Search Results (18)

Background/Objectives: There exist three principal treatment modalities employed in the management of hyperthyroidism attributable to excessive hormone secretion by the thyroid gland: antithyroid pharmacotherapy, surgical intervention, and radioactive iodine (RAI) therapy. Surgical intervention is typically indicated for markedly enlarged thyroid glands that exert pressure on the trachea. The objective of this investigation was to ascertain the influence of RAI on thyroid volume and tracheal diameter. Methods: This study included 20 patients, six females and 14 males, who received 20 mCi radioactive iodine treatment for toxic nodular goiter at a tertiary university hospital between March 2019 and February 2020. Pre-treatment and six-month post-treatment neck MRI scans were conducted on the cohort. Thyroid and tracheal volumes were quantified using the Cavalieri method based on MRI sections, and comparisons were conducted pre-and post-treatment. Statistical analysis of the comparative values was performed using the dependent samples t-test. Results: A statistically significant reduction in thyroid volume was observed among the 20 patients, averaging a decrease of 36.06% following RAI treatment compared to baseline measurements (p < 0.001). Additionally, an average increase of 12.76% in tracheal volume was noted post-treatment in comparison to initial measurements, which was also statistically significant (p < 0.05). None of the patients exhibited respiratory distress in the immediate postoperative period. Conclusions: The findings indicate that RAI therapy leads to a reduction in thyroid size, accompanied by an increase in tracheal diameters subsequent to treatment. Given the potential complications and risks associated with surgical intervention, it may be prudent to consider large thyroids for RAI therapy as an alternative to surgery. Full article

High flow oxygen (HFO) therapy is a well-established treatment in respiratory disease. Concurrent aerosol delivery can greatly expediate their recovery. The aim of this work was to complete a comprehensive characterisation of one such HFO therapy system, the Airvo2^TM, used in combination with the Aerogen Solo^TM vibrating mesh nebuliser. Representative adult, infant, and paediatric head models were connected to a breathing simulator via a collection filter placed at the level of the trachea. A tracheostomy interface and nasal cannulas were used to deliver the aerosol. Cannula size and gas flow rate were varied across the full operating range recommended by the manufacturer. The tracheal and emitted doses were quantified via UV-spectrophotometry. The aerosol droplet diameter at the exit of the nares and tracheal interface was measured via cascade impaction. High gas flow rates resulted in low emitted and tracheal doses (%). Nasal cannula size had no significant effect on the tracheal dose (%) available in infant and paediatric models. Higher gas flow rates resulted in smaller aerosol droplets at the exit of the nares and tracheostomy interface. Gas flow rate was found to be the primary parameter affecting aerosol delivery. Thus, gas flow rates should be kept low and where possible, delivered using larger nasal cannulas to maximise aerosol delivery. Full article

Cetaceans, including beluga whales (Delphinapterus leucas), have high morbidity and mortality rates due to bacterial or fungal lower respiratory infections. Bronchoalveolar lavage fluid (BALF) collection by bronchoscopy is beneficial for detecting pathogenic microorganisms in the lower respiratory tract. Efficient and safe bronchoscopy requires characterizing the bronchial tree systems of beluga whales, as no reports exist on bronchial length and bifurcation. In this study, bronchoscopy was performed on five captive beluga whales (9–44 years old) to detect bronchial length and bifurcation. The lengths from the blowhole to the scope impassable points due to the minimized bronchi diameters of the left principal bronchus (LPB), right principal bronchus (RPB), and tracheal bronchus (TB) were 110–155, 110–150, and 80–110 cm, respectively, and were correlated with the body length. Bronchoscopy identified more than 10, 10, and 6 bifurcated bronchi from the LPB, RPB, and TB, respectively. This is the first report to clarify the differences in bronchial tree systems between beluga whales and other cetaceans, as well as the differences for each individual beluga whale. These results could be useful for obtaining BALF via bronchoscopy to detect pathogenic microorganisms causing infections in the lower respiratory tract of beluga whales. Full article

Tracheal hypoplasia is a major concern in brachycephalic dogs, but there is no consensus for the trachea in brachycephalic cats. We aimed to compare tracheal length and diameter between normo- and brachycephalic cats using computed tomography (CT) image measurements and evaluate their usefulness in tracheostomy planning. A total of 15 normocephalic and 14 brachycephalic cats were included in the study. Tracheas of normocephalic cats were significantly longer compared with brachycephalic cats. No difference was detected in tracheal diameter between normocephalic and brachycephalic cats. Both groups had a lateral diameter significantly larger than the dorsoventral diameter at the level of the cranial end of the manubrium sterni and at the level of the second rib. Normocephalic and brachycephalic cats’ tracheas have the same dorsoventral flattening at the level of the cranial end of the manubrium sterni and at the level of the second rib. The location between the 4th and 5th cervical vertebrae seems the best place to perform a tracheostomy in cats due to its round shape and easily accessible anatomical location. No sign of tracheal hypoplasia in brachycephalic cats was detected. Finally, 7 mm appears to be an adequate diameter for the tracheal tubes used to perform feline tracheostomies. Full article

Background: Our aim was to report on the use of an innovative technique for airway management utilizing a small diameter, short-cuffed, long orotracheal tube for assisting operative rigid bronchoscopy in critical airway obstruction. Methods: We retrospectively reviewed the clinical data of 36 patients with life-threatening critical airway stenosis submitted for rigid bronchoscopy between January 2008 and July 2021. The supporting ventilatory tube, part of the Translaryngeal Tracheostomy KIT (Fantoni method), was utilized in tandem with the rigid bronchoscope during endoscopic airway reopening. Results: Indications for collateral intubation were either tumors of the trachea with near-total airway obstruction (13), or tumors of the main carina with total obstruction of one main bronchus and possible contralateral involvement (23). Preliminary dilation was necessary before tube placement in only 2/13 patients with tracheal-obstructing tumors (15.4%). No postoperative complications were reported. There was one case of an intraoperative cuff tear, with no further technical problems. Conclusions: In our experience, this innovative method proved to be safe, allowing for continuous airway control. It enabled anesthesia inhalation, use of neuromuscular blockage and reliable end-tidal CO₂ monitoring, along with protection of the distal airway from blood flooding. The shorter time of the procedure was due to the lack of need for pauses to ventilate the patient. Full article

Background and Objectives: Supraglottic airway devices (SADs) are known to be useful in eliminating the drawbacks of laryngoscopy and tracheal intubation, especially ocular pressure and stress responses. The ultrasonographic measurement of optic nerve sheath diameter (ONSD) reflects increases in intracranial pressure (ICP). In our study, we aimed to compare the effects of SADs on hemodynamic response and ONSD. Materials and Methods: Our prospective study included 90 ASA I–II patients over the age of 18 who did not have a history of difficult intubation or ophthalmic pathology. The patients were randomly divided into three groups based on the laryngeal mask airway (LMA) devices used: ProSeal LMA (pLMA, n = 30), LMA Supreme (sLMA, n = 30), and I-gel (n = 30). The bilateral ONSD measurements and hemodynamic data of the patients who underwent standard anesthesia induction and monitoring were recorded before induction (T0) and 1 min (T1), 5 min (T5), and 10 min (T10) after SAD placement. Results: At all measurement times, the hemodynamic responses and ONSD values of the groups were similar. In all three groups, intergroup hemodynamic changes at T0 and T1 were similar and higher than those at other times of measurement (p < 0.001). The ONSD values of all groups increased at T1, and they tended to return to baseline values afterward (p < 0.001). Conclusions: We concluded that all three SADs could be used safely because they preserved both hemodynamic stability and ONSD changes in their placement processes, and they did not cause elevations in ONSD to an extent that would lead to increased ICP. Full article

The structure of a traditional rigid bronchoscope includes proximal, distal, and body, representing an important means to treat hypoxic diseases. However, the body structure is too simple, resulting in the utilization rate of oxygen being usually low. In this work, we reported a deformable rigid bronchoscope (named Oribron) by adding a Waterbomb origami structure to the body. The Waterbomb’s backbone is made of films, and the pneumatic actuators are placed inside it to achieve rapid deformation at low pressure. Experiments showed that Waterbomb has a unique deformation mechanism, which can transform from a small-diameter configuration (#1) to a large-diameter configuration (#2), showing excellent radial support capability. When Oribron entered or left the trachea, the Waterbomb remained in #1. When Oribron is working, the Waterbomb transforms from #1 to #2. Since #2 reduces the gap between the bronchoscope and the tracheal wall, it effectively slows down the rate of oxygen loss, thus promoting the absorption of oxygen by the patient. Therefore, we believe that this work will provide a new strategy for the integrated development of origami and medical devices. Full article

In thoracic surgery, the double lumen endotracheal tube (DLT) is used for differential ventilation of the lung. DLT allows lung collapse on the surgical side that requires access to the thoracic and mediastinal areas. DLT placement for a given patient depends on two settings: a tube of the correct size (or ‘size’) and to the correct insertion depth (or ‘depth’). Incorrect DLT placements cause oxygen desaturation or carbon dioxide retention in the patient, with possible surgical failure. No guideline on these settings is currently available for anesthesiologists, except for the aid by bronchoscopy. In this study, we aimed to predict DLT ‘depths’ and ‘sizes’ applied earlier on a group of patients (n = 231) using a computer modeling approach. First, for these patients we retrospectively determined the correlation coefficient (r) of each of the 17 body parameters against ‘depth’ and ‘size’. Those parameters having r > 0.5 and that could be easily obtained or measured were selected. They were, for both DLT settings: (a) sex, (b) height, (c) tracheal diameter (measured from X-ray), and (d) weight. For ‘size’, a fifth parameter, (e) chest circumference was added. Based on these four or five parameters, we modeled the clinical DLT settings using a Support Vector Machine (SVM). After excluding statistical outliers (±2 SD), 83.5% of the subjects were left for ‘depth’ in the modeling, and similarly 85.3% for ‘size’. SVM predicted ‘depths’ matched with their clinical values at a r of 0.91, and for ‘sizes’, at an r of 0.82. The less satisfactory result on ‘size’ prediction was likely due to the small target choices (n = 4) and the uneven data distribution. Furthermore, SVM outperformed other common models, such as linear regression. In conclusion, this first model for predicting the two DLT key settings gave satisfactory results. Findings would help anesthesiologists in applying DLT procedures more confidently in an evidence-based way. Full article

Airway collapse (AC) in dogs includes a tracheal collapse, mainstem and lobar bronchial collapse, and bronchomalacia (i.e., segmental/subsegmental bronchial collapse). The clinical presentation of AC may overlap with non-collapsible airway disease (NCAD) or another non-lower airway respiratory disease (NLARD). This study determined whether paired inspiratory (I)/expiratory (E)-breath-hold computed tomography (I/E-BH CT) can detect a static and dynamic AC in dogs with spontaneous respiratory disease and it compared the CT-derived metrics of the AC to the tracheobronchoscopy metrics. The CT-acquired I and E diameter and cross-sectional area (CSA) for the trachea, mainstem and lobar bronchi in dogs with an AC (n = 16), NCAD (16), and NLARD (19) served for a dynamic percent of the airway narrowing (%AN) calculation. A scoring system assessed the bronchomalacia. The circularity was calculated for each airway. The results were compared to the tracheobronchoscopy collapse grading. In the dogs with an AC, the %AN was larger for the trachea, right mainstem bronchus and right middle lobar bronchus when they were compared to the dogs with NCAD and NLARD. Flattening was only identified for the trachea of the AC dogs. The agreement between the CT and tracheobronchoscopy scores was 20% from trachea to the lobar bronchi and 47% for the segmental/subsegmental bronchi. Paired I/E-BH CT can detect static and dynamic AC with limited agreement with the tracheobronchoscopy metrics. Independent scoring systems that are tailored to the clinical manifestations of functional impairments are needed. Full article

Pulmonary drug delivery aims to deliver particles deep into the lungs, bypassing the mouth–throat airway geometry. However, micron particles under high flow rates are susceptible to inertial impaction on anatomical sites that serve as a defense system to filter and prevent foreign particles from entering the lungs. The aim of this study was to understand particle aerodynamics and its possible deposition in the mouth–throat airway that inhibits pulmonary drug delivery. In this study, we present an analysis of the aerodynamics of inhaled particles inside a patient-specific mouth–throat model generated from MRI scans. Computational Fluid Dynamics with a Discrete Phase Model for tracking particles was used to characterize the airflow patterns for a constant inhalation flow rate of 30 L/min. Monodisperse particles with diameters of 7 $\mathsf{\mu }$m to 26 $\mathsf{\mu }$m were introduced to the domain within a 3 cm-diameter sphere in front of the oral cavity. The main outcomes of this study showed that the time taken for particle deposition to occur was 0.5 s; a narrow stream of particles (medially and superiorly) were transported by the flow field; larger particles > 20 $\mathsf{\mu }$m deposited onto the oropharnyx, while smaller particles < 12 $\mathsf{\mu }$m were more disperse throughout the oral cavity and navigated the curved geometry and laryngeal jet to escape through the tracheal outlet. It was concluded that at a flow rate of 30 L/min the particle diameters depositing on the larynx and trachea in this specific patient model are likely to be in the range of 7 $\mathsf{\mu }$m to 16 $\mathsf{\mu }$m. Particles larger than 16 $\mathsf{\mu }$m primarily deposited on the oropharynx. Full article

Background: Tracheal lesions are pathologies derived from the most diverse insults that can result in a fatal outcome. Despite the number of techniques designed for the treatment, a limiting factor is the extent of the extraction. Therefore, strategies with biomaterials can restructure tissues and maintain the organ’s functionality, like decellularized Wharton’s jelly (WJ) as a scaffold. The aim is to analyze the capacity of tracheal tissue regeneration after the implantation of decellularized WJ in rabbits submitted to a tracheal defect. Methods: An in vivo experimental study was undertaken using twenty rabbits separated into two groups (n = 10). Group 1 submitted to a tracheal defect, group 2 tracheal defect, and implantation of decellularized WJ. The analyses were performed 30 days after surgery through immunohistochemistry. Results: Inner tracheal area diameter (p = 0.643) didn’t show significance. Collagen type I, III, and Aggrecan highlighted no significant difference between the groups (both collagens with p = 0.445 and the Aggrecan p = 0.4). Conclusion: The scaffold appears to fit as a heterologous implant and did not trigger reactions such as rejection or extrusion of the material into the recipient. However, these results suggested that although the WJ matrix presents several characteristics as a biomaterial for tissue regeneration, it did not display histopathological benefits in trachea tissue regeneration. Full article

Tracheomegaly (TM) is a rare appearance that is radiologically defined as an excessive enlargement of the tracheal diameter. We present a comprehensive analysis of tracheal diameter measurements and TM incidence in patients admitted and treated due to COVID-19 pneumonitis and its association with possible respiratory complications. In this retrospective study, we included 1015 patients divided into three groups: 383 patients treated using mechanical ventilation (MV), 132 patients treated using high-flow ventilation (HFV), and 500 randomly selected patients using nasal catheter (NC) oxygenation. The tracheal lumen diameter was measured continuously using a chest X-ray, and the cuff/trachea (C/T) diameter ratio was calculated. We detected TM in 71 patients (18.54%). Regression analysis showed statistical significance in MV patients for the trachea diameter at the level of the cuff, maximal trachea diameter and C/T diameter ratio, and days on MV. Respiratory complications showed a significant association with the C/T diameter ratio. The C/T diameter ratio was shown to be a reliable potential predictor of the occurrence of respiratory complications. The results of the study highlight the importance of the early detection and prevention of TM in COVID-19 patients on MV using a chest X-ray and measurement of the C/T diameter ratio. Full article

Particulate matter (PM) exposure may cause adverse health effects such as respiratory disorders. We evaluated the protective effects of various Opuntia ficus-indica (OFI) extracts on airway inflammation associated with exposure to PM10D with an aerodynamic diameter <10 μm (PM10) and diesel exhaust particles (DEP). BALB/c mice were exposed to PM10D via intranasal tracheal injection three times over a period of 12 days and various OFI extracts (water, 30% ethanolic, or 50% ethanolic extracts) were administered orally for 12 days. All OFI extracts suppressed neutrophil infiltration and the number of immune cells (CD3⁺/CD4⁺, CD3⁺/CD8⁺, and Gr-1⁺/CD11b) in bronchoalveolar lavage fluid (BALF) and lungs. OFI extracts decreased the expression of cytokines and chemokines, including chemokine (C-X-C motif) ligand (CXCL)-1, interleukin (IL)-17, macrophage inflammatory protein-2, tumor necrosis factor (TNF)-α, cyclooxygenase-2, IL-1α, IL-1β, IL-5, IL-6, transient receptor potential cation channel subfamily V member 1, and mucin 5AC, and inhibited IRAK-1, TNF-α, and CXCL-1 localization in BALF and lungs of mice with PM10D-induced airway inflammation. Serum asymmetric and symmetric dimethyl arginine levels were also decreased by OFI extracts treatment. Moreover, all OFI extracts restored histopathological damage in the trachea and lungs of mice with PM10D-induced airway inflammation. These results indicate that OFI extracts may be used to prevent and treat airway inflammation and respiratory diseases. Full article

Studies of flow through the human airway have shown that inhalation time (IT) and secondary flow structures can play important roles in particle deposition. However, the effects of varying IT in conjunction with the respiratory rate (RR) on airway flow remain unknown. Using three-dimensional numerical simulations of oscillatory flow through an idealized airway model (consisting of a mouth, glottis, trachea, and symmetric double bifurcation) at a trachea Reynolds number ($Re$) of 4200, we investigated how varying the ratio of IT to breathing time (BT) from 25% to 50% and RR from 10 breaths per minute (bpm) corresponding to a Womersley number ($Wo$) of 2.41 to 1000 bpm ($Wo$ = 24.1) impacts airway flow characteristics. Irrespective of IT/BT, axial flow during inhalation at tracheal cross-sections was non-uniform for $Wo$ = 2.41, as compared to centrally concentrated distribution for $Wo$ = 24.1. For a given $Wo$ and IT/BT, both axial and secondary (lateral) flow components unevenly split between left and right branches of a bifurcation. Irrespective of $Wo$, IT/BT and airway generation, lateral dispersion was a stronger transport mechanism than axial flow streaming. Discrepancy in the oscillatory flow relation $Re$/$W{o}^2$ = 2 L/D (L = stroke length; D = trachea diameter) was observed for IT/BT ≠ 50%, as L changed with IT/BT. We developed a modified dimensionless stroke length term including IT/BT. While viscous forces and convective acceleration were dominant for lower $Wo$, unsteady acceleration was dominant for higher $Wo$. Full article

Background: Kommerell’s diverticulum is a rare vascular anomaly characterized as an outpouch at the onset of an aberrant subclavian artery. In the variant of a right-sided aortic arch, the trachea and esophagus are enclosed dorsally by the arch. In the configuration of an aberrant left subclavian artery, a Kommerell’s diverticulum and persisting ductus arteriosus or ductal ligament enclose the lateral side, forming a vascular ring which may result in (symptomatic) esophageal or tracheal compression. Spontaneous rupture of an aneurysmatic Kommerell’s diverticulum has also been reported. Due to the rarity of this condition and underreporting in the literature, the clinical implications of a Kommerell’s diverticulum are not well defined. Case summary: We describe seven consecutive adult patients with a right-sided aortic arch and an aberrant course of the left subclavian artery (arteria lusoria), and a Kommerell’s diverticulum, diagnosed in our tertiary hospital. One patient had severe symptoms related to the Kommerell’s diverticulum and underwent surgical repair. In total, two of the patients experienced mild non-limiting dyspnea complaints and in four patients the Kommerell’s diverticulum was incidentally documented on a computed tomography (CT) scan acquired for a different indication. The size of the Kommerell’s diverticulum ranged from 19 × 21 mm to 30 × 29 mm. In the six patients that did not undergo surgery, a strategy of periodic follow-up with structural imaging was pursued. No significant growth of the Kommerell’s diverticulum was observed and none of the patients experienced an acute aortic syndrome to date. Discussion: Kommerell’s diverticulum in the setting of a right-sided aortic arch with an aberrant left subclavian artery is frequently associated with tracheal and esophageal compression and this may result in a varying range of symptoms. Guidelines on management of Kommerell’s diverticulum are currently lacking. This case series and literature overview suggests that serial follow-up is warranted in adult patients with a Kommerell’s diverticulum with small dimensions and no symptoms, however, that surgical intervention should be considered when patients become symptomatic or when the diameter exceeds 30 mm in the absence of symptoms. Full article