Traheobronhalna morfometrija korelira s demografskim obilježjima i infekcijama u kritično oboljelih pacijenata

Tracheal measurements in the intensive care unit (ICU) are important for the choice of endotracheal tube and may correlate with patient demographic characteristics and infections. The study included 42 surgical patients, age 60 [48-71] years, who underwent diagnostic chest computed tomography (CT) scans during treatment in the ICU, Osijek University Hospital, in 2019 and 2020. CT scans were analyzed using AW Server 3.2. Measurement analysis showed that the diameters of the tracheobronchial tree, the length of the trachea and left main bronchus were significantly larger in men compared to women (p<0.05 all). The smallest tracheal upper diameter was 15.25 [IQR 11.8-18.8] mm vs. 17.95 [13.55-20.05] mm in septic and nonseptic patients, respectively (p=0.028). A total of 26 patients who underwent CT scans developed nosocomial pneumonia. It was right-sided in 15, left-sided in 6 and bilateral in 5 patients, and correlated significantly with the left main bronchus length (ρ=0.515, p=0.007). No correlation was observed between tracheobronchial measurements and length of ICU treatment, number of hours spent on mechanical ventilation, or survival. A larger study could provide better data on the importance of tracheobronchial tree measurements in ICU patients.Izmjere traheje u jedinici intenzivnog liječenja (JIL) važne su zbog odabira veličine tubusa te mogu korelirati s demografskim obilježjima bolesnika i infekcijama. U ovoj studiji su analizirana 42 kirurška bolesnika u dobi od 60 [48-71] godina kojima je učinjena dijagnostička kompjutorizirana tomografija (CT) prsnog koša za vrijeme liječenja u JIL-u Kliničkog bolničkog centra Osijek tijekom 2019. i 2020. godine. Snimci CT-a su analizirani programom AW Server 3.2. Analiza izmjera pokazala je da su promjeri traheobronhalnog stabla, duljina dušnika i lijevog glavnog bronha značajno veći kod muškaraca nego kod žena (p<0,05 za sve). Najuži gornji promjer dušnika bio je 15,25 [IQR 11,8-18,8] naspram 17,95 [13,55-20,05] mm u septičkih i neseptičkih bolesnika (p=0,028). Kod ukupno 26 bolesnika koji su podvrgnuti CT-u tijekom liječenja u JIL-u dijagnosticirana je pneumonija. Bila je desnostrana u 15, lijevostrana u 6, a obostrana u 5 bolesnika i značajno je korelirala s duljinom lijevog glavnog bronha (ρ=0,515, p=0,007). Nije uočena korelacija između traheobronhalnih mjerenja i duljine liječenja u JIL-u, duljine mehaničke ventilacije ili preživljenja. Veća studija bi mogla pružiti bolje podatke o značenju dimenzija traheobronhalnog stabla kod kritično oboljelih pacijenata

Measurements of the tracheobronchial tree and patients' outcomes in the Department of Intensive Care Medicine of the Osijek University Hospital

Cilj istraživanja: Ispitati utjecaj izmjera traheobronhalnog stabla na ishod liječenja kritično oboljelih pacijenata te povezanost izmjera s duljinom liječenja u JIL-u, satima provedenim na mehaničkoj ventilaciji i pojavom bolničke pneumonije. Nacrt studije: presječno istraživanje Ispitanici i metode: U istraživanje je uključeno 42 pacijenta kojima je tijekom liječenja u Jedinici intenzivnog liječenja KBC-a Osijek učinjen CT prsnog koša tijekom 2019. i 2020. godine. Analizirane su CT snimke te su zabilježene izmjere traheobronhalnog stabla. Iz medicinske dokumentacije zabilježeni su podatci o duljini boravka u JIL-u, satima provedenim na mehaničkoj ventilaciji, razvoju bolničke pneumonije i konačnom ishodu ispitanika. Korištene statističke metode su: Mann Whitney U test, Pearsonov i Spearmanov koeficijent korelacije. Rezultati: Medijan dobi svih bolesnika je 60 godina, a većina pacijenata primljena je u JIL putem hitnog prijema. Najučestaliji komorbiditet bila je respiracijska insuficijencija zbog koje je 90 % ispitanika bilo mehanički ventilirano, a 48 % ispitanika razvilo je bolničku pneumoniju, iako nije uočena povezanost s izmjerama traheobronhalnog stabla. Niti kod jednog ispitanika nisu zabilježene anomalije niti značajnije anatomske varijacije traheobronhalnog stabla. Analizom izmjera zabilježeno je da su promjeri traheobronhalnog stabla te duljina traheje i lijevog glavnog bronha značajno veći kod muškaraca u usporedbi sa ženama. Nije uočena povezanost izmjera s duljinom liječenja u JIL-u niti s brojem sati provedenih na mehaničkoj ventilaciji. Zaključak: Nije uočena povezanost izmjera traheobronhalnog stabla s duljinom liječenja u JIL-u, niti s brojem sati provedenih na mehaničkoj ventilaciji, kao niti s razvojem bolničke pneumonije i konačnim ishodom.Objectives: The aim of this study was to examine the influence of tracheobronchial tree measurements on the treatment outcome of critically ill patients and the connection of measurements with the length of ICU stay, hours spent on mechanical ventilation, the development of nosocomial pneumonia and patient’s outcome. Study Design: Cross-sectional study Participants and Methods: The study included 42 patients hospitalized at Intensive care unit of the Clinical Hospital Centre Osijek who had a chest CT during 2019. and 2020. CT scans were analysed and tracheobronchial tree measurements were recorded. Data on the length of ICU stay, hours spent on mechanical ventilation, the development of nosocomial pneumonia and the final outcome of the patients were obtained from the BIS, disease history analysis and therapeutic lists. Statistical analysis was performed using Mann Whitney U test and Pearson’s and Spearman’s correlation coefficient. Results: The median age of patients was 60. Most patients were admitted to the ICU through the emergency department. Due to respiratory insufficiency, which was the most frequent comorbidity, 90 % of the patients were mechanically ventilated, and 48 % of the patients developed nosocomial pneumonia. No connection has been noticed between tracheobronchial tree measurements and suggested comorbidities. No anomalies or significant anatomical variations were noticed in any of the patients. Analysis of tracheobronchial tree measurements revealed that the diameters of the tracheobronchial tree and the length of the trachea and the left main bronchus are significantly larger in men than in women. No correlation has been found between tracheobronchial tree measurements with the length of ICU stay. Furthermore, number of hours spent on mechanical ventilation, development of nosocomial pneumonia and final outcome, are not correlated to tracheobronchial tree measurements. Conclusion: No correlation was observed between tracheobronchial tree measurements with the length of ICU stay, nor with the number of hours spent on mechanical ventilation, nor with the development of nosocomial pneumonia and the final outcome

Measurements of the tracheobronchial tree and patients' outcomes in the Department of Intensive Care Medicine of the Osijek University Hospital

Cilj istraživanja: Ispitati utjecaj izmjera traheobronhalnog stabla na ishod liječenja kritično oboljelih pacijenata te povezanost izmjera s duljinom liječenja u JIL-u, satima provedenim na mehaničkoj ventilaciji i pojavom bolničke pneumonije. Nacrt studije: presječno istraživanje Ispitanici i metode: U istraživanje je uključeno 42 pacijenta kojima je tijekom liječenja u Jedinici intenzivnog liječenja KBC-a Osijek učinjen CT prsnog koša tijekom 2019. i 2020. godine. Analizirane su CT snimke te su zabilježene izmjere traheobronhalnog stabla. Iz medicinske dokumentacije zabilježeni su podatci o duljini boravka u JIL-u, satima provedenim na mehaničkoj ventilaciji, razvoju bolničke pneumonije i konačnom ishodu ispitanika. Korištene statističke metode su: Mann Whitney U test, Pearsonov i Spearmanov koeficijent korelacije. Rezultati: Medijan dobi svih bolesnika je 60 godina, a većina pacijenata primljena je u JIL putem hitnog prijema. Najučestaliji komorbiditet bila je respiracijska insuficijencija zbog koje je 90 % ispitanika bilo mehanički ventilirano, a 48 % ispitanika razvilo je bolničku pneumoniju, iako nije uočena povezanost s izmjerama traheobronhalnog stabla. Niti kod jednog ispitanika nisu zabilježene anomalije niti značajnije anatomske varijacije traheobronhalnog stabla. Analizom izmjera zabilježeno je da su promjeri traheobronhalnog stabla te duljina traheje i lijevog glavnog bronha značajno veći kod muškaraca u usporedbi sa ženama. Nije uočena povezanost izmjera s duljinom liječenja u JIL-u niti s brojem sati provedenih na mehaničkoj ventilaciji. Zaključak: Nije uočena povezanost izmjera traheobronhalnog stabla s duljinom liječenja u JIL-u, niti s brojem sati provedenih na mehaničkoj ventilaciji, kao niti s razvojem bolničke pneumonije i konačnim ishodom.Objectives: The aim of this study was to examine the influence of tracheobronchial tree measurements on the treatment outcome of critically ill patients and the connection of measurements with the length of ICU stay, hours spent on mechanical ventilation, the development of nosocomial pneumonia and patient’s outcome. Study Design: Cross-sectional study Participants and Methods: The study included 42 patients hospitalized at Intensive care unit of the Clinical Hospital Centre Osijek who had a chest CT during 2019. and 2020. CT scans were analysed and tracheobronchial tree measurements were recorded. Data on the length of ICU stay, hours spent on mechanical ventilation, the development of nosocomial pneumonia and the final outcome of the patients were obtained from the BIS, disease history analysis and therapeutic lists. Statistical analysis was performed using Mann Whitney U test and Pearson’s and Spearman’s correlation coefficient. Results: The median age of patients was 60. Most patients were admitted to the ICU through the emergency department. Due to respiratory insufficiency, which was the most frequent comorbidity, 90 % of the patients were mechanically ventilated, and 48 % of the patients developed nosocomial pneumonia. No connection has been noticed between tracheobronchial tree measurements and suggested comorbidities. No anomalies or significant anatomical variations were noticed in any of the patients. Analysis of tracheobronchial tree measurements revealed that the diameters of the tracheobronchial tree and the length of the trachea and the left main bronchus are significantly larger in men than in women. No correlation has been found between tracheobronchial tree measurements with the length of ICU stay. Furthermore, number of hours spent on mechanical ventilation, development of nosocomial pneumonia and final outcome, are not correlated to tracheobronchial tree measurements. Conclusion: No correlation was observed between tracheobronchial tree measurements with the length of ICU stay, nor with the number of hours spent on mechanical ventilation, nor with the development of nosocomial pneumonia and the final outcome