Spatial orientation and mechanical properties of the human trachea: A computed tomography study

Alberto Zanella, Massimo Cressoni, Daniela Ferlicca, Chiara Chiurazzi, Myra Epp, Cristina Rovati, Davide Chiumello, Antonio Pesenti, Luciano Gattinoni, Theodor Kolobow

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The literature generally describes the trachea as oriented toward the right and back, but there is very little detailed characterization. Therefore, the aim of this study was to precisely determine the spatial orientation and to better characterize the physical properties of the human trachea. METHODS: We analyzed lung computed tomography scans of 68 intubated and mechanically ventilated subjects suffering from acute lung injury/ARDS at airway pressures (Paw) of 5, 15, and 45 cm H2O. At each Paw, the inner edge of the trachea from the subglottal space to the carina was captured. Tracheal length and diameter were measured. Tracheal orientation and compliance were estimated from processing barycenter and surface tracheal sections. RESULTS: Tracheal orientation at a Paw of 5 cmH2O showed a 4.2_5.3° angle toward the right and a 20.6_6.9° angle downward toward the back, which decreased significantly while increasing Paw (19.4_6.9° at 15 cm H2O and 17.1_6.8° at 45 cm H2O, P <.001). Tracheal compliance was 0.0113_0.0131 mL/cm H2O/cm of trachea length from 5 to 15 cm H2O and 0.004_0.0041 mL/cm H2O/cm of trachea length from 15 to 45 cm H2O (P <.001). Tracheal diameter was 19.6_3.4 mm on the medial-lateral axis and 21.0_4.3 mm on the sternal-vertebral axis. CONCLUSIONS: The trachea is oriented downward toward the back at a 20.6_6.9° angle and slightly toward the right at a 4.2_5.3° angle. Understanding tracheal orientation may help in enhancing postural drainage and respiratory physiotherapy, and knowing the physical properties of the trachea may aid in endotracheal tube cuff design.

Original languageEnglish
JournalRespiratory Care
Volume60
Issue number4
DOIs
Publication statusPublished - 2015

Fingerprint

Trachea
Tomography
Compliance
Postural Drainage
Acute Lung Injury
Pressure
Lung

Keywords

  • Trachea anatomy
  • Trachea orientation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Zanella, A., Cressoni, M., Ferlicca, D., Chiurazzi, C., Epp, M., Rovati, C., ... Kolobow, T. (2015). Spatial orientation and mechanical properties of the human trachea: A computed tomography study. Respiratory Care, 60(4). https://doi.org/10.4187/respcare.03479

Spatial orientation and mechanical properties of the human trachea : A computed tomography study. / Zanella, Alberto; Cressoni, Massimo; Ferlicca, Daniela; Chiurazzi, Chiara; Epp, Myra; Rovati, Cristina; Chiumello, Davide; Pesenti, Antonio; Gattinoni, Luciano; Kolobow, Theodor.

In: Respiratory Care, Vol. 60, No. 4, 2015.

Research output: Contribution to journalArticle

Zanella, A, Cressoni, M, Ferlicca, D, Chiurazzi, C, Epp, M, Rovati, C, Chiumello, D, Pesenti, A, Gattinoni, L & Kolobow, T 2015, 'Spatial orientation and mechanical properties of the human trachea: A computed tomography study', Respiratory Care, vol. 60, no. 4. https://doi.org/10.4187/respcare.03479
Zanella, Alberto ; Cressoni, Massimo ; Ferlicca, Daniela ; Chiurazzi, Chiara ; Epp, Myra ; Rovati, Cristina ; Chiumello, Davide ; Pesenti, Antonio ; Gattinoni, Luciano ; Kolobow, Theodor. / Spatial orientation and mechanical properties of the human trachea : A computed tomography study. In: Respiratory Care. 2015 ; Vol. 60, No. 4.
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T2 - A computed tomography study

AU - Zanella, Alberto

AU - Cressoni, Massimo

AU - Ferlicca, Daniela

AU - Chiurazzi, Chiara

AU - Epp, Myra

AU - Rovati, Cristina

AU - Chiumello, Davide

AU - Pesenti, Antonio

AU - Gattinoni, Luciano

AU - Kolobow, Theodor

PY - 2015

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N2 - BACKGROUND: The literature generally describes the trachea as oriented toward the right and back, but there is very little detailed characterization. Therefore, the aim of this study was to precisely determine the spatial orientation and to better characterize the physical properties of the human trachea. METHODS: We analyzed lung computed tomography scans of 68 intubated and mechanically ventilated subjects suffering from acute lung injury/ARDS at airway pressures (Paw) of 5, 15, and 45 cm H2O. At each Paw, the inner edge of the trachea from the subglottal space to the carina was captured. Tracheal length and diameter were measured. Tracheal orientation and compliance were estimated from processing barycenter and surface tracheal sections. RESULTS: Tracheal orientation at a Paw of 5 cmH2O showed a 4.2_5.3° angle toward the right and a 20.6_6.9° angle downward toward the back, which decreased significantly while increasing Paw (19.4_6.9° at 15 cm H2O and 17.1_6.8° at 45 cm H2O, P <.001). Tracheal compliance was 0.0113_0.0131 mL/cm H2O/cm of trachea length from 5 to 15 cm H2O and 0.004_0.0041 mL/cm H2O/cm of trachea length from 15 to 45 cm H2O (P <.001). Tracheal diameter was 19.6_3.4 mm on the medial-lateral axis and 21.0_4.3 mm on the sternal-vertebral axis. CONCLUSIONS: The trachea is oriented downward toward the back at a 20.6_6.9° angle and slightly toward the right at a 4.2_5.3° angle. Understanding tracheal orientation may help in enhancing postural drainage and respiratory physiotherapy, and knowing the physical properties of the trachea may aid in endotracheal tube cuff design.

AB - BACKGROUND: The literature generally describes the trachea as oriented toward the right and back, but there is very little detailed characterization. Therefore, the aim of this study was to precisely determine the spatial orientation and to better characterize the physical properties of the human trachea. METHODS: We analyzed lung computed tomography scans of 68 intubated and mechanically ventilated subjects suffering from acute lung injury/ARDS at airway pressures (Paw) of 5, 15, and 45 cm H2O. At each Paw, the inner edge of the trachea from the subglottal space to the carina was captured. Tracheal length and diameter were measured. Tracheal orientation and compliance were estimated from processing barycenter and surface tracheal sections. RESULTS: Tracheal orientation at a Paw of 5 cmH2O showed a 4.2_5.3° angle toward the right and a 20.6_6.9° angle downward toward the back, which decreased significantly while increasing Paw (19.4_6.9° at 15 cm H2O and 17.1_6.8° at 45 cm H2O, P <.001). Tracheal compliance was 0.0113_0.0131 mL/cm H2O/cm of trachea length from 5 to 15 cm H2O and 0.004_0.0041 mL/cm H2O/cm of trachea length from 15 to 45 cm H2O (P <.001). Tracheal diameter was 19.6_3.4 mm on the medial-lateral axis and 21.0_4.3 mm on the sternal-vertebral axis. CONCLUSIONS: The trachea is oriented downward toward the back at a 20.6_6.9° angle and slightly toward the right at a 4.2_5.3° angle. Understanding tracheal orientation may help in enhancing postural drainage and respiratory physiotherapy, and knowing the physical properties of the trachea may aid in endotracheal tube cuff design.

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