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      Measurement and Analysis of the Tracheobronchial Tree in Chinese Population Using Computed Tomography

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          Abstract

          Objective

          To ascertain accurate measurements of, and the relationships between, the normative parameters of the tracheobronchial trees in the Chinese population using multi-slice spiral computed tomography (CT) and multi-planar reconstruction (MPR).

          Materials and Methods

          Measurements were performed on 2107 patients who underwent thoracic CT scans in the PLA General Hospital. The lengths of the trachea and the main stem bronchi, and the sizes of the subcarinal angle were obtained through CT or MPR imaging. Multi-variance analyses were performed to detect potential correlations between obtained parameters.

          Results

          The mean length of the trachea was 104.9 ± 13.4 mm (107.8 ± 13.2 mm for men and 101.4 ± 12.8 mm for women). The mean lengths of the right and left main stem bronchi were 13.6 ± 4.3 and 48.3 ± 6.5 mm, respectively. The right bronchus angle and the left bronchus angle were 34.9 and 42.5 degrees, respectively. Significant gender differences were found in all the parameters measured except for the angle of the right upper lobe bronchus. There are no statistically significant correlations among these parameters.

          Conclusions

          The normal reference values and the likely ranges of distribution of the tracheobronchial trees in the Chinese population have been established. Significant gender differences exist in the dimensions of the trachea, with the exception of the Right upper bronchial angle (RUA).

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          Most cited references27

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          Margin of safety in positioning modern double-lumen endotracheal tubes.

          The authors have defined the margin of safety in positioning a double-lumen tube as the length of tracheobronchial tree over which it may be moved or positioned without obstructing a conducting airway. The purpose of this study was to measure the margin of safety in positioning three modern double-lumen tubes (Mallinkrodt [Broncho-Cath], Rusch [Endobronchial tubes], and Sheridan [Broncho-Trach]). The margin of safety in positioning a: 1) left-sided double-lumen tube (all manufacturers) is the length of the left mainstem bronchus minus the length from the proximal margin of the left cuff to left lumen tip; 2) Mallinkrodt right-sided double-lumen tube is the length of the right mainstem bronchus minus the length of the right cuff; and 3) Rusch right-sided double-lumen tube is the length of the right upper lobe ventilation slot minus the diameter of the right upper lobe. The length of the right and left mainstem bronchi were measured by in vivo fiberoptic bronchoscopy (n = 69), in fresh cadavers (n = 42), and in lung casts (n = 55), and the diameter of the right upper lobe bronchus was measured in lung casts (n = 55). The average +/- SD male left and right mainstem bronchial lengths were 49 +/- 8 and 19 +/- 6 mm, respectively, the average +/- SD female left and right mainstem bronchial lengths were 44 +/- 7 and 15 +/- 5 mm, respectively, the average right upper lobe bronchial diameter was 11 mm, the proximal left cuff to left lumen tip distance was 30 mm, the length of the Mallinkrodt right cuff was 10 mm, and the length of the Rusch right upper lobe ventilation slot was 15 mm. The average margin of safety in positioning left-sided double-lumen tubes ranged 16-19 mm for the different manufacturers. The average margin of safety in positioning Mallinkrodt right-sided double-lumen tubes was 8 mm, and the margin of safety in positioning Rusch right-sided double-lumen tubes ranged 1-4 mm, depending on French size. The authors concluded that left-sided double-lumen tubes are much preferable to right-sided double-lumen tubes because they have a much greater positioning margin of safety, and that proper confirmation of proper position of either a left- or right-sided double-lumen tube should be aided by fiberoptic bronchoscopy, because the absolute distances that constitute the margin of safety are extremely small.
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            Dimensions of the normal human trachea.

            The coronal and sagittal diameters of the tracheal air column were measured on posteroanterior and lateral chest radiographs of 808 patients with no clinical or radiographic evidence of respiratory disease. The 430 male and 378 female subjects were 10-79 years of age. Assuming a normative range that encompasses three standard deviations from the mean or 99.7% of the normal population, the upper limits of normal for coronal and sagittal diameters, respectively, in men aged 20-79, are 25 mm and 27 mm; in women, they are 21 mm and 23 mm, respectively. The lower limit of normal for both dimensions is 13 mm in men and 10 mm in women. Deviation from these figures reflects pathologic widening or narrowing of the tracheal air column. No statistically significant correlation was found between tracheal caliber and body weight or body height.
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              Dimensions of the growing trachea related to age and gender.

              Computed tomography measured the lengths, anteroposterior (AP) diameters, transverse diameters, cross-sectional areas, and contained volumes of the tracheas of 130 subjects in their first two decades. Patients below age 6 were scanned at low lung volumes. The others were scanned at or near total lung capacity. The results are shown by age and gender. There were no differences between boys and girls until age 14, when girls' tracheas stopped growing. The data suggest that male tracheas continue to enlarge (but not lengthen) for a time after growth in height ceases. Mean transverse diameters tended to be greater than mean AP diameters to the age of 6; the diameters were then nearly identical until age 18, when the AP diameters usually became slightly larger. The tracheas were nearly round in cross section, especially at high lung volumes. In individual tracheas, changes from level to level were small. These measurements should be useful in the detection of tracheal abnormalities, in problems in respiratory physiology, and in endotracheal intubation, endoscopy, and tracheostomy.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                20 April 2015
                2015
                : 10
                : 4
                : e0123177
                Affiliations
                [1 ]Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, 100853, China
                [2 ]Department of Ultrasound, The Southern Building, Chinese PLA General Hospital, Beijing, 100853, China
                [3 ]Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China
                [4 ]Department of Anesthesia, The 309th hospital of Chinese PLA, Beijing, 100096, China
                University of Pennsylvania, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: WM CZ LY. Performed the experiments: CZ HW JC CL. Analyzed the data: CZ CL FG XW. Contributed reagents/materials/analysis tools: HW JC FG TY XW. Wrote the paper: CZ HW CL.

                Article
                PONE-D-14-52580
                10.1371/journal.pone.0123177
                4404098
                25894917
                d3f1d29d-ec32-432d-bc03-1bb64200de03
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 27 November 2014
                : 16 February 2015
                Page count
                Figures: 5, Tables: 6, Pages: 14
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Custom metadata
                Relevant data are deposited into Figshare: http://dx.doi.org/10.6084/m9.figshare.1316570.

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