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Zhang YN, Shi HY, Shen WQ, Shi JH, Zhu YP, Xu YH, Wu HL. Effect of varying cuff sizes with identical inner diameter on endotracheal intubation in critically ill adults: A sealed tracheal controlled trial. Medicine (Baltimore) 2024; 103:e38326. [PMID: 38875381 PMCID: PMC11175911 DOI: 10.1097/md.0000000000038326] [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: 06/16/2024] Open
Abstract
BACKGROUND The present study aims to determine the impact of different cuff diameters on the cuff pressure of endotracheal tubes (ETTs) when the trachea is adequately sealed. METHODS In the present single-center clinical trial, adult patients who underwent cardiothoracic surgery were assigned to use ETTs from 2 brands (GME and GZW). The primary endpoint comprised of the following: cuff diameter, inner diameter of the ETT, manufacturer, and the number of subjects with tracheal leakage when the cuff pressure was 30 cm H2O. RESULTS A total of 298 patients were assigned into 2 groups, based on the 2 distinct brands of ETTs: experimental group (n = 122, GME brand) and control group (n = 176, GZW brand). There were no significant differences in baseline characteristics. However, the cuff diameter was significantly smaller in the control group, when compared to the experimental group (P = .001), and the incidence of tracheal leakage was significantly higher in the control group (P = .001). Furthermore, the GME brand ETT had a significantly larger cuff diameter, when compared to the GZW brand ETT. CONCLUSION The cuff size would mismatch the tracheal area in clinical practice. Therefore, chest computed tomography is recommended to routinely evaluate the tracheal cross-sectional area during anesthesia, in order to ensure the appropriate cuff size selection.
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Affiliation(s)
- Yan-Nan Zhang
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Hai-Yan Shi
- Nursing Department, The People's Hospital of Rugao, and Affiliated Rugao Hospital of Nantong University, Nantong City, Jiangsu, China
| | - Wang-Qin Shen
- Nursing Department, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Jia-Hai Shi
- Department of Cardiothoracic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yan-Ping Zhu
- Intensive Care Unit, Southeast University Affiliated Zhong Da Hospital, Nanjing, Jiangsu, China
| | - Yang-Hui Xu
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Hong-Lei Wu
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Wu H, Wu Y, Shen W, Shi J, Zhu Y, Xu Y, Shen H, Ding L. Risk factor evaluation of cuff pressure of >30 cmH 2O to stop air leakage during mechanical ventilation: A prospective observational study. Nurs Open 2024; 11:e2187. [PMID: 38837558 PMCID: PMC11150861 DOI: 10.1002/nop2.2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/26/2024] [Indexed: 06/07/2024] Open
Abstract
AIM The commonly recommended endotracheal tube cuff pressure is 20-30 cmH2O. However, some patients require a cuff pressure of >30 cmH2O to prevent air leakage. The study aims to determine the risk factors that contribute to the endotracheal tube cuff pressure of >30 cmH2O to prevent air leakage. DESIGN A multi-centre prospective observational study. METHODS Eligible patients undergoing mechanical ventilation in the intensive care unit of three hospitals between March 2020 and July 2022 were included. The endotracheal tube cuff pressure to prevent air leakage was determined using the minimal occlusive volume technique. The patient demographics and clinical information were collected. RESULTS A total of 284 patients were included. Among these patients, 55 (19.37%) patients required a cuff pressure of >30 cmH2O to prevent air leakage. The multivariate logistic regression results revealed that the surgical operation (odds ratio [OR]: 8.485, 95% confidence interval [CI]: 1.066-67.525, p = 0.043) was inversely associated with the endotracheal tube cuff pressure of >30 cmH2O, while the oral intubation route (OR: 0.127, 95% CI: 0.022-0.750, p = 0.023) and cuff inner diameter minus tracheal area (OR: 0.949, 95% CI: 0.933-0.966, p < 0.001) were negatively associated with the endotracheal tube cuff pressure of >30 cmH2O. Therefore, a significant number of patients require an endotracheal tube cuff pressure of >30 cmH2O to prevent air leakage. Several factors, including the surgical operation, intubation route, and difference between the cuff inner diameter and tracheal area at the T3 vertebra, should be considered when determining the appropriate cuff pressure during mechanical ventilation.
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Affiliation(s)
- Hong‐Lei Wu
- Nursing DepartmentAffiliated Hospital of Nantong UniversityNantongJiangsuChina
| | - Yue‐Hong Wu
- College of NursingAnhui University of Chinese MedicineHefeiAnhuiChina
| | - Wang‐Qin Shen
- Nursing DepartmentNantong UniversityNantongJiangsuChina
| | - Jia‐Hai Shi
- Department of Cardiothoracic SurgeryAffiliated Hospital of Nantong UniversityNantongJiangsuChina
| | - Yan‐Ping Zhu
- Intensive Care Unit of Southeast University Affiliated Zhong da HospitalNanjingJiangsuChina
| | - Yang‐Hui Xu
- Nursing DepartmentAffiliated Hospital of Nantong UniversityNantongJiangsuChina
| | - Hong‐Wu Shen
- Nursing DepartmentAffiliated Hospital of Nantong UniversityNantongJiangsuChina
| | - Lei Ding
- Intensive Care Unit of Nantong Third People's HospitalAffiliated Nantong Hospital 3 of Nantong UniversityNantongJiangsuChina
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Lam K, Hoang LV, Anh LV. Tracheal bronchus and associated pathologies detected by multidetector-row computed tomography in the Vietnamese population. J Clin Imaging Sci 2022; 12:56. [PMID: 36325494 PMCID: PMC9609878 DOI: 10.25259/jcis_40_2022] [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: 04/10/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
Tracheal bronchus (TB) is a very rare condition, which is often associated with some other pathologies. This study was designed to characterize the morphology of tracheal bronchus and associated pathologies in Vietnamese individuals using multidetector-row computed tomography (MDCT). From August 2016 to February 2021, 16, 64-, and 128-detector-row computed tomography scanners were used to perform chest scans of 3663 patients, of whom 32 had tracheal bronchus and associated pathologies. The prevalence of tracheal bronchus was 0.9%, of which 0.6% were male and 0.3% were female. We found that one patient had bilateral tracheal bronchus (3.1%) and 31 patients (96.9%) had right-sided tracheal bronchus. Most patients (75.1%) had type II tracheal bronchus, whereas 15.6% and 6.2% had type III and type I tracheal bronchus, respectively. The average distance from the tracheal bronchus to the carina was 6.6 ± 6.4 mm. The average diameter of the tracheal bronchus was 4.4 ± 2.2 mm; the group with 2–4-mm tracheal bronchus accounted for the highest proportion (46.9%). Associated pathologies included congenital heart diseases (i.e., valvular heart disease, tetralogy of Fallot, cyanotic congenital heart disease-APSO, and aortic coarctation) (43.7%), stenosis of the bilateral pulmonary arteries (15.6%), absent left pulmonary artery (6.2%), stenosis of the right pulmonary artery (3.1%), anomalous pulmonary venous connection (3.1%), stenosis of the trachea (3.1%), stenosis of the left main bronchus (3.1%), bronchogenic cyst (3.1%), and bronchial atresia (3.1%), and the remaining 12.5% had no abnormalities. tracheal bronchus is a very rare abnormality among Vietnamese and is often accompanied by other pathologies. MDCT with a high spatial resolution and a good tissue contrast, along with contrast agent and appropriate scanning protocols, is efficient in detecting tracheal bronchus and associated pathologies.
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Affiliation(s)
- Khanh Lam
- Department of Diagnostic Imaging, Hospital 108, Hanoi, Vietnam
| | - Luong Van Hoang
- Department of Diagnostic Imaging, National Lung Hospital, Hanoi, Vietnam
| | - Lam Viet Anh
- College of Health Sciences, Vin University, Hanoi, Vietnam,
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Biciuşcă V, Popescu IAS, Traşcă DM, Olteanu1 M, Stan IS, Durand P, Camen GC, Bălteanu MA, Cazacu IM, Demetrian AD, Streba CT, Călăraşu C, Cioboată R, Cioboată R. Diagnosis of lung cancer by flexible fiberoptic bronchoscopy: a descriptive study. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:369-381. [PMID: 36374142 PMCID: PMC9804073 DOI: 10.47162/rjme.63.2.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Flexible fiberoptic bronchoscopy (FFB) remains the most important minimally invasive method for the diagnosis of lung cancer (LC). We performed a retrospective study to assess the main endoscopic findings of malignant lung tumors in the large airways in a cohort of Romanian patients. The group consisted of 32 (84.21%) men and six (15.78%) women, with an average age of 64.63±6.07 years. The bronchoscopic examination allowed the detection and biopsy of 36 malignant lung tumors, and in two other cases, due to malignant atelectasis, the patients were sent to a Department of Thoracic Surgery, to perform the biopsy following the surgery. Histopathological (HP) examination revealed the presence of squamous cell carcinoma (SCC) in 19 (50%) patients, adenocarcinoma (ADC) in 11 (28.94%) patients and small cell lung cancer (SCLC) in eight (21.05%) patients. The macroscopic and microscopic analysis of the lung tumors showed that infiltrative forms were found in most cases (58.33%), followed by exophytic (mass) endobronchial lesions (22.22%) and mixed forms (19.44%). If most infiltrative forms were SCC (66.66%), the exophytic and mixed lesions were most frequently ADC (50% and 57.14%). The tumor lesions caused both malignant bronchial stenosis (57.89%) and malignant atelectasis (42.1%). The main mechanisms involved in bronchial malignant obstruction were endoluminal (50%), mixed (31.57%) and extraluminal (18.42%) mechanisms. In conclusion, FFB remains the main method of diagnosing LC in the large airways. The most common macroscopic appearance of lung tumors revealed by bronchoscopy was the infiltrative appearance. In half of our patients, the malignant bronchial obstruction was achieved by endoluminal mechanism. The most common pathological form found in our patients was the SCC, as described in half of the investigated patients.
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Affiliation(s)
- Viorel Biciuşcă
- Department of Internal Medicine, Department of Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania; ;
| | - Iulian Alin Silviu Popescu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Diana Maria Traşcă
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Mihai Olteanu1
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Ionelia Sorina Stan
- Resident Physician, Department of Internal Medicine, Emergency County Hospital, Craiova, Romania
| | - Patricia Durand
- Resident Physician, Department of Internal Medicine, Filantropia Municipal Hospital, Craiova, Romania
| | - Georgiana-Cristiana Camen
- Department of Radiology and Medical Imaging, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Mara Amalia Bălteanu
- Department of Pneumology, Faculty of Medicine, Titu Maiorescu University, Romania
| | - Irina Mihaela Cazacu
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alin Dragoş Demetrian
- Department of Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Costin Teodor Streba
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Cristina Călăraşu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Ramona Cioboată
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
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Plaksin SA. [Diagnosis and treatment of benign lung tumors]. Khirurgiia (Mosk) 2021:106-111. [PMID: 34029044 DOI: 10.17116/hirurgia2021061106] [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: 11/18/2022]
Abstract
Benign lung tumors account 2-12% of all lung neoplasms. The classification of lung tumors, adopted by the World Health Organization in 2015, is reported with a detailed indication of all changes based on immunohistochemical and genetic studies. Diagnosis with computed tomography, dynamic and perfusion computed tomography, virtual bronchoscopy and positron emission tomography is described. These methods ensure 94-98% sensitivity for differentiation with malignancies. CT and ultrasound signs of benign tumors are presented. Surgical strategy for newly diagnosed nodes in the lungs is analyzed depending on their dimensions and risk factors. It was shown that comprehensive examination with possible surgical verification of the diagnosis is necessary for nodes over 6 mm and moderate-to-high risk factors. The authors describe argon plasma and laser destruction, bronchoplastic procedures for central benign tumors, thoracoscopy for peripheral neoplasms. One can conclude that high-tech methods of radiological and nuclear diagnosis are valuable to determine benign neoplasms and their dimensions with a high degree of reliability. Endoscopic and thoracoscopic procedures are successfully used for benign tumors.
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Affiliation(s)
- S A Plaksin
- Vagner Perm State Medical University, Perm, Russia
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Abstract
Background and objectives Tracheal bronchus (TB) is a rare congenital airway anomaly originating from the trachea, with a reported prevalence of 0.9%-3% in children. Although TB was studied in the literature, this anomaly was not evaluated in Qatar. Our study aimed to identify the prevalence and congenital anomalies associated with TB in children in Qatar. Design In this descriptive study, we identified patients who underwent flexible bronchoscopy (FB) at two large tertiary centers in Qatar from July 2007 to November 2020. The patients’ demographic, bronchoscopic, and radiologic data were collected. The prevalence of TB and associated congenital anomalies were determined. Results Of 1786 patients who underwent FB, 20 (1.12%) were diagnosed with TB. The median age at the time of diagnosis was 31 months (range, 2-154 months). The associated congenital anomalies were identified in 16 cases (80%; p = 0.007). Cardiac defects represent the most common associated anomaly (8/20, 40%). Conclusion This study revealed that TB is an uncommon airway anomaly and emphasizes its significant association with other congenital malformations. Our findings should alert physicians to other associated TB anomalies and provide timely management when needed.
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Affiliation(s)
| | - Sara Hamad
- Pediatric Pulmonology, Hamad Medical Corporation, Doha, QAT
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Choi MJ, Kang H. CT Findings of Central Airway Lesions Causing Airway Stenosis-Visualization and Quantification: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1441-1476. [PMID: 36238875 PMCID: PMC9431977 DOI: 10.3348/jksr.2020.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/02/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
The tracheobronchial tree is a system of airways that allows the passage of air to aerate the lungs and entire body. Several pathological conditions can affect this anatomical region. Multidetector CT (MDCT) helps identify and characterize various large airway diseases. Post-processing tools, such as virtual bronchoscopy and automatic lung analysis, can help enhance the performance of imaging studies. In this pictorial essay review, we provide imaging findings of various bronchial lesions manifested as wall thickening and endoluminal nodules on conventional MDCT and advanced image visualization and analysis.
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Affiliation(s)
- Myeong Jin Choi
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Hee Kang
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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Suzuki M, Miyawaki E, Hojo M, Sugiyama H. Unexpected Bronchial Foreign Body Aspiration. Intern Med 2020; 59:1111-1112. [PMID: 32295997 PMCID: PMC7205526 DOI: 10.2169/internalmedicine.3970-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Eriko Miyawaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
- Division of Thoracic Oncology, Shizuoka Cancer Center, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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Abstract
OBJECTIVES To characterize the real size and morphology of tracheas in childhood for the optimal selection of endotracheal tube. DESIGN A retrospective cohort study of pediatric patients who received CT scan of the cervical spine from July 2011 to March 2018. Cross-sectional CT images vertical to trachea were reconstructed and the accurate tracheal diameters were measured. The validity of the traditional age-based formula for predicting the endotracheal tube size was assessed for the best fit to trachea. SETTING Tertiary Emergency and Critical Care Center of Kyushu University Hospital. PATIENTS Children, who are 1 month to 15 years old, received CT scan of the cervical spine. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We enrolled 86 children with median age of 53 months. The cross-sectional shape of pediatric trachea was circular at the cricoid level and elliptical at the infraglottic level. The narrowest part of pediatric trachea was the transverse diameter at the infraglottic level at any age. Significant positive correlation between age and the narrowest diameter was observed. When compared the transverse diameter at the infraglottic level with the outer diameter of endotracheal tubes, uncuffed endotracheal tubes selection based on the traditional age-based formula ran a significant risk of oversized endotracheal intubation until 10 years old compared with cuffed endotracheal tubes selection (60.0% vs 23.8%; p < 0.05). CONCLUSIONS These findings indicate the safety and efficacy of cuffed endotracheal tubes in infants and children and the reconsideration for the airway management in pediatric anesthesia and intensive care.
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Abstract
Tumors of trachea and bronchi are uncommon and can occur in the form of benign or low- and high-grade malignant tumors. Although tracheobronchial tumors (TBTs) represent only 0.6% of all pulmonary tumors, they are clinically significant. Delays in diagnosis of these tumors commonly occur because the signs and symptoms caused by these tumors are nonspecific and chest radiographs are often considered unremarkable. Therefore, novel radiological techniques and better access to flexible bronchoscopy enable detection of larger number of TBT. The purpose of this article is to provide a review of tracheal and bronchial tumors and discuss significant aspects of the different TBT with focus on clinical manifestations and diagnostic procedures.
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Affiliation(s)
- Ruza Stevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia;; Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia;; Clinic for Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
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