生体内に挿入した気管カニューレの超高精細CTによる臨床評価

抄録

Background and Objectives: Ultra-high-resolution Computed Tomography (UHRCT) was recently released as a next-generation imaging technology. This novel technology can deliver 160 simultaneous slices with a super-thin 0.25-mm thickness, and we previously reported the feasibility of UHRCT for visualizing the vocalizing larynx. The present study examined the clinical feasibility of UHRCT for visualizing cuffed endotracheal tubes and surrounding tracheal structures in tracheostomized patients.

Materials and Methods: Two patients who would require future laryngotracheal separation procedures were included in this study. One patient (33 years old, male) had cerebral hemorrhaging, and the other (57 years old, female) had multiple system atrophy inducing chronic respiratory distress and dysphagia. UHRCT was performed with the patients in the supine position, and 3D reconstruction of the cervical tracheal regions was performed. The shapes of the endotracheal tubes, cuff, and surrounding tracheal structures were examined using the reconstructed images.

Results: Reconstructed UHRCT images clearly visualized the flange, shaft, cuff, cuff inflation line, and suction line of endotracheal tubes. While the cuff pressures were properly controlled (20-25 mmH₂O), the inflated tracheostomy tube cuff was observed in the folds of the cuff wall, and the distal tip of the cannula did not stay in the middle of the trachea in one patient.

Conclusions: This was the first study to show the clinical utility of UHRCT for assessing cuffed endotracheal tubes and the surrounding tracheal structures. Our findings support the idea that the inflated cuff and folds in the cuff wall in vivo visualized by UHRCT could predict an air leakage and aspiration of fluid.