were determined for the ETT and the cuff. The study cohort included 42 patients ranging in age from 1 to 114 months. An ETT with a polyvinylchloride cuff was used in 24 patients, and an ETT with a polyurethane cuff was used in 18 patients. The ETT was located near the posterior wall of the trachea in approximately 24-38% of patients, being most likely to be centrally located at the proximal end and at its mid-portion. The middle part of the cuff was most likely to be positioned in the mid-portion of the trachea but tended to skew anteriorly at both the proximal and distal ends. This is the first study using CT imaging to identify the uniformity of cuff inflation within the trachea in children. With commonly used cuffed ETTs, cuff inflation and the final position of ETT cuff within the tracheal lumen were not uniform. Future investigations are needed to determine the reasons for this asymmetry and its clinical implications.

Impact on the trachea in children with prenatally diagnosed vascular ring formed by a right aortic arch.

There has been a rise in the prenatal detection of right sided aortic arch (RAA). When associated with a left-sided arterial duct (LD), this forms a vascular ring encircling the trachea. Infants may have symptoms or signs suggestive of tracheoesophageal compression but many are asymptomatic. The objective of this study was to investigate the relationship between symptoms and severity of tracheobronchial compression assessed by bronchoscopy. Retrospective review of all cases of prenatally diagnosed RAA-LD in the absence of associated congenital heart disease at Evelina London Children's Hospital and Kings College Hospital over a 4-year period between April 2015-2019. Clinical records, fetal echocardiograms, and free-breathing flexible bronchoscopy (FB) data were reviewed. One hundred and twelve cases of isolated RAA-LD were identified of whom 82 cases (73%) underwent FB. FB was performed median age of 11 months (range 1-36 months), no complications occurred. Aberrant left subclavian artery (ALSA) was present in 86% (96/112) and mirror image branching (MIB) in 13% (15/112). 34/112 (30%) reported symptoms during follow-up. 36/77 (47%) with ALSA who underwent FB showed moderate-severe compression mostly at distal tracheal and carinal level of whom 38% had parent-reported symptoms. Moderate-severe compression was seen in 3/5 (60%) with MIB mostly at mid tracheal level; 3 were symptomatic but only 2 had tracheal compression. In total 36% (18/50) of investigated asymptomatic patients showed moderate-severe compression. Respiratory symptoms were poorly predictive of moderate-severe tracheal compression (positive predictive value 66%, negative predictive value 64%). The absence of symptoms did not exclude significant tracheal compression. The anatomical effect of the vascular ring is under appreciated when symptoms alone are used as a marker of tracheal compression.

Application of the Artificial Neural Network in the Diagnosis of Infantile Bronchial Bridge with 64-Slice Multislice Spiral CT.

The objective is to study the application of spiral CT in the diagnosis of the trachea in children. In this study, the effect of 64-slice multislice spiral CT in diagnosing infant bronchial bridge was studied based on an artificial neural network. From June 2020 to December 2020, 100 cases of children with the trachea in the outpatient department of our hospital were selected as the research object. They were divided into the study group and the control group, with 50 cases in each group. The results showed that among the 50 cases in the control group, 42 cases were found to have a bronchial foreign body and 8 cases were missed; the detection rate was 84%. There were 7 cases of trachea foreign body, 15 cases of left bronchial foreign body, 14 cases of right bronchial foreign body, and 6 cases of medium bronchial foreign body. The detection rate of the study group was significantly higher than that of the control group, with a statistical significance (P < 0.05). Conclusion. The detection rate of neural networks in MSCT is higher than that of X-ray, and the MSCT based on the artificial neural network can clearly show the morphology, position, and the relationship between the foreign body and trachea, which is worthy of clinical promotion and application.

Length of the Cricoid and Trachea in Children: Predicting Intubation Depth to Prevent Subglottic Stenosis.

Define the length of the subglottis and trachea in children to predict a safe intubation depth. Patients <18 years undergoing rigid bronchoscopy from 2013 to 2020 were included. The carina and inferior borders of the cricoid and true vocal folds were marked on a bronchoscope and distances were measured. Patient age, weight, height, and chest height were recorded. Four styles of cuffed pediatric endotracheal tubes (ETT) were measured and potential positions of each cuff and tip were calculated within each trachea using five depth of intubation scenarios. Multivariate linear regression was performed to identify predictors of subglottic and tracheal length. Measurements were obtained from 210 children (141 male, 69 female), mean (SD) age 3.21 (3.66) years. Patient height was the best predictor of subglottic length (R2 : 0.418): Lengthsg (mm) =0.058 * height (cm) +2.8, and tracheal length (R2 : 0.733): Lengtht (mm)=0.485 * height (cm) + 21.3. None of the depth of intubation scenarios maintained a cuff-free subglottis for all ETT styles investigated. A formula for depth of intubation: Lengthdi (mm) =0.06 * height (cm) +8.8 found that no ETT cuffs would be in the subglottis and all tips would be above the carina. Current strategies for determining appropriate depth of intubation pose a high risk of subglottic ETT cuff placement. Placing the inferior border of the vocal cords 0.06 * height (cm) +8.8 from the superior border of the inflated ETT cuff may prevent subglottic cuff placement and endobronchial intubation. 4 Laryngoscope, 132:S1-S10, 2022.

Reconstructive surgeries on the larynx and cervical trachea in children

Introduction. One of the urgent problems in pediatric surgery and otorhinolaryngology is stenosis of the upper respiratory tract in children. Among many causes leading to airway narrowing , basic ones are: cicatricial stenosis, bilateral vocal cord paralysis and volumetric formations.Diagnostics. Currently, fibroscopy of the upper respiratory tract is a gold standard of this pathology examination.Methods. There are many surgical techniques to treat upper airway stenosis, but currently there is no any unified approach to the choice of surgical tactics. The given article presents an overview on modern techniques of reconstructive surgery which have demonstrated good and excellent results and a high percentage of decannulation. Among them, there are two basic ones - endoluminal surgery and open surgery. Recently, reports on the effectiveness of microsurgical interventions have been published , namely, reinnervation of the larynx to restore vocal cords. The most effective endoscopic surgeries in pediatrics are balloon dilation, bougienage and CO2- laser treatment. Patients with stenosis of stages III-IV, with extended stenosis, marked laryngomalacia, larynx and trachea deformity because of unsuccessful previous surgeries are recommended to have open reconstructive surgery. Laryngoplasty, laryngoplasty with T-tube and crico-tracheal resection are regarded as a choice option in case of ineffective previous surgeries.Conclusion. Thus, type of surgical intervention, indications and patient’s age for surgery are chosen individually for each patient with upper respiratory tract stenosis.

Factors Associated with Fracture and Migration of Tracheostomy Tube into Trachea in Children: A Case Series.

IntroductionTracheostomy is done to bypass the obstructed upper airway. Rare complication of this procedure is the fracture of the tube. Early identification and management of this condition is a great challenge to an otolaryngologist. To study the factors associated with the fracture and migration of tracheostomy tube into tracheobronchial tree in paediatric age group.Materials and Methods:This study is a case series study conducted on children with a diagnosis of fractured tracheostomy tube presenting as a foreign body airway over five years duration. Data regarding the possible patient and tube factors responsible for the condition were collected and analysed. Results:Total 11 patients (males-5 and females-6, average age-10.18 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-8 years) were included in the study. Aspirated tubes were Jackson’s metallic inner tube, Romson polyvinyl chloride plastic tube and Fuller’s outer tube flange in 5 (45.5%), 4 (36.4%) and 2 (18.1%) patients respectively. The most common fracture site was at the junction between tube and neck plate (90.9%). The most common causes for fracture tube were prolonged use in 10 cases (90.9%), stomal narrowing in 9 cases (81.8%), and infection with peri-stomal granulation tissue in 9 cases (81.8%). Conclusion:A fractured tracheostomy tube is a rare but preventable late complication of tracheostomy. Appropriate training about proper tracheostomy care, timely check-up of tracheostomy tube for signs of wear and tear, scheduled replacement, regular follow up and awareness may prevention this complication.

Management of Foreign Body of Peanuts in the Trachea in Children

Foreign body is an object that enters an organ that comes from outside the body or from inside the body that does not normally exist. One of the objects in the respiratory tract can occur in the trachea and occur in many children. Case report: a girl, 1 year 11 months of age with complaints of shortness of breath since 1 day before, had tachypnea, indirect laryngoscopy: multiple secretions, difficulty speaking vocal cords, inspiratory-expiratory stridor (+), suprasternal, epigastric and intercostal ( +). Bronchoscopy: white round foreign body (impression: peanut) covering&gt; 50% of the tracheal lumen over the carina, mucosal edema, and hyperemia. A bronchoscopy was administered as a diagnostic and therapeutic role

Value of application of sevoflurane anesthesia induction in anesthesia management of foreign matter removal from trachea in children

Objective To explore the value of application of Sevoflurane anesthesia induction in anesthesia management of foreign matter removal from trachea in children. Methods Sixty five cases of children with tracheal foreign matter related in our hospital from January 2015 to December 2016 were selected as the study objects, and were divided into two groups according to random number table method. The control group of 32 cases was given 2.5 mg/kg propofol to induce anaesthesia, and the observation group of 33 cases was given 8% Sevoflurane inhalation to induce anesthesia. One shot success rate, deoxygenation time, operation time, recovery time and the relative parameters (systolic pressure, diastolic pressure, respiratory rate and pulse oxygen saturation) at entrance time, before and after setting the mirror were contrasted and analyzed, and the intraoperative and postoperative adverse reactions were recorded in the two groups. Results There were no significant differences in respiratory rate, blood oxygen saturation, systolic blood pressure and diastolic blood pressure between two groups at entrance time and before setting the mirror (P>0.05). The respiratory rate and blood oxygen saturation of the observation group were higher than those of control group after setting the mirror and at withdrawing mirror time, with statistically significant differences (P 0.05). Deoxygenation time, operation time and recovery time of the observation group were significantly lower than those in the control group (P<0.05). The total incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). Conclusions Sevoflurane anesthesia induction can obviously shorten operation time and recovery time in foreign matter removal from trachea in children, and reduce the incidence of intraoperative and postoperative adverse reactions. It has good clinical effect. Key words: Methyl ethers/AD; Foreign bodies/SU; Tracheal diseases/SU; Anesthesia

Biodegradable airway stents in infants – Potential life-threatening pitfalls

ObjectiveThe solution of severe tracheobronchial obstructions in early childhood means a great challenge. Biodegradable stents were intended to be a minimally invasive temporary solution which may decrease the number of interventions and limit the possible complications of stenting procedures. However, our first experiences have brought out a new, - especially in childhood - potentially life-threatening complication of this concept. MethodsFive SX-ELLA biodegradable polydioxanone stents was applied in three patients because of severe tracheobronchial obstruction: congenital tracheomalacia (7 day-old), acquired tracheomalacia (10 month-old), and congenital trachea-bronchomalacia (10 month-old). ResultsThe breathing of all children improved right after the procedure. We observed degradation of the stent from the 5th postoperative week which resulted in large intraluminar fragments causing significant airway obstruction: one patient died of severe pneumonia, the other baby required urgent bronchoscopy to remove the obstructing ‘foreign body’ from the trachea. In the third case repeated stent placements successfully maintained the tracheal lumen. ConclusionsPolydioxanone stents may offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children; however, large decaying fragments mean a potential risk especially in the small size pediatric airway. The fragmentation of the stent, which generally starts in the 4–6 postoperative weeks, may create large sharp pieces. These may be anchored to the mucosa and covered by crust leading to obstruction. As repeated interventions are required, we do not consider the application of biodegradable stents unambiguously advantageous.

Trachea transplantation: from laboratory to patient.

Today, tracheal lesions occupying<30%of the trachea in children and<50%in adults can be treated with primary resection, followed by end-to-end anastomosis. However, lesions larger than this require a tracheal replacement, of which there are currently few options available. The recent advancement of tissue-engineering principles in tracheal research is quickly opening up new vistas for airway reconstruction and creating a very promising future for medical science. This review discusses the main criteria required for the development of a tissue-engineered tracheal replacement. The criteria include: (a) appropriate cell types and sources; (b) biomolecules to direct the differentiation of the cells to the desired lineage; (c) a suitable scaffold for a cellular matrix; and (d) a bioreactor to facilitate cell attachment and proliferation and construct transport to theatre. Our group has designed and developed the world’s first synthetic tracheal replacement, using a novel nanocomposite material, also developed in our laboratory. It was implanted clinically in June 2011 with a successful outcome. The application of tissue-engineering approaches to tracheal replacement development is the first step towards the much-anticipated ‘off-the-shelf’ tissue-engineered technology, contributing extensively to the advancement in treatment and rehabilitation of patients afflicted with tracheal pathology.

The Prevalence of Tracheal Bronchus in Pediatric Patients Undergoing Rigid Bronchoscopy

Tracheal bronchus (TB) is defined as an abnormal bronchus that originates directly from the lateral wall of the trachea above the carina and goes towards the upper lobe territory of the lung. We analyzed rigid endoscopies of the trachea in children to determine the incidence and characteristics of TB. In total, 1021 rigid endoscopies of the trachea recorded from children aged 0 to 6 years were analyzed. Endoscopic examination was performed from supraglottic region to carina using a 0-degree Hopkins rod-lens telescope. Patients with a TB were identified and the site of origin of the TB and its level above the carina was noted. Data of the identified patients was reviewed for the presence of preoperative airway findings such as stridor, upper lobe pneumonia and wheezing or atelectasis, other congenital anomalies, and intraoperative complications. TB was detected in 11 (1.06%) of 1021 upper airway endoscopic examinations. All originated from the right lateral wall of the trachea. Six children had retained secretions in the TB, and 3 children had perioperative airway problems unrelated to the TB. One child showed right main stem bronchus narrowing as seen at the true carina, in the presence of a TB. All the children with TB exhibited at least 1 additional congenital anomaly at birth besides TB. TB is a relatively common congenital endoscopic lower airway anomaly in childhood, which is itself rarely symptomatic, but almost always coexists with other congenital anomalies.

Residual anaesthesia drugs in intravenous lines – a silent threat?

Residual anaesthesia drugs in intravenous lines – a silent threat?

Endoscopic airway findings in children with or without prior endotracheal intubation

Airway alterations found after endotracheal intubation are usually associated with mechanical trauma from the tube. However, no studies are available concerning alterations in airways that have never been intubated before. It was the aim of the study to compare endoscopic findings in the larynx and trachea of children who had undergone prior endotracheal intubation with findings in children who had not been intubated before. In 1021 children aged from 0 to 6 years, rigid endoscopies were performed before planned elective endotracheal intubation. The anonymized endoscopy videos were reviewed and graded by five international airway experts. Data was compared between the two groups using the chi-square test (P ≤ 0.05). Endoscopic records of 971 children (473 with prior intubation; 498 without prior airway intubation) were included in the final calculations. Most patients (93.7%) with prior intubation had been intubated with a cuffed tube. The number of intubations ranged from 1 to 27. The median interval between intubation and endoscopy was 0.53 years (0.003-5.57 years). Abnormal findings were observed in 31.7% and 26.8% of patients with and without prior intubation, respectively (P = 0.063). Glottic granulomas were significantly more common after intubation (3.6% vs 1.4%; P = 0.028). The incidence of other abnormal findings was similar in both groups. Endoscopic airway alterations can be observed in about one-quarter of children presenting for routine surgery without prior intubation. Except for glottic granulomas, the abnormalities are found with similar frequency in patients with and without prior intubation. No relevant airway damage from short-term endotracheal intubation was found.

A comparison of three methods that assess tracheal tube leakage: leak conductance, fractional volume loss, and audible assessment

When intubating a child's trachea with an uncuffed tracheal tube (TT), it is current practice in anesthesia and intensive care to use the leak test to assess TT fit. The aim of this study is to compare three measures of assessing leak around uncuffed tracheal tubes in the PICU. We obtained institutional ethical permission and written informed consent, prior to any clinical investigation, from the parents of 135 children who had surgery for cardiac defects. On admission to the PICU, we measured leak by audible assessment, fractional volume loss, and leak conductance for each patient. Measurements of fractional volume loss and leak conductance were repeated every 4 h thereafter until extubation. On admission to the PICU, calculated values of leak conductance were significantly different between each grade of audible leak (P < 0.001). Values of fractional volume loss were not significantly different between 'no leak' and 'small leak' grades of leak. Throughout the PICU stay, a significant correlation between mean leak conductance and mean fractional volume loss was found (0.86, 95% CI, 0.81-0.90). Significant agreement within time series of leak conductance and fractional volume recorded for each patient occurred in 47/128 cases (37%). On admission to the PICU, values of leak conductance are more strongly associated with audible assessment than with fractional volume loss. Throughout PICU stay, leak conductance is associated with fractional volume loss. This study demonstrates that leak conductance, calculated from routinely available pressure and flow signals, has the potential to represent the characteristics of the leak interface between a TT and the trachea.

Efficacy of dexmedetomidine as an adjunct to combined intravenous-inhalational anesthesia for removal of foreign body in trachea in children

Objective To investigate the efficacy of dexmedetomidine as an adjunct to combined intravenous-inhalational anesthesia for removal of foreign body in the trachea in children.Methods Sixty ASA Ⅰ or Ⅱ children,aged 1-4 yr,weighing 8-23 kg,were randomly divided into 2 groups(n =30 each):combined intravenous-inhalational anesthesia group(group Ⅰ)and dexmedetomidine as an adjunct to combined intravenous-inhalational anesthesia group(group Ⅱ).In group Ⅱ,8％ sevoflurane was inhaled by mask to induce sleep after entering the operating room,and the concentration was reduced to 4％ after the children sere asleep.Anesthesia was maintained with iv infusion of dexmedetomidine 0.5 μg/kg,and then iv injection of propofo1 2 mg/kg,followed by iv infusion of propofol at 6 rag· kg-1· h-1 and remifentanil at 0-15 μg· kg-1 ·min-t.In group Ⅰ,dexmedetomidine was not used and the other procedures were the same as those in group Ⅱ.Sevoflurane inhalation was stopped 2 min later and the rigid bronchoscope was inserted.HR and SpO2 were monitored and recorded before insertion and at 1 and 5 min after insertion.Complications such as respiratory depression,laryngeal edema,and bradycardia were reconded.The amount of propofol and remifentanil consumed,satisfactory level of bronchoscopy,and emergence time were recorded after operation.Results Compared with group Ⅰ,HR was significantly decreased at 1 and 5 min after insertion,SpO2 was significantly increased at 1 min after insertion,the amount of propofol and remifentanil consumed was significantly reduced,the operation time was significantly shortened,the emergence time was significanlly prolonged,the satisfactory level of bronchoscopy was significandy increased,and the incidence of respiratory depression and laryngeal edema was significantly decreased in grmp Ⅱ(P ＜ 0.05).Conclnslon The efficacy of dexmedetomidine as an adjunct to combined intravenous-inhalational anesthesia is better than that of combined intravenous-inhalational anesthesia for removal of foreign body in the trachea in children,with fewer complications. Key words: Dexmedetomidine; Anesthesia, general; Child; Trachea; Foreign bodies

Assessment of the subglottic region by ultrasonography for estimation of appropriate size endotracheal tube: A clinical prospective study.

Background:Endotracheal intubation is important to carry out various surgical procedures. The estimation of endotracheal tube size is governed by narrowest diameter of the upper airway. The objective of the study was to assess the narrowest tracheal diameter by ultrasound for selection of the appropriate size endotracheal tube.Materials and Methods:After the approval of institution ethical committee and written informed consent, 112 patients aged 3 to 18 years of both genders with normal airways, scheduled for surgery under general anesthesia and intubation, were enrolled for this prospective clinical observational study. Preanesthetic ultrasonography of the subglottic region was performed by experienced ultrasonologist with a high-resolution linear array transducer in sniffing position for every patient and the subglottic tracheal diameter was estimated to select the appropriate-size endotracheal tube. The endotracheal tube, calculated on the basis of physical indices and by ultrasound, was statistically correlated with the appropriate size endotracheal tube used clinically for intubation.Results:The ultrasound guided selection criterion has estimated the appropriate-sized endotracheal tube better than physical indices (age or height)-based formulas. The estimated endotracheal tube size by ultrasound was significantly correlated with the clinically used endotracheal tube.Conclusion:Ultrasonography may be used for the assessment of the subglottic diameter of trachea in children to estimate the appropriate size endotracheal tube for intubation.

First Experience With Biodegradable Airway Stents in Children

We here report our experience with biodegradable polydioxanone stents for tracheal narrowing in children. Eleven custom-made polydioxanone stents were implanted in 4 patients with airway narrowing due to external compression or intrinsic collapse. The median stent diameter was 9 mm (range, 6 to 14 mm) and median length was 15 mm (range, 13 to 70 mm). Narrowing was relieved initially in all cases. There was no bleeding or perforation after polydioxanone stent implantation. Size mismatching was a problem in 2 cases. Three patients needed repeat stenting after stent absorption. There was 1 death, unrelated to the stent implantation. All 3 survivors are in good clinical condition up to 12 months after first stenting. This pilot study shows that polydioxanone stents offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children. They may avoid the need for permanent stenting and allow subsequent growth of the airway.

Systematic Review of Endoscopic Airway Findings in Children with Gastroesophageal Reflux Disease

We performed a systematic review of published literature correlating findings on endoscopic evaluation of the larynx and trachea in the pediatric population with the incidence of gastroesophageal reflux disease. Eight articles were identified through a structured PubMed search of English-language literature using the key terms laryngopharyngeal reflux, extraesophageal reflux, and gastroesophageal reflux. A systematic review was performed relating the presence of reflux in the pediatric population to findings on endoscopic airway evaluation. A covariant analysis was performed, and each study was weighted according to the number of available samples in that study as a fraction of the total. Overall odds ratios and confidence intervals were computed for each endoscopic finding on the basis of the documented absence or presence of gastroesophageal reflux disease. A correlation was seen between the endoscopic findings and the presence of reflux. Arytenoid, postglottic, and vocal fold edema and erythema, lingual tonsil hypertrophy, laryngomalacia, and subglottic stenosis are among the endoscopic findings most frequently identified in patients with gastroesophageal reflux disease. Certain findings commonly encountered on endoscopic evaluation of the larynx and trachea in children who present with respiratory symptoms do indeed demonstrate a correlation with the presence of laryngopharyngeal reflux disease and may indicate the need for antireflux therapy.

Dexmedetomidine and magnesium sulfate in the perioperative management of a child undergoing laparoscopic resection of bilateral pheochromocytomas

The case of an 8 year-old boy undergoing resection of pheochromocytoma, who received a combination of dexmedetomidine and magnesium sulfate (MgSO4) for hemodynamic control, is reported. He was prepared for surgery with phenoxybenzamine and atenolol. Dexmedetomidine was started in the preoperative holding area and, with MgSO4, continuously infused for most of the case. Good cardiovascular stability was achieved, but low-dose esmolol and nicardipine infusions were required during tumor manipulation. There was minimal post-resection hypotension, the neuromuscular block was easily antagonized, and the child's trachea was quickly extubated.

Malignant tumor of the trachea in children: diagnostic pitfalls and surgical management

Primary tracheal malignant neoplasms are very rare. Histologically, squamous cell and adenoid cystic carcinomas are the most common types of malignant primary tracheal tumors when all age groups are studied. In the past 5 years, we treated 2 children with tracheal mucoepidermoid carcinoma. Herein we report both cases and review the literature on the subject with particular emphasis on diagnosis and surgical management.