Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Leimer, E.
The occurrence of major vessels at possible front of neck
airway access sites in children
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 94
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Heschl Stefan
- Altmetrics:
- Abstract:
- Question The focus of the study is to declare an age-dependent, topographical relation between big vessels or OIAS (=other important anatomical structure) to the trachea in sites of a possible front of neck access (=FONA) in children. This is done in order to improve the risk assessment of a possible major bleeding through the injury of a big vessel or OIAS during the establishment of a FONA (either coniotomy or tracheotomy). Patients and methods Computed tomography- and magnetic resonance imaging images (CT- and MRI images) of children between the age of 0-18 years were inspected retrospectively. The areas anterior, left and right lateral to the trachea have been checked in the cranial border (caudal of the thyroid cartilage), in the middle and in the caudal border (cranial of the sternum) on the prevalence of big vessels, for example, the carotid arteries, the brachiocephalic trunk, the innominate veins, the anterior and internal jugular veins, the aortic arch, the subclavian veins and arteries and further vessels, which were too small to characterize. Furthermore, the occurrence of the thyroid gland and the esophagus have been investigated. Additionally, some distance measurements were made, for example, the anterior-poster diameter of the trachea at the cranial border. Results Overall, the data of 310 patients was included, which was divided by age into 7 groups whereat group 2-7 contained the data of 50 patients respectively. Because of the rarity of data from group 1, it only contained the images of 10 patients. 166 (54%) male patients were found. 235 (76%) MRI and 75 (24%) CT images were examined. Within 109 cases (35%) in the area cranial anterior, within 124 cases (40%) in the middle anterior area and within 295 cases (95%) in the area caudal anterior, at least one big vessel or OIAS occurred. The results were itemized by the age groups. With the Kruskal-Wallis test no age-dependent, significant difference could be shown. Overall, the most prevalent vessel in the cranial anterior area was the right anterior jugular vein (36%), as well as in the middle anterior area (33%), whereas caudal anterior the brachiocephalic trunk (78%) occurred most often. 13 Interestingly, the aortic arch occurred in the caudal anterior area in children under the age of 5 years in 8% of the cases. In comparison, within children over the age of 5 years the aortic arch only occurred in 1% of the cases. The anterior-posterior diameter of the trachea showed a median of 10mm (maximum=24mm, minimum=3mm, standard deviation=4mm) and is therefore assumed to be very small. Conclusion This study reveals a significant number of pediatric patients in every age group who showed a high probability of having a big vessel or OIAS occurrence in the area of a possible surgical airway access site. Therefore, the risk of considerable bleeding as a complication is likely to be increased, especially at the caudal border.