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October 22, 2017
43030.645833 - 43030.729167
Room Exhibit Hall B2 - Area D
Volume Relationships of Cricoid and Mainstem Bronchi in Children Using Three Dimensional Computed Tomography Imaging
Tariq M. Wani, M.D., Abdul B. Mir, M.D., Tanveer Hussain, M.D., Faris S. Al Ghamdi, M.D., Fahad A. AlKhedhaira, M.D., Hanadi M. AlMashouq, M.D., Joseph D. Tobias, M.D.
King Fahad Medical City/Nationwide Children's Hospital, Columbus, Ohio, United States
Disclosures: T.M. Wani: None. A.B. Mir: None. T. Hussain: None. F.S. Al Ghamdi: None. F.A. AlKhedhaira: None. H.M. AlMashouq: None. J.D. Tobias: None.
Background: There are limited data to guide the selection of the appropriate sized endobronchial tube for main stem intubation during one-lung ventilation in children. The relationship between the cricoid and the main bronchi (right and left) has been previously evaluated using two-dimensional computed tomography (CT) images and video-bronchoscopic images.(1-4) The present study attempts to define the three-dimensional, CT-derived volume-based relationships between the right main-stem bronchus (RMSB), left main-stem bronchus (LMSB), and the cricoid ring, and determine factors (age, height and weight that influence these relationships.

Methods: The three-dimensional CT images of 35 children, less than 8 years of age, undergoing radiological evaluation unrelated to airway or mediastinal symptomatology were examined. The images of the airway column were evaluated at the level of the cricoid and main stem bronchi (right and left). The measurements recorded included the volumes of 3 mm slices at the cricoid, right main stem bronchus, and left main stem bronchus (Figure 1). Volumes were calculated and comparisons made between these levels (cricoid, right, and left main stem bronchi) using paired t-tests.

Results: There were no differences based on gender for cricoid and main stem bronchi volumes. The ratios between cricoid and main stem bronchi (right and left) were 0.89 ± 0.25 and 0.72 ± 0.24 respectively, whereas ratio between the left and right main stem bronchi was 0.83 ± 0.28 (Table 1). A statistically significant difference was observed between the cricoid and left main stem bronchi volumes (CI 0.039-0.075, p=0.00) as well as between the right and left main stem bronchi volumes (CI 0.0153-0.054, p= 0.01) (Table 2). The ratio of these volumes remained constant within each age range.

Conclusion: We have derived a consistent ratio between cricoid and the bronchial volumes using 3D CT based measurements. Future clinical trials as needed to evaluate whether this ratio may be employed as a guide to choosing the appropriately sized lung isolation device. Clinical studies can be now designed on the basis of the derived ratios to check the validity of the findings in this current study based on radiological imaging.References:

1. Wani TM et al. Cricoid and left bronchial diameter in pediatric population. Paediatr Anaesth 2016 Jun;26(6):608-12.

2. Masters IB et al. A new method for objective identification and measurement of airway lumen in paediatric flexible videobronchoscopy. Thorax 2005;60:652-58.

3. Hegde SV et al. Tracheobronchial foreign bodies in children: imaging assessment. Semin Ultrasound CT MR 2015;36:8-20.

4.Ming Z et al. Evaluation of tracheal bronchus in Chinese children using multidetector CT. Pediatr Radiol 2007;37:1230-34.

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