Tracheal Size and Morphology on the Reconstructed CT Imaging*

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
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

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A previously healthy 7-month-old male infant presented for evaluation of fever, deceased oral intake, and intermittent noisy breathing. Physical examination revealed neck tenderness. Soft tissue neck radiographs and computed tomography (CT) scan supported a diagnosis of retropharyngeal swelling with extension to the superior mediastinum. Surgical exploration was planned, and endotracheal intubation was performed in the operating room. Significant cardiorespiratory derangements developed immediately after the tracheal tube was inserted, including hypotension, hypoxia, and bradycardia with signs of cardiac ischemia. The pati...
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Illustrative Cases Source Type: research
Conclusion We have reviewed the literature and identified blood biomarkers with the highest discriminative abilities as determined by operating characteristics in four commonly encountered clinical situations: diagnosing concussion, predicting the need for a CT scan after mTBI, predicting delayed recovery after mTBI, and predicting poor outcome after sTBI. The top performers in each category may provide insight into pathogenic mechanisms of TBI that most influence the measured endpoint. Nonetheless, many challenges remain before these biomarkers can be incorporated into clinical practice. In particular, it remains unclear...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Joong-Goo Kim1,2, Han-Bin Lee2 and Sang-Beom Jeon2* 1Department of Neurology, Jeju National University Hospital, Jeju, South Korea 2Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Objectives: The use of dexmedetomidine and ketamine (DEX–KET) combination for magnetic resonance imaging (MRI) sedation has not been evaluated. We investigated the efficacy and safety of DEX–KET for sedation of patients undergoing MRI of the brain. Methods: This quasi-experimental study was conducted to compare the DEX–KET combination and midazolam for MRI sed...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
In conclusion, we described the US semeiotics of various lung disorders assessed during VATS by reporting the preliminary data of the first s tudy which applies the methodology systematically to all patients undergoing the surgery procedure. Final results from the study will further elucidate how the technique could be of use during the VATS procedure.
Source: Journal of Ultrasound - Category: Radiology Source Type: research
Conclusions: The upper airway of the subglottic area and the cricoid area in cleft palate children are elliptical, with the transverse dimension narrow and the anteroposterior dimension wide. Cleft palate children with airway stenosis underwent surgery smoothly by using a portable visible laryngoscope. PMID: 30630255 [PubMed - in process]
Source: Shanghai Journal of Stomatology - Category: Dentistry Authors: Tags: Zhonghua Kou Qiang Yi Xue Za Zhi Source Type: research
Rationale: Most of esophageal rupture is a very serious life-threatening benign gastrointestinal tract disease with high mortality. However, there are a few cases of spontaneous esophageal rupture during gastroscopy. Patient concerns: A 57-year-old man who underwent a routine diagnostic gastroscopy due to food obstruction was reported. During the gastroscopy, he vomited severely, which was followed by severe left chest pain radiating into the back and upper abdomen. The diagnosis was made by computed tomography (CT) scan without delay. Enhanced CT showed extensive mediastinal emphysema, a small amount of left pleural ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Endotracheal intubation in the prehospital setting is known to be a difficult form of intubation due to the conditions in which it must be performed [1]. Every patient should be treated as a patient on a full stomach, as well as an additional risk of vomiting in patients with head injuries [2,3]. In accordance with many worldwide standards, trauma patients should have their cervical spine immobilized until a cervical spine injury is excluded on the basis of such imaging modalities as CT scans or X-rays.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research
This study determines whether dementia influences the medical care that a cancer patient receives at the end of life. We conducted a nationwide population-based cohort study on patients aged ≥20 with newly diagnosed cancer during 2000-2012. After matching to reduce confounders, there were 7,111 patients with and 28,444 without dementia. The adjusted odd ratios (OR) for medical interventions, including intensive care, palliative care, invasive procedures, and advanced diagnostic testing, were calculated for the final month and three months of life by a multiple logistic regression model. In the final month before death, ...
Source: Oncotarget - Category: Cancer & Oncology Tags: Oncotarget Source Type: research
CONCLUSION: Chest tube was inserted in less than half of patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be included in the decision-making regarding chest tube insertion. Observation of pneumothorax of volume less than 30 mL appears safe. PMID: 28741012 [PubMed - as supplied by publisher]
Source: Singapore Medical Journal - Category: General Medicine Authors: Tags: Singapore Med J Source Type: research
A 3-day-old, 2.2-kg former 34-week premature infant with imperforate anus required loop ileostomy surgery. At delivery, the child had respiratory distress. Endotracheal intubation was “confirmed” by detection of exhaled carbon dioxide with a Pedi-Cap (Covidien, Dublin, Ireland) and subsequent chest x-ray. On arrival to the operating room, the pulse oximeter reading was 100% despite a large leak around the endotracheal tube and high-airway pressures. Packing the throat reduced the leak and increased the tidal volume. Intraoperative bronchospasm occurred during the surgery. On postoperative day 1, fiberoptic exam...
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research
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