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Quantitative Assessment of Tracheal Collapsibility in Infants with Tracheomalacia

Department of Anesthesiology (B1), Graduate School of Medicine, Chiba University, Chiba; Department of Neonatology; and Department of Cardiovascular Surgery, Matsudo City Hospital, Matsudo, Japan

Correspondence and requests for reprints should be addressed to Shiroh Isono, M.D., Department of Anesthesiology (B1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana-cho, Chuo-ku, Chiba, 260–8670, Japan. E-mail: isonos{at}ho.chiba-u.ac.jp

Infantile tracheomalacia is a potentially life-threatening disease requiring prolonged artificial respiratory support. Diagnosis and management of this disease may be further improved by establishing a suitable objective and quantitative assessment protocol for tracheal collapsibility. It is our hypothesis that tracheal collapsibility can be represented by the relationship between intraluminal pressure and the cross-sectional area of the trachea. To test this hypothesis, static pressure/area relationships of the trachea were obtained from anesthetized and paralyzed infants, who were diagnosed as having tracheomalacia by endoscopic observation. These relationships were fitted on a linear regression model, followed by calculation of the estimated closing pressure. The tracheal closing pressure ranged from –8 to –27 cm H₂O, suggesting easy collapsibility of the trachea during crying or coughing and noncollapsibility during the spontaneous respiratory cycle, which coincided with the infants' symptoms. It is our conclusion that tracheal collapsibility of infants with tracheomalacia can be quantitatively assessed by the static pressure/area relationship of the trachea obtained under general anesthesia and paralysis.

Key Words: anesthesia • closing pressure • endoscopy • paralysis • tube law

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