-
Comprehensive Physiology Jul 2011The transport of oxygen and carbon dioxide in the gas phase from the ambient environment to and from the alveolar gas/blood interface is accomplished through the... (Review)
Review
The transport of oxygen and carbon dioxide in the gas phase from the ambient environment to and from the alveolar gas/blood interface is accomplished through the tracheobronchial tree, and involves mechanisms of bulk or convective transport and diffusive net transport. The geometry of the airway tree and the fluid dynamics of these two transport processes combine in such a way that promotes a classical fractionation of ventilation into dead space and alveolar ventilation, respectively. This simple picture continues to capture much of the essence of gas phase transport. On the other hand, a more detailed look at the interaction of convection and diffusion leads to significant new issues, many of which remain open questions. These are associated with parallel and serial inhomogeneities especially within the distal acinar units, velocity profiles in distal airways and terminal spaces subject to moving boundary conditions, and the serial transport of respiratory gases within the complex acinar architecture. This article focuses specifically on the theoretical foundations of gas transport, addressing two broad areas. The first deals with the reasons why the classical picture of alveolar and dead space ventilation is so successful; the second examines the underlying assumptions within current approximations to convective and diffusive transport, and how they interact to effect net gas exchange.
Topics: Air; Animals; Diffusion; Humans; Pulmonary Alveoli; Pulmonary Gas Exchange
PubMed: 23733643
DOI: 10.1002/cphy.c090016 -
Frontiers in Pediatrics 2023We sought to classify patients with congenital tracheal stenosis (CTS) according to tracheobronchial morphology and determine anatomic features associated with...
BACKGROUND
We sought to classify patients with congenital tracheal stenosis (CTS) according to tracheobronchial morphology and determine anatomic features associated with tracheobronchial anomalies (TBAs) and concurrent cardiovascular defects (CVDs).
METHODS
We enrolled 254 patients who underwent tracheoplasty between November 1, 2009 and December 30, 2018. The anatomic features of the tracheobronchial tree and cardiovascular system were abstracted from bronchoscopy, echocardiography, computerized tomography, and operative reports.
RESULTS
Four types of tracheobronchial morphology were identified: Type-1, which included normal tracheobronchial arborization (Type-1A, = 29) and tracheal bronchus (Type-1B, = 22); Type-2 (tracheal trifurcation; = 49), and Type-3 (typical bridging bronchus; = 47). Type-4 (bronchus with an untypical bridging pattern) was divided into Type-4A (involving bronchial diverticulum; = 52) and Type-4B (absent bronchus; = 55). Carinal compression and tracheomalacia were significantly more frequent in Type-4 patients than in the other patients (< 0.01). CVDs were common in patients with CTS, especially in patients with Type-3 and Type-4 (< 0.01). Persistent left superior vena cava was most common among patients with Type-3 (< 0.01), and pulmonary artery sling was most frequent among those with Type-4 (< 0.01). Outflow tract defects were most likely to occur in Type-1B. Early mortality was detected in 12.2% of all patients, and young age (= 0.02), operation in the early era (< 0.01), and bronchial stenosis (= 0.03) were proven to be risk factors.
CONCLUSIONS
We demonstrated a useful morphological classification for CTS. Bridging bronchus was most closely linked with vascular anomalies, while tracheal bronchus was frequently associated with outflow tract defects. These results may provide a clue to CTS pathogenesis.
PubMed: 37287629
DOI: 10.3389/fped.2023.1123237 -
Quantitative Imaging in Medicine and... Feb 2016Asthma is a heterogeneous condition and approximately 5-10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway... (Review)
Review
Asthma is a heterogeneous condition and approximately 5-10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. In severe asthmatics, morphologic changes in large airways, quantitatively assessed using 2D-3D airway registration and recent algorithms, are characterized by airway wall thickening, luminal narrowing and bronchial stenoses. Extent of expiratory gas trapping, quantitatively assessed using lung densitometry, may be used to assess indirectly small airway remodeling. Investigators have used these quantitative imaging techniques in order to attempt severity grading of asthma, and to identify clusters of asthmatic patients that differ in morphologic and functional characteristics. Although standardization of image analysis procedures needs to be improved, the identification of remodeling pattern in various phenotypes of severe asthma and the ability to relate airway structures to important clinical outcomes should help target treatment more effectively.
PubMed: 26981458
DOI: 10.3978/j.issn.2223-4292.2016.02.08 -
Indian Journal of Anaesthesia Sep 2015Clinical application of anatomical and physiological knowledge of respiratory system improves patient's safety during anaesthesia. It also optimises patient's... (Review)
Review
Clinical application of anatomical and physiological knowledge of respiratory system improves patient's safety during anaesthesia. It also optimises patient's ventilatory condition and airway patency. Such knowledge has influence on airway management, lung isolation during anaesthesia, management of cases with respiratory disorders, respiratory endoluminal procedures and optimising ventilator strategies in the perioperative period. Understanding of ventilation, perfusion and their relation with each other is important for understanding respiratory physiology. Ventilation to perfusion ratio alters with anaesthesia, body position and with one-lung anaesthesia. Hypoxic pulmonary vasoconstriction, an important safety mechanism, is inhibited by majority of the anaesthetic drugs. Ventilation perfusion mismatch leads to reduced arterial oxygen concentration mainly because of early closure of airway, thus leading to decreased ventilation and atelectasis during anaesthesia. Various anaesthetic drugs alter neuronal control of the breathing and bronchomotor tone.
PubMed: 26556911
DOI: 10.4103/0019-5049.165849 -
Ear, Nose, & Throat Journal Sep 2022Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic disease with a stable course that involves the mucous membrane of the tracheobronchial tree. Most...
BACKGROUND
Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic disease with a stable course that involves the mucous membrane of the tracheobronchial tree. Most cases present no specific symptoms, and there are currently no established guidelines for diagnosis and treatment. In this report, we discuss a single case of a patient with TO who was diagnosed based on clinical imaging and histopathology.
CASE SUMMARY
A patient with a history of smoking and alcohol consumption, but no specific clinical symptoms, was diagnosed with TO after undergoing fiber-optic bronchoscopy. Nodular processes with smooth surface mucosa and detached bronchial mucosa were observed. The presence of TO was confirmed by pathological examination.
CONCLUSION
The diagnosis of TO is difficult, and early fiber-optic bronchoscopy and pathological examination should be performed to facilitate the diagnosis.
Topics: Bronchi; Bronchoscopy; Humans; Osteochondrodysplasias; Tracheal Diseases
PubMed: 33124932
DOI: 10.1177/0145561320969445 -
Wideochirurgia I Inne Techniki... Mar 2022Iatrogenic injuries to the trachea and main bronchi present one of the most dramatic complications traditionally treated by thoracotomy and transcervical-transtracheal...
INTRODUCTION
Iatrogenic injuries to the trachea and main bronchi present one of the most dramatic complications traditionally treated by thoracotomy and transcervical-transtracheal approaches but almost never by video-assisted thoracic surgery.
AIM
To evaluate our experience in a video-assisted thoracic surgery repair of iatrogenic tracheal lacerations.
MATERIAL AND METHODS
The group under analysis consisted of 5 consecutive patients (1 male, mean age: 52 years, range: 32-56 years) who were treated for postintubation and intraoperative damage to the tracheobronchial tree using video-assisted thoracic surgery within the period 2015-2018. Thoracic computed tomography and fibreoptic tracheobronchoscopy were used to confirm iatrogenic tracheal ruptures before surgery. The membranous rupture of the trachea was closed with interrupted absorbable sutures, which were additionally sutured through the oesophageal wall or the wall of the gastric conduit to strengthen the suture line. Postoperative treatment included broad-spectrum antibiotic therapy and control tracheobronchoscopy.
RESULTS
The average duration of thoracoscopic tracheal rupture repair with suture line reinforcement was 103 min (range: 60-180 min). All patients were treated thoracoscopically without resorting to open surgery and were discharged without any postoperative complications within 16 days (range: 8-22 days).
CONCLUSIONS
The minimally invasive thoracoscopic approach may be the method of choice for the treatment of intraoperative and post-intubation injuries of the tracheobronchial tree.
PubMed: 35251412
DOI: 10.5114/wiitm.2021.107816 -
Journal of Pediatric Intensive Care Mar 2015Thoracic injury in children deserves special attention because, although it accounts for less than 10% of traumatic injuries in children, there is a significant... (Review)
Review
Thoracic injury in children deserves special attention because, although it accounts for less than 10% of traumatic injuries in children, there is a significant associated morbidity and mortality. This review discusses the anatomic and physiologic factors resulting in such injury severity with blunt thoracic trauma in children. Specific organ injuries, including most common chest wall injuries, hemo- and pneumothoraces, and pulmonary parenchymal injuries, are discussed, encompassing epidemiology, presentation, diagnosis, and management. Rare injuries including tracheobronchial tree injuries, cardiovascular injuries, esophageal injuries, and diaphragmatic injuries are also briefly discussed.
PubMed: 31110848
DOI: 10.1055/s-0035-1554987 -
Acta Otorrinolaringologica Espanola 2013Cough lasting more than 8 weeks is considered chronic. If the classic causes of chronic cough have been discarded, vagus nerve sensory disturbances are currently... (Review)
Review
Cough lasting more than 8 weeks is considered chronic. If the classic causes of chronic cough have been discarded, vagus nerve sensory disturbances are currently considered the most important etiological cause. Patients with chronic cough of laryngeal origin have associated symptoms such as globus, dysphagia, dysphonia, dyspnoea and/or stridor. These patients are more likely to have paradoxical vocal fold movement. There is a higher cough reflex sensibility and neuropathic laryngeal response, mainly caused by viral infection or reflux. The cough associated with reflux has 2 mechanisms: Exposure to acid in the distal oesophagus (gastroesophageal reflux) and microaspiration of oesophageal contents into the larynx and tracheo-bronchial tree (pharyngo-laryngeal reflux). Laryngeal neuropathy hypersensitivity responds well to speech therapy as a treatment for refractory chronic cough. Because chronic cough is a sign of laryngeal sensory, neuropathy can improve with neuroleptic drugs such as amitriptyline and gabapentin.
Topics: Algorithms; Chronic Disease; Cough; Humans; Laryngeal Diseases
PubMed: 23305863
DOI: 10.1016/j.otorri.2012.10.001 -
Turkish Journal of Ophthalmology Apr 2019Relapsing polychondritis is a potentially lethal but rare systemic autoimmune disease. The major site of inflammation is the connective tissue, usually involving the...
Relapsing polychondritis is a potentially lethal but rare systemic autoimmune disease. The major site of inflammation is the connective tissue, usually involving the ears, nose, larynx, tracheobronchial tree, and cardiovascular system. Although scleritis and episcleritis are known to be the most probable ocular manifestation, it may also present with uveitis. We present the case of a 22-year-old young lady who initially referred with bilateral red and painful eyes caused by anterior uveitis. Her right ear was also red and painful, consistent with cartilaginous inflammation. She was diagnosed with relapsing polychondritis with bilateral anterior uveitis and chondritis of the ear in conjunction with the rheumatology department. Bilateral anterior uveitis should evaluated and monitored carefully in patients with relapsing polychondritis.
PubMed: 31055895
DOI: 10.4274/tjo.galenos.2018.28909 -
Tuberculosis Research and Treatment 2015Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree with microbial and histopathological evidence. The clinical symptoms...
Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree with microbial and histopathological evidence. The clinical symptoms of the diseases are nonspecific. Chronic cough is the major symptom of the disease. The diagnosis is often delayed due to its nonspecific presentation and misdiagnosed as bronchial asthma. This case is presented to recall the notion that the endobronchial tuberculosis can mimic asthma and the importance of bronchoscopic evaluation in a patient with chronic cough and treatment resistant asthma.
PubMed: 26798513
DOI: 10.1155/2015/781842