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Michael J. Rutter - One of the best experts on this subject based on the ideXlab platform.
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diagnosis and management of complete Tracheal Rings with concurrent tracheoesophageal fistula
International Journal of Pediatric Otorhinolaryngology, 2020Co-Authors: Nikolaus E Wolter, Michael J. Rutter, Aimee A Kennedy, Clyde Matava, Osami Honjo, Priscila L Chiu, Evan J PropstAbstract:Abstract Objective Characterize patients with complete Tracheal Rings and tracheoesophageal fistula (TEF) and summarize management options. Methods A systematic review of patients under 18 years of age with complete Tracheal Rings and TEF was conducted. Authors were contacted for additional patient information and new cases were added. Patients with iatrogenic TEF and Tracheal stenosis due to other causes were excluded. Results Sixteen patients with a median (IQR) follow-up of 10 months (3–12 months) were identified. All had a distal TEF with complete Tracheal Rings distal to the TEF. There were 10 (63%) type C esophageal atresia + TEF (EA/TEF), and 1 (6%) type D (5 missing data). Median (IQR) airway diameter was 2 mm (1.5–2.2 mm). Complete Tracheal Rings were diagnosed prior to TEF repair in 5 (31.3%) patients, after ≥1 failed extubation in 3 (12.5%) patients, and intra-operatively during respiratory distress in 1 patient. Ten patients (62.5%) were intubated with an endoTracheal tube and one with a 6 Fr flexible aortic canula (5 missing data). Four patients with an endoTracheal tube for TEF repair developed ventilatory problems. Complete Tracheal Rings were repaired in 9 (56%) patients (8 slide tracheoplasty, 1 pericardial patch) and followed conservatively in 3 (19%). One patient required tracheotomy. Four patients died. Conclusions Complete Tracheal Rings with concurrent TEF is a rare entity that pose challenges for ventilatory management during operative repair. Bronchoscopy prior to TEF repair is critical to allow for proper preoperative planning.
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Congenital Tracheal Anomalies: Complete Tracheal Rings, Tracheomalacia, and Vascular Compression
Multidisciplinary Management of Pediatric Voice and Swallowing Disorders, 2020Co-Authors: Lyndy J. Wilcox, Claire Miller, Michael J. RutterAbstract:The normal trachea consists of approximately 15–20 cartilaginous Rings situated in a “horseshoe” or “C shape” as well as a posterior membranous portion in a 4–5:1 ratio (Cummings et al. Otolaryngology – head & neck surgery [print/digital]. Philadelphia: Elsevier Mosby, 2005). Alterations in this ratio are seen in two of the most common congenital Tracheal anomalies, Tracheal stenosis and tracheomalacia. Congenital disorders of the trachea, while rare, can cause a wide range of symptoms with varying severity. The diversity in presentation mandates a high degree of clinical suspicion to identify these disorders. Management has evolved significantly, such that there is potential to address both morbidity and mortality in this patient population. Concomitant congenital anomalies may be present and can complicate management. A multidisciplinary approach to care is necessary to ensure the best airway, feeding, and overall outcomes for these complex patients. This chapter will focus on the clinical presentation, diagnosis, and management of congenital Tracheal stenosis, most commonly caused by complete Tracheal Rings. Additionally, other causes of Tracheal stenosis and disorders involving Tracheal collapse, including both intrinsic and extrinsic causes, will be reviewed.
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Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2019Co-Authors: Lyndy J. Wilcox, Catherine K. Hart, Alessandro De Alarcon, Claudia Schweiger, Nithin S Peddireddy, Michael J. RutterAbstract:ObjectiveThis study documents the growth and course of repaired complete Tracheal Rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic me...
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Unrepaired Complete Tracheal Rings: Natural History and Management Considerations.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2018Co-Authors: Lyndy J. Wilcox, Catherine K. Hart, Alessandro De Alarcon, Claudia Schweiger, Nithin S Peddireddy, Meredith E. Tabangin, Michael J. RutterAbstract:Objectives To document the natural growth pattern of unrepaired complete Tracheal Rings (UCTRs) and describe the patient population managed conservatively. Study Design Case series with chart review. Setting Tertiary pediatric academic center. Subjects/Methods Medical records of patients with confirmed complete Tracheal Rings on bronchoscopy from 1993 to 2017 were reviewed. Patients aged 0 to 18 who had documented Tracheal sizing over time and did not require surgical intervention were included. Exclusion criteria included Tracheal stenosis not caused by complete Tracheal Rings. Comorbidities and airway characteristics were documented in addition to endoscopic findings. These were compared with children requiring surgical repair. Results In total, 149 patients with complete Tracheal Rings were identified. Twenty-five had UCTRs for an overall 16.8% rate of conservative management. Nineteen patients met inclusion criteria and underwent a total of 90 microlaryngoscopy and bronchoscopies (MLBs) with sizing. The growth of the UCTRs over time, based on MLB sizing, was chronicled. The median airway growth noted was 0.38 mm/y. A moderately strong positive correlation was seen between age and airway size ( rs = 0.72, P < .0001). Children with UCTRs were less likely to have long-segment involvement than those who required repair (92%, P = .024). Conclusions A select group of children with complete Tracheal Rings can be managed expectantly without surgical intervention. Conservative management may be less successful in children with long-segment complete Tracheal Rings. Airway growth does occur in this population and can be monitored over time. Having a standardized method for sizing UCTRs allows for more effective communication between providers and assurance of continued growth of the airway while following these patients.
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Segmental deficiency of cervical Tracheal Rings masquerading as complete Tracheal Rings: A case report and literature review
International journal of pediatric otorhinolaryngology, 2017Co-Authors: Andre M. Wineland, James R. Thomsen, April M. Landry, Dan Benscoter, Michael J. RutterAbstract:Congenital deficiency of distal Tracheal Rings is a rare anomaly and has been previously reported in the literature. Here we report the first case deficient Tracheal Rings confined to the cervical trachea. Patient was transferred to our institution for management of what was initial thought to be complete Tracheal Rings. The patient was successfully managed with a Tracheal resection and short segment cervical slide tracheoplasty. Presentation, surgical approach, histological findings, and literature review are described.
Fernando Romero - One of the best experts on this subject based on the ideXlab platform.
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Relaxant effects of a hydroalcoholic extract of Ruta graveolens on isolated rat Tracheal Rings
Biological Research, 2015Co-Authors: Luis Aguila, Jenny Ruedlinger, Karina Mansilla, José Ordenes, Raul P. Salvatici, Rui Ribeiro De Campos, Fernando RomeroAbstract:Background Ruta graveolens L. (R. graveolens) is a medicinal plant employed in non-traditional medicines that has various therapeutic properties, including anthelmintic, and vasodilatory actions, among others. We evaluated the trachea-relaxant effects of hydroalcoholic extract of R. graveolens against potassium chloride (KCl)- and carbachol-induced contraction of rat Tracheal Rings in an isolated organ bath.
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Relaxant effects of a hydroalcoholic extract of Ruta graveolens on isolated rat Tracheal Rings
Biological Research, 2015Co-Authors: Luis Aguila, Jenny Ruedlinger, Karina Mansilla, José Ordenes, Raul P. Salvatici, Rui Ribeiro De Campos, Fernando RomeroAbstract:Background Ruta graveolens L. ( R. graveolens ) is a medicinal plant employed in non-traditional medicines that has various therapeutic properties, including anthelmintic, and vasodilatory actions, among others. We evaluated the trachea-relaxant effects of hydroalcoholic extract of R. graveolens against potassium chloride (KCl)- and carbachol-induced contraction of rat Tracheal Rings in an isolated organ bath. Results The results showed that the airway smooth muscle contraction induced by the depolarizing agent (KCl) and cholinergic agonist (carbachol) was markedly reduced by R. graveolens in a concentration-dependent manner, with maximum values of 109 ± 7.9 % and 118 ± 2.6 %, respectively (changes in tension expressed as positive percentages of change in proportion to maximum contraction), at the concentration of 45 μg/mL (half-maximal inhibitory concentration IC_50: 35.5 μg/mL and 27.8 μg/mL for KCl- and carbachol-induced contraction, respectively). Additionally, the presence of R. graveolens produced rightward parallel displacement of carbachol dose–response curves and reduced over 35 % of the maximum smooth muscle contraction. Conclusions The hydroalcoholic extract of R. graveolens exhibited relaxant activity on rat Tracheal Rings. The results suggest that the trachea-relaxant effect is mediated by a non-competitive antagonistic mechanism. More detailed studies are needed to identify the target of the inhibition, and to determine more precisely the pharmacological mechanisms involved in the observed biological effects.
Luis Aguila - One of the best experts on this subject based on the ideXlab platform.
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Relaxant effects of a hydroalcoholic extract of Ruta graveolens on isolated rat Tracheal Rings
Biological Research, 2015Co-Authors: Luis Aguila, Jenny Ruedlinger, Karina Mansilla, José Ordenes, Raul P. Salvatici, Rui Ribeiro De Campos, Fernando RomeroAbstract:Background Ruta graveolens L. (R. graveolens) is a medicinal plant employed in non-traditional medicines that has various therapeutic properties, including anthelmintic, and vasodilatory actions, among others. We evaluated the trachea-relaxant effects of hydroalcoholic extract of R. graveolens against potassium chloride (KCl)- and carbachol-induced contraction of rat Tracheal Rings in an isolated organ bath.
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Relaxant effects of a hydroalcoholic extract of Ruta graveolens on isolated rat Tracheal Rings
Biological Research, 2015Co-Authors: Luis Aguila, Jenny Ruedlinger, Karina Mansilla, José Ordenes, Raul P. Salvatici, Rui Ribeiro De Campos, Fernando RomeroAbstract:Background Ruta graveolens L. ( R. graveolens ) is a medicinal plant employed in non-traditional medicines that has various therapeutic properties, including anthelmintic, and vasodilatory actions, among others. We evaluated the trachea-relaxant effects of hydroalcoholic extract of R. graveolens against potassium chloride (KCl)- and carbachol-induced contraction of rat Tracheal Rings in an isolated organ bath. Results The results showed that the airway smooth muscle contraction induced by the depolarizing agent (KCl) and cholinergic agonist (carbachol) was markedly reduced by R. graveolens in a concentration-dependent manner, with maximum values of 109 ± 7.9 % and 118 ± 2.6 %, respectively (changes in tension expressed as positive percentages of change in proportion to maximum contraction), at the concentration of 45 μg/mL (half-maximal inhibitory concentration IC_50: 35.5 μg/mL and 27.8 μg/mL for KCl- and carbachol-induced contraction, respectively). Additionally, the presence of R. graveolens produced rightward parallel displacement of carbachol dose–response curves and reduced over 35 % of the maximum smooth muscle contraction. Conclusions The hydroalcoholic extract of R. graveolens exhibited relaxant activity on rat Tracheal Rings. The results suggest that the trachea-relaxant effect is mediated by a non-competitive antagonistic mechanism. More detailed studies are needed to identify the target of the inhibition, and to determine more precisely the pharmacological mechanisms involved in the observed biological effects.
Robin T. Cotton - One of the best experts on this subject based on the ideXlab platform.
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Nonoperative management of complete Tracheal Rings
Archives of otolaryngology--head & neck surgery, 2004Co-Authors: Michael J. Rutter, J. Paul Willging, Robin T. CottonAbstract:Background Children with complete Tracheal Rings are often challenging to manage. Most children will present early with a severely compromised airway and will require Tracheal reconstruction. Objective To show that a small number of minimally symptomatic patients with complete Tracheal Rings experience airway growth over time and do not require tracheoplasty. Design A retrospective medical chart review over a 10-year period. Setting A tertiary care pediatric hospital. Patients Children (N = 10) with a diagnosis of complete Tracheal Rings, confirmed on bronchoscopy, who were observed for a minimum of 1 year prior to determining the need for tracheoplasty. Main Outcome Measures Patient symptoms, bronchoscopic findings, airway size, and the progression of these over time. Other congenital anomalies, the reason for initial diagnosis, and the need for tracheoplasty were documented. Results The 10 patients in our series fell into the following 3 categories: 5 patients were minimally symptomatic or asymptomatic, showed bronchoscopic evidence of progressive airway growth, and did not require tracheoplasty; 2 patients had worsening symptoms of exercise intolerance, showed minimal airway growth, and ultimately required tracheoplasty; and 3 patients are still being clinically observed and may eventually require tracheoplasty. Periods of observation have varied from 1 year to over 12 years. Conclusions Not all patients with complete Tracheal Rings require tracheoplasty. Some have satisfactory airway growth and do not require airway reconstruction. A period of observation to monitor airway growth and clinical symptoms is safe and may spare some patients from undergoing unwarranted airway reconstruction.
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Slide tracheoplasty for the management of complete Tracheal Rings
Journal of pediatric surgery, 2003Co-Authors: Michael J. Rutter, Robin T. Cotton, Richard G. Azizkhan, Peter B. ManningAbstract:Abstract Background/purpose Although rare, complete Tracheal Rings are the most common cause of congenital Tracheal stenosis. The last 2 decades have seen an evolution in management, with increasing awareness of the potential advantages of slide tracheoplasty. Methods Between March 2001 and August 2002, 11 children had complete Tracheal Rings corrected by slide tracheoplasty. Ages ranged from newborn to 15 years, and weight ranged from 1.8 to 57 kg. Length of stenosis ranged from 3 Rings to virtually the whole length of the trachea. The most narrow point in the airway varied from less than 1.9 mm to 4.8 mm. Eight children had other congenital anomalies, severe in one child. Most children underwent repair on cardiopulmonary bypass. Results Nine children are asymptomatic or minimally symptomatic, although 2 have endoscopic evidence of mild residual Tracheal stenosis. One child, who had been unstable pre-operatively, died of multiple organ failure 7 weeks postoperatively. A second child required a tracheotomy for bronchomalacia at 6 months and died at 9 months with tracheotomy tube occlusion. Both children had adequate Tracheal repairs. Complications have included lateral Tracheal stenosis (the "Figure 8" trachea) and recurrent laryngeal nerve damage. Conclusions Our management of complete Tracheal Rings has evolved over the last decade, and slide tracheoplasty currently is our preferred surgical approach for Tracheal stenosis regardless of the length of narrowing.
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Tracheoplasty for Congenital Complete Tracheal Rings
Archives of otolaryngology--head & neck surgery, 1994Co-Authors: Thomas M. Andrews, Robin T. Cotton, Warren W. Bailey, Charles M. Myer, S. Russell VesterAbstract:Objective: To better appreciate the complex nature of the pediatric patient with Tracheal stenosis due to congenital complete Tracheal Rings, we evaluated clinical presentation, methods of evaluation, necessity for surgical repair, associated anomalies, and outcome. Design: Retrospective study. Patients: Eighteen patients with long-segment Tracheal stenosis due to congenital complete Tracheal Rings were evaluated at Cincinnati (Ohio) Children's Hospital Medical Center between 1985 and 1991. Three patients did not require surgical intervention. Fifteen patients underwent tracheoplasty with cardiopulmonary bypass through a midline sternotomy. Results: The patients with congenital complete Tracheal Rings usually present with respiratory compromise in the first year of life. In the majority of patients, a diagnosis was made based on the symptoms and findings of an endoscopic examination with the aid of plain film roentgenography. In selected patients, computed tomography or magnetic resonance imaging was used. We evaluated symptoms, length of stenosis, type of repair, duration of intubation, and complications, as well as the mortality associated with this procedure. Conclusions: The technique of tracheoplasty has evolved at our institution, including the use of a posterior Tracheal division, anterior castellated division, autologous pericardial patch grafting, and cricoid split with intubation for 7 to 21 days. We found the mortality associated with this procedure quite high at 47%, compared with previously published reports with mortality figures between zero and 77%. (Arch Otolaryngol Head Neck Surg. 1994;120:1363-1369)
David Schaner - One of the best experts on this subject based on the ideXlab platform.
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A novel airway device with tactile sensing capabilities for verifying correct endoTracheal tube placement
Journal of Clinical Monitoring and Computing, 2014Co-Authors: Pauwel Goethals, Harshu Chaobal, Dominiek Reynaerts, David SchanerAbstract:We present a new device for verifying endoTracheal tube (ETT) position that uses specialized sensors intended to distinguish anatomical features of the trachea and esophagus. This device has the potential to increase the safety of resuscitation, surgery, and mechanical ventilation and decrease the morbidity, mortality, and health care costs associated with esophageal intubation and unintended extubation by potentially improving the process and maintenance of endoTracheal intubation. The device consists of a tactile sensor connected to the airway occlusion cuff of an ETT. It is intended to detect the presence or absence of Tracheal Rings immediately upon inflation of the airway occlusion cuff. The initial study detailed here verifies that a prototype device can detect contours similar to Tracheal Rings in a Tracheal model.
