1
|
Fyles F, FitzMaurice TS, Robinson RE, Bedi R, Burhan H, Walshaw MJ. Dynamic chest radiography: a state-of-the-art review. Insights Imaging 2023; 14:107. [PMID: 37332064 DOI: 10.1186/s13244-023-01451-4] [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: 02/15/2023] [Accepted: 05/14/2023] [Indexed: 06/20/2023] Open
Abstract
Dynamic chest radiography (DCR) is a real-time sequential high-resolution digital X-ray imaging system of the thorax in motion over the respiratory cycle, utilising pulsed image exposure and a larger field of view than fluoroscopy coupled with a low radiation dose, where post-acquisition image processing by computer algorithm automatically characterises the motion of thoracic structures. We conducted a systematic review of the literature and found 29 relevant publications describing its use in humans including the assessment of diaphragm and chest wall motion, measurement of pulmonary ventilation and perfusion, and the assessment of airway narrowing. Work is ongoing in several other areas including assessment of diaphragmatic paralysis. We assess the findings, methodology and limitations of DCR, and we discuss the current and future roles of this promising medical imaging technology.Critical relevance statement Dynamic chest radiography provides a wealth of clinical information, but further research is required to identify its clinical niche.
Collapse
Affiliation(s)
- Fred Fyles
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thomas S FitzMaurice
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Ryan E Robinson
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ram Bedi
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hassan Burhan
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Martin J Walshaw
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
2
|
Fujisawa T, Hatakeyama J, Omoto K. Airway obstruction caused by achalasia: A case report. Respir Med Case Rep 2023; 44:101866. [PMID: 37229482 PMCID: PMC10203765 DOI: 10.1016/j.rmcr.2023.101866] [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] [Received: 11/24/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
We report a rare case of airway obstruction caused by megaesophagus associated with achalasia. A 78-year-old man was admitted with post meal dyspnea, decreased consciousness, expiratory and inspiratory wheezing, and respiratory distress. Arterial blood gas analysis showed findings of marked acute respiratory acidosis (pH 7.18, PaCO2 75 mmHg, PaO2 225 mm Hg, HCO3- 22 mmol/L). An emergency laryngoscopy was performed because of a suspected airway obstruction, but no abnormalities were observed from the airway to the glottis. Noninvasive positive pressure ventilation (NPPV) was immediately introduced, and the respiratory rate and breathing pattern was normalized. A chest X-ray showed an enlarged upper mediastinal outline and an ill-defined border of the trachea. A computed tomography (CT) scan showed an enlarged esophagus with a maximum diameter of 9.90 cm, compressing the trachea to the back of the sternal notch. Following removal of the esophageal contents using a nasogastric tube, NPPV was discontinued with no respiratory episodes. After he was stabilized, he was transferred to another hospital for endoscopic myotomy. In a review of the literature, we identified 66 cases of airway obstruction due to achalasia, mainly in older women. None of the patients received NPPV. As a differential diagnosis for acute airway obstruction, achalasia-related airway obstruction should be considered, particularly in older women. Furthermore, since this condition is suspected to involve tracheomalacia, NPPV may be a useful respiratory support therapy.
Collapse
Affiliation(s)
- Tokuo Fujisawa
- Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Japan
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Kenichiro Omoto
- Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Japan
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| |
Collapse
|
3
|
Banach A, Naito M, King F, Masaki F, Tsukada H, Hata N. Computer-based airway stenosis quantification from bronchoscopic images: preliminary results from a feasibility trial. Int J Comput Assist Radiol Surg 2023; 18:707-713. [PMID: 36528684 DOI: 10.1007/s11548-022-02808-8] [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: 06/29/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Airway Stenosis (AS) is a condition of airway narrowing in the expiration phase. Bronchoscopy is a minimally invasive pulmonary procedure used to diagnose and/or treat AS. The AS quantification in a form of the Stenosis Index (SI), whether subjective or digital, is necessary for the physician to decide on the most appropriate form of treatment. The literature reports that the subjective SI estimation is inaccurate. In this paper, we propose an approach to quantify the SI defining the level of airway narrowing, using depth estimation from a bronchoscopic image. METHODS In this approach we combined a generative depth estimation technique combined with depth thresholding to provide Computer-based AS quantification. We performed an interim clinical analysis by comparing AS quantification performance of three expert bronchoscopists against the proposed Computer-based method on seven patient datasets. RESULTS The Mean Absolute Error of the subjective Human-based and the proposed Computer-based SI estimation was [Formula: see text] [%] and [Formula: see text] [%], respectively. The correlation coefficients between the CT measurements were used as the gold standard, and the Human-based and Computer-based SI estimation were [Formula: see text] and 0.46, respectively. CONCLUSIONS We presented a new computer method to quantify the severity of AS in bronchoscopy using depth estimation and compared the performance of the method against a human-based approach. The obtained results suggest that the proposed Computer-based AS quantification is a feasible tool that has the potential to provide significant assistance to physicians in bronchoscopy.
Collapse
Affiliation(s)
- Artur Banach
- National Center for Image-guided Therapy, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- QUT Centre for Robotics, Queensland University of Technology, Brisbane, 4000, Australia.
| | - Masahito Naito
- National Center for Image-guided Therapy, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Franklin King
- National Center for Image-guided Therapy, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Fumitaro Masaki
- National Center for Image-guided Therapy, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Healthcare Optics Research Laboratory Canon U.S.A., Cambridge, MA, USA
| | - Hisashi Tsukada
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nobuhiko Hata
- National Center for Image-guided Therapy, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Majid A, Ospina-Delgado D, Ayala A, Gangadharan SP, Alape D, Buitrago D, Parikh MS, Wilson JL, Chee AC, Fernandez-Bussy S, Herth FJF, Kheir F. Stent Evaluation for Expiratory Central Airway Collapse: Does the Type of Stent Really Matter? J Bronchology Interv Pulmonol 2023; 30:37-46. [PMID: 35318996 DOI: 10.1097/lbr.0000000000000842] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/05/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Careful selection of patients with expiratory central airway collapse (ECAC) that may benefit from tracheobronchoplasty (TBP) can be aided by a short-term airway stent evaluation. This can be performed with either silicone Y-stents (SYSs) or uncovered self-expanding metallic airway-stents (USEMAS). No direct comparison has been made between these 2 stent types. METHODS This was a small retrospective review of consecutive patients that underwent a stent evaluation. A propensity score was used to match patients in the USEMAS and SYS groups. Outcomes included complications, changes in the health-related quality-of-life (HR-QoL), and changes in exercise capacity. Baseline measurements were compared with those obtained during stent evaluation and after TBP. RESULTS Forty-two patients with severe ECAC underwent USEMAS placement, while 18 patients had an SYS placed. Propensity score matching resulted in 13 matched SYS and USEMAS pairs. The SYS group had an increased rate of mucus plugging (38.5% vs. 0%, P <0.047). Although not statically significant, a clinical improvement was observed in HR-QoL and exercise capacity in the USEMAS group during stent placement. In patients who underwent TBP, both USEMAS and SYS groups had a statistically significant change in the Modified Medical Research Council Dyspnea Scale during stent evaluation and after TBP. CONCLUSION In patients with severe ECAC, short-term evaluation with airway stents appears to be safe and improves respiratory symptoms, HR-QoL, and exercise capacity. The use of USEMAS led to a lower complication rate, a greater improvement in HR-QoL and exercise capacity, and appeared to better predict how the patients would respond to TBP.
Collapse
Affiliation(s)
- Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Daniel Ospina-Delgado
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Alvaro Ayala
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Daniel Alape
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Daniel Buitrago
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Mihir S Parikh
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Jennifer L Wilson
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Alex C Chee
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | | | - Felix J F Herth
- Department of Pulmonary and Critical Care Medicine, Thoraxklinik-University of Heidelberg, Heidelberg, Germany
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| |
Collapse
|
5
|
Grillo LJ, Housley GM, Gangadharan S, Majid A, Hull JH. Physiotherapy for large airway collapse: an ABC approach. ERJ Open Res 2022; 8:00510-2021. [PMID: 35211621 PMCID: PMC8864626 DOI: 10.1183/23120541.00510-2021] [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: 08/17/2021] [Accepted: 10/17/2021] [Indexed: 11/05/2022] Open
Abstract
Large airway collapse (LAC) describes the phenomenon of excessive, abnormal, inward movement of the large airways (i.e. trachea and/or main bronchi and/or bronchus intermedius) occurring during the expiratory phase of the respiratory cycle. It is an increasingly well-recognised problem and a prevalent comorbidity in other chronic respiratory conditions (e.g. COPD and asthma). LAC is associated with pervasive respiratory features such as a barking cough, exertional dyspnoea and an increased propensity to lower respiratory tract infection. These symptoms are unpleasant, and patients are often limited in their daily life and their function. The pathophysiology of this condition impairs airway clearance and can cause breathlessness and exercise intolerance, due to a loss of airway patency during expiratory flow. Dysfunctional adaptations to breathing and coughing may further amplify symptoms. This article provides, for the first time, clinically focused physiotherapeutic intervention advice based on our understanding of the pathophysiology of LAC, to support conservative management. It uses the available evidence from LAC, transferable evidence from other conditions and knowledge based on clinical experience. It proposes a practical "ABC model" to ensure physiotherapy assessment and treatments are centred around optimising three key clinical areas: Airways, including airway clearance and cough; Breathing, including breathlessness and breathing pattern; and Capacity for exercise, including an assessment of functional exercise ability.
Collapse
Affiliation(s)
- Lizzie J.F. Grillo
- Royal Brompton and Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Sidhu Gangadharan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adnan Majid
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James H. Hull
- Royal Brompton and Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Institute of Sport, Exercise and Health, UCL, London, UK
| |
Collapse
|
6
|
Kheir F, Ospina-Delgado D, Beattie J, Singh R, Vidal B, VanderLaan PA, Parikh M, Chee A, Gangadharan SP, Wilson J, Majid A. Argon Plasma Coagulation (APC) for the Treatment of Excessive Dynamic Airway Collapse (EDAC): An Animal Pilot Study. J Bronchology Interv Pulmonol 2021; 28:221-227. [PMID: 34151900 DOI: 10.1097/lbr.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical stabilization of the airway through tracheobronchoplasty (TBP) is the current treatment modality for patients with severe symptomatic excessive dynamic airway collapse. However, TBP is associated with increased morbidity and mortality. Bronchoscopic treatment of the posterior membrane using argon plasma coagulation (APC) may be a safer alternative to TBP in highly selected patients. This study aimed to evaluate the effect of APC in the tracheobronchial tree of a sheep animal model. PATIENTS AND METHODS Two adult sheep were used for this study. Under flexible bronchoscopy, the posterior tracheal membrane was treated with precise APC using different power settings. Chest computed tomography was done at 2 days and bronchoscopy was performed at 30 days following initial procedure, before euthanasia. The airways were assessed for the presence of treatment-related histopathologic changes along with expression of genes associated with fibrosis. RESULTS There was no perioperative or postoperative morbidity or mortality. Chest computed tomography showed no signs of pneumomediastinum or pneumothorax. Flexible bronchoscopy showed adequate tracheobronchial tissue healing process, independent of the power settings used. Histologic changes demonstrated an increased extent of fibroblastic collagen deposition in the treated posterior membrane when higher power settings were used. In a similar manner, APC treatment managed to activate fibrosis-associated gene transcription factors, with higher settings achieving a higher level of expression. CONCLUSION APC at high-power settings achieved higher levels of fibroblast collagen deposition at the posterior membrane and higher expression of fibrosis-associated gene transcription factors, when compared with lower settings.
Collapse
Affiliation(s)
- Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology
| | | | - Jason Beattie
- Division of Interventional Pulmonary, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rani Singh
- Division of Thoracic Surgery and Interventional Pulmonology
| | - Barbara Vidal
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mihir Parikh
- Division of Thoracic Surgery and Interventional Pulmonology
| | - Alex Chee
- Division of Thoracic Surgery and Interventional Pulmonology
| | | | | | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology
| |
Collapse
|
7
|
Thermoablative Techniques for Excessive Central Airway Collapse: An Ex Vivo Pilot Study on Sheep Tracheal Tissue. J Bronchology Interv Pulmonol 2021; 27:195-199. [PMID: 32101912 DOI: 10.1097/lbr.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tracheobronchoplasty is the definitive treatment for patients with symptomatic excessive central airway collapse. This procedure is associated with high morbidity and mortality rates. Bronchoscopic techniques are an appealing alternative with less morbidity and the ability to apply it in nonsurgical patients. Although thermoablative methods have been proposed as treatment options to induce fibrosis of the posterior tracheobronchial wall, no studies have compared direct histologic effects of such methods. This study compared the effects of electrocautery, radiofrequency ablation, potassium titanyl phosphate laser, and argon plasma coagulation (APC) in the tracheobronchial tree in an ex vivo animal model. METHODS Four adult sheep cadavers were used for this study. Under flexible bronchoscopy, the posterior tracheal membrane was treated using different power settings on 4 devices. The airways were assessed for the presence of treatment-related histopathologic changes. RESULTS Histologic changes observed were that of acute thermal injury including: surface epithelium ablation, collagen fiber condensation, smooth muscle cytoplasm condensation, and chondrocyte pyknosis. No distinct histologic differences in the treated areas among different modalities and treatment effects were observed. APC at higher power settings was the only modality that produced consistent and homogenous thermal injury effects across all tissue layers with no evidence of complete erosion. CONCLUSION Although electrocautery, radiofrequency ablation, potassium titanyl phosphate laser, and APC all induce thermal injury of the airway wall, only APC at high power settings achieves this effect without complete tissue erosion, favoring potential regeneration and fibrosis. Live animal studies are now plausible.
Collapse
|
8
|
Chubachi S, Yamada Y, Yamada M, Yokoyama Y, Tanabe A, Matsuoka S, Niijima Y, Yamasawa W, Irie H, Murata M, Fukunaga K, Jinzaki M. Differences in airway lumen area between supine and upright computed tomography in patients with chronic obstructive pulmonary disease. Respir Res 2021; 22:95. [PMID: 33789651 PMCID: PMC8010787 DOI: 10.1186/s12931-021-01692-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND No clinical studies to date have compared the inspiratory and expiratory airway lumen area between supine and standing positions. Thus, the aims of this study were twofold: (1) to compare inspiratory and expiratory airway lumen area (IAA and EAA, respectively) on computed tomography (CT) among supine and standing positions; and (2) to investigate if IAA and EAA are associated with lung function abnormality in patients with chronic obstructive pulmonary disease (COPD). METHODS Forty-eight patients with COPD underwent both low-dose conventional (supine position) and upright CT (standing position) during inspiration and expiration breath-holds and a pulmonary function test (PFT) on the same day. We measured the IAA and EAA in each position. RESULTS For the trachea to the third-generation bronchi, the IAA was significantly larger in the standing position than in the supine position (4.1-4.9% increase, all p < 0.05). The EAA of all bronchi was significantly larger in the standing position than in the supine position (9.7-62.5% increases, all p < 0.001). The correlation coefficients of IAA in the standing position and forced expiratory volume in 1 s were slightly higher than those in the supine position. The correlation coefficients of EAA or EAA/IAA in the standing position and residual volume, and the inspiratory capacity/total lung capacity ratio were higher than those in the supine position. CONCLUSIONS Airway lumen areas were larger in the standing position than in the supine position. IAAs reflect airway obstruction, and EAAs reflect lung hyperinflation. Upright CT might reveal these abnormalities more precisely. Trial registration University Hospital Medical Information Network (UMIN 000026587), Registered 17 March 2017. URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000030456 .
Collapse
Affiliation(s)
- Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Akiko Tanabe
- Department of Clinical Laboratory, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Shiho Matsuoka
- Department of Clinical Laboratory, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Yuki Niijima
- Office of Radiation Technology, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Wakako Yamasawa
- Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Hidehiro Irie
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| |
Collapse
|
9
|
Yamada Y, Tanabe K, Nagase K, Ishihara T, Iida H. A Comparison of the Required Bronchial Cuff Volume Obtained by 2 Cuff Inflation Methods, Capnogram Waveform-Guided Versus Pressure-Guided: A Prospective Randomized Controlled Study. Anesth Analg 2021; 132:827-835. [PMID: 33002924 DOI: 10.1213/ane.0000000000005179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Double-lumen endobronchial tubes (DLTs) are used for one-lung ventilation (OLV) during thoracic surgery. Overinflation into the bronchial cuff causes damage to the tracheobronchial mucosa, whereas underinflation leads to an incomplete collapse of the nonventilated lung or incomplete ventilation of the ventilated lung. However, how to determine the appropriate bronchial cuff volume and pressure during OLV is unclear. The objective of this study is to compare the required bronchial cuff volume for lung separation obtained by 2 different cuff inflation methods under closed- and open-chest conditions. METHODS A total of 64 patients scheduled to undergo elective thoracic surgery requiring OLV were recruited. Left DLTs were used for both right- and left-sided surgery. The patients were randomly assigned to 1 of 2 inflation-type groups to estimate the bronchial cuff volume. In the capnogram waveform-guided bronchial cuff inflation group (capno group, n = 27), the bronchial cuff was inflated until a capnometer sampling gas containing CO2 from the nonventilated lung displayed a flat line. The corresponding bronchial cuff volume and pressure were then recorded. In the pressure-guided bronchial cuff inflation group (pressure group, n = 29), the bronchial cuff was inflated by a cuff inflator to a pressure of 20 cm H2O. Lung separation was confirmed when a flat line of a capnometer was observed after gas sampling from the nonventilated lung. RESULTS Under closed-chest conditions, the bronchial cuff sealing volume for the capno group was significantly lower than that for the pressure group (mean [standard deviation {SD}], 1.00 [0.65] mL vs 1.44 [0.59] mL, mean difference, -0.44; 97.5% confidence interval [CI], -0.78 to -0.11; P = .010). Under open-chest conditions, the bronchial cuff sealing volume for the capno group was also significantly lower than that for the pressure group (mean [SD], 0.65 [0.66] mL vs 1.22 [0.45] mL, mean difference, -0.58; 97.5% CI, -0.88 to -0.27; P < .001). CONCLUSIONS The lowest cuff volume providing an air-tight bronchial seal was obtained by the capnogram waveform-guided bronchial cuff inflation method. Since the cuff volume required to achieve an air-tight seal decreases after opening the chest, readjustment of the bronchial cuff volume to prevent bronchial cuff damage to the tracheobronchial mucosa after opening the chest may be advisable.
Collapse
Affiliation(s)
- Yuko Yamada
- From the Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kumiko Tanabe
- From the Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kiyoshi Nagase
- From the Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takuma Ishihara
- Gifu University Hospital Innovative and Clinical Research Promotion Center, Gifu University, Gifu, Japan
| | - Hiroki Iida
- From the Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|
10
|
Diaz Milian R, Foley E, Bauer M, Martinez-Velez A, Castresana MR. Expiratory Central Airway Collapse in Adults: Anesthetic Implications (Part 1). J Cardiothorac Vasc Anesth 2019; 33:2546-2554. [DOI: 10.1053/j.jvca.2018.08.205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 12/17/2022]
|
11
|
Guibert N, Didier A, Moreno B, Lepage B, Leyx P, Plat G, Mhanna L, Murris M, Mazières J, Hermant C. Treatment of complex airway stenoses using patient-specific 3D-engineered stents: a proof-of-concept study. Thorax 2019; 74:810-813. [PMID: 30944151 DOI: 10.1136/thoraxjnl-2018-212732] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 11/03/2022]
Abstract
Anatomically complex airway stenosis (ACAS) represents a challenging situation in which commercially available stents often result in migration or granulation tissue reaction due to poor congruence. This proof-of-concept clinical trial investigated the feasibility and safety of computer-assisted designed (CAD) and manufactured personalised three-dimensional (3D) stents in patients with ACAS from various origins. After CAD of a virtual stent from a CT scan, a mould is manufactured using a 3D computer numerical control machine, from which a medical-grade silicone stent is made. Complication rate, dyspnoea, quality of life and respiratory function were followed after implantation. The congruence of the stent was assessed peroperatively and at 1 week postimplantation (CT scan). The stent could be implanted in all 10 patients. The 3-month complication rate was 40%, including one benign mucus plugging, one stent removal due to intense cough and two stent migrations. 9 of 10 stents showed great congruence within the airways, and 8 of 10 induced significant improvement in dyspnoea, quality of life and respiratory function. These promising outcomes in highly complex situations support further investigation on the subject, including technological improvements. TRIAL REGISTRATION NUMBER: NCT02889029.
Collapse
Affiliation(s)
- Nicolas Guibert
- Service de Pneumologie, Pôle des Voies Respiratoires, CHU Toulouse, Hôpital Larrey, Toulouse, France .,Universite Toulouse III Paul Sabatier Faculte des Sciences et d'Ingenierie, Toulouse, France
| | - Alain Didier
- Service de Pneumologie, Pôle des Voies Respiratoires, CHU Toulouse, Hôpital Larrey, Toulouse, France.,Universite Toulouse III Paul Sabatier Faculte des Sciences et d'Ingenierie, Toulouse, France
| | | | - Benoit Lepage
- Universite Toulouse III Paul Sabatier Faculte des Sciences et d'Ingenierie, Toulouse, France
| | | | - Gavin Plat
- Service de Pneumologie, Pôle des Voies Respiratoires, CHU Toulouse, Hôpital Larrey, Toulouse, France
| | - Laurent Mhanna
- Service de Pneumologie, Pôle des Voies Respiratoires, CHU Toulouse, Hôpital Larrey, Toulouse, France
| | - Marlene Murris
- Service de Pneumologie, Pôle des Voies Respiratoires, CHU Toulouse, Hôpital Larrey, Toulouse, France
| | - Julien Mazières
- Service de Pneumologie, Pôle des Voies Respiratoires, CHU Toulouse, Hôpital Larrey, Toulouse, France.,Universite Toulouse III Paul Sabatier Faculte des Sciences et d'Ingenierie, Toulouse, France
| | - Christophe Hermant
- Service de Pneumologie, Pôle des Voies Respiratoires, CHU Toulouse, Hôpital Larrey, Toulouse, France
| |
Collapse
|
12
|
Rendo M, Sjulin TJ, Morris MJ, Burguete S. Upper airway wheezing: Inducible laryngeal obstruction vs. excessive dynamic airway collapse. Respir Med Case Rep 2019; 27:100827. [PMID: 30989047 PMCID: PMC6446124 DOI: 10.1016/j.rmcr.2019.100827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/02/2022] Open
Abstract
There are multiple causes of dyspnea upon exertion in young, healthy patients to primarily include asthma and exercise-induced bronchospasm. Excessive dynamic airway collapse (EDAC) describes focal collapse of the trachea or main bronchi with maintained structural integrity of the cartilaginous rings. It is commonly associated with pulmonary disorders like bronchiectasis, chronic obstructive pulmonary disease and asthma. It is believed to result secondary to airway obstruction in these conditions. While uncommon in young, healthy adults, it has recently been found as a cause of dyspnea in this population. Inducible laryngeal obstruction (ILO) is an umbrella term that describes an induced, intermittent upper airway impediment. While ILO is found in 10% of young patients with exertional dyspnea, it is primarily inspiratory in nature due to paradoxical closure of the glottis or supraglottis. This report highlights the presentation of a United States Army soldier who after a deployment was given a diagnosis of asthma, later found to have ILO and was subsequently diagnosed with concurrent EDAC. We follow up with a literature review and discussion of symptomatology, diagnosis, exercise bronchoscopy, and treatment modalities for both EDAC and ILO.
Collapse
Affiliation(s)
- Matthew Rendo
- San Antonio Military Medical Center, Internal Medicine, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234-6160, USA
| | - Tyson J Sjulin
- San Antonio Military Medical Center, Pulmonary/Critical Care, USA
| | - Michael J Morris
- San Antonio Military Medical Center, Pulmonary/Critical Care, USA
| | - Sergio Burguete
- University of Texas Health Science Center at San Antonio, Pulmonary/Critical Care, USA
| |
Collapse
|
13
|
Majid A, Kheir F, Alape D, Kent M, Lembo A, Rangan VV, Carreiro M, Gangadharan SP. The Prevalence of Gastroesophageal Reflux in Patients With Excessive Central Airway Collapse. Chest 2018; 155:540-545. [PMID: 30312588 DOI: 10.1016/j.chest.2018.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/10/2018] [Accepted: 09/24/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux (GER) is increasingly recognized as an exacerbating or causal factor in several respiratory diseases. There is a high prevalence of GER in infants with airway malacia. However, such data are lacking in adults. METHODS This retrospective study was conducted to determine the relationship between GER and excessive central airway collapse (ECAC). The study included consecutive patients with ECAC referred to the Complex Airway Center at Beth Israel Deaconess Medical Center who underwent esophageal pH testing for GER between July 2014 and June 2018. RESULTS Sixty-three of 139 patients with ECAC (45.3%) had documented GER as shown by an abnormal esophageal pH test result. The mean DeMeester score was 32.2, with a symptom association probability of 39.7% of GER-positive patients. Twenty-nine of 63 patients (46%) with GER reported improvement in respiratory symptoms following maximal medical therapy or antireflux surgery without requiring further treatment for ECAC. CONCLUSIONS GER is prevalent among patients with ECAC, and aggressive reflux treatment should be considered in these patients prior to considering invasive airway procedures or surgery.
Collapse
Affiliation(s)
- Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Daniel Alape
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael Kent
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Anthony Lembo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vikram V Rangan
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Megan Carreiro
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
14
|
Improving Quality of Dynamic Airway Computed Tomography Using an Expiratory Airflow Indicator Device. J Thorac Imaging 2018; 33:191-196. [PMID: 29470258 DOI: 10.1097/rti.0000000000000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Dynamic computed tomography (CT) of the airways is increasingly used to evaluate patients with suspected expiratory central airway collapse, but current protocols are susceptible to inadequate exhalation caused by variable patient compliance with breathing instructions during the expiratory phase. We developed and tested a low-cost single-use expiratory airflow indicator device that was designed to improve study quality by providing a visual indicator to both patient and operator when adequate expiratory flow was attained. MATERIALS AND METHODS A total of 56 patients undergoing dynamic airway CT were evaluated, 35 of whom were scanned before introduction of the indicator device (control group), with the rest comprising the intervention group. Lung volumes and tracheal cross-sectional areas on inspiratory/expiratory phases were computed using automated lung segmentation and quantitative software analysis. Inadequate exhalation was defined as absolute volume change of <500 mL during the expiratory phase. RESULTS Fewer patients in the intervention group demonstrated inadequate exhalation. The average change in volume was higher in the intervention group (P=0.004), whereas the average minimum tracheal cross-sectional area was lower (P=0.01). CONCLUSIONS The described expiratory airflow indicator device can be used to ensure adequate exhalation during the expiratory phase of dynamic airway CT. A higher frequency of adequate exhalation may improve reliability and sensitivity of dynamic airway CT for diagnosis of expiratory central airway collapse.
Collapse
|
15
|
Gallardo Estrella L, Pompe E, Kuhnigk JM, Lynch DA, Bhatt SP, van Ginneken B, van Rikxoort EM. Computed tomography quantification of tracheal abnormalities in COPD and their influence on airflow limitation. Med Phys 2017; 44:3594-3603. [PMID: 28423189 DOI: 10.1002/mp.12274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To present a method to automatically quantify tracheal morphology changes during breathing and investigate its contribution to airflow impairment when adding CT measures of emphysema, airway wall thickness, air trapping and ventilation. METHODS Because tracheal abnormalities often occur localized, a method is presented that automatically determines the most abnormal trachea section based on automatically computed sagittal and coronal lengths. In this most abnormal section, trachea morphology is encoded using four equiangular rays from the center of the trachea and the normalized lengths of these rays are used as features in a classification scheme. Consequently, trachea measurements are used as input for classification into GOLD stages in addition to emphysema, air trapping and ventilation. A database of 200 subjects distributed across all GOLD stages is used to evaluate the classification with a k nearest neighbour algorithm. Performance is assessed in two experimental settings: (a) when only inspiratory scans are taken; (b) when both inspiratory and expiratory scans are available. RESULTS Given only an inspiratory CT scan, measuring tracheal shape provides complementary information only to emphysema measurements. The best performing set in the inspiratory setting was a combination of emphysema and bronchial measurements. The best performing feature set in the inspiratory-expiratory setting includes measurements of emphysema, ventilation, air trapping, and trachea. Inspiratory and inspiratory-expiratory settings showed similar performance. CONCLUSIONS The fully automated system presented in this study provides information on trachea shape at inspiratory and expiratory CT. Addition of tracheal morphology features improves the ability of emphysema and air trapping CT-derived measurements to classify COPD patients into GOLD stages and may be relevant when investigating different aspects of COPD.
Collapse
Affiliation(s)
- Leticia Gallardo Estrella
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands
| | - Esther Pompe
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Jan-Martin Kuhnigk
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, 28359, Germany
| | - David A Lynch
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Bram van Ginneken
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands.,Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, 28359, Germany
| | - Eva Marjolein van Rikxoort
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands.,Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, 28359, Germany
| |
Collapse
|
16
|
Majid A, Alape D, Kheir F, Folch E, Ochoa S, Folch A, Gangadharan SP. Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse. Respiration 2016; 92:389-396. [DOI: 10.1159/000450961] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022] Open
|
17
|
Stockley RA, Parr DG. Chronic obstructive pulmonary disease. IMAGING 2016. [DOI: 10.1183/2312508x.10002515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|