A Retrospective Evaluation of Airway Anatomy in Young Children and Implications for One-Lung Ventilation

Abstract

Objective: One-lung ventilation (OLV) in children remains a niche practice with few studies to guide best practices. The objective of this study was to describe lower airway anatomy relevant to establishment of OLV in young children.

Design: Retrospective, observational study using pre-existing studies in the electronic health record.

Setting: Single institution, academic medical center, tertiary-care hospital.

Participants: Pediatric patients <8 years old.

Interventions: None.

Measurements and main results: Chest computed tomographic scans of 111 children 4 days to 8 years of age were reviewed. Measurements were taken from the thyroid isthmus to the carina, carina to first lobar branch on the left and right, diameter of the trachea at the carina, and diameter of the left and right mainstem bronchi. Dimensions were correlated with the outer diameter of endotracheal tubes and bronchial blockers. The left mainstem bronchus is consistently smaller than the right. Lung isolation using a mainstem technique on the left should use an endotracheal tube a half size smaller than would be used for tracheal intubation. The length from the carina to the first lobar branch on the left is consistently 3 times longer than on the right. Further, age-delineated bronchial diameters suggest that the clinician should transition from a 5F to a 7F Arndt bronchial blocker at 3-to-4 years of age.

Conclusion: A more detailed and accurate understanding of pediatric lower airway anatomy may assist the clinician in successfully performing OLV in young children.

Keywords: anesthesia; lower airway anatomy; pediatric; single-lung ventilation.