Printed three-dimensional airway model assists planning of single-lung ventilation in a small child

C A Wilson; O J Arthurs; A E Black; S Schievano; C Hunt; S van Hoog; C Wallis; M R J Sury

doi:10.1093/bja/aev305

Printed three-dimensional airway model assists planning of single-lung ventilation in a small child

Br J Anaesth. 2015 Oct;115(4):616-20. doi: 10.1093/bja/aev305.

Authors

C A Wilson¹, O J Arthurs², A E Black³, S Schievano⁴, C Hunt⁵, S van Hoog⁶, C Wallis⁷, M R J Sury⁸

Affiliations

¹ Department of Anaesthesia, Institute of Child Health, University College London, London, UK [email protected].
² Department of Radiology, Institute of Child Health, University College London, London, UK Institute of Child Health, Institute of Child Health, University College London, London, UK.
³ Department of Anaesthesia, Institute of Child Health, University College London, London, UK Portex Department of Anaesthesia, Institute of Child Health, University College London, London, UK.
⁴ Institute of Cardiovascular Science, University College London, London, UK Cardiorespiratory Unit, London, UK.
⁵ Kings College Medical School, London, UK.
⁶ Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁷ Institute of Child Health, Institute of Child Health, University College London, London, UK Department of Respiratory Paediatrics, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK.
⁸ Department of Anaesthesia, Institute of Child Health, University College London, London, UK Institute of Cardiovascular Science, University College London, London, UK.

PMID: 26385670
DOI: 10.1093/bja/aev305

Abstract

Background: Single-lung ventilation in infants and small children is challenging because suitable sizes of double-lumen cuffed tracheal tubes are not available. A 6-yr-old child required pulmonary saline washout for primary alveolar proteinosis, and therefore needed sequential single-lung ventilation in order to achieve safe oxygenation. Before undertaking this potentially hazardous procedure, we practised bronchial intubation on an anatomical model of her airway constructed from computed tomography (CT) data.

Methods: We created a full-scale, anatomically accurate, transparent plastic model of the trachea and main bronchi on a three-dimensional printer using data from a CT scan. We then performed several different airway approaches to identify those likely to be most suitable, ex vivo, before the clinical procedure was carried out on the patient.

Results: The model helped us to choose the type and size of bronchial tubes and to practise their insertion beforehand. Subsequently, during anaesthesia, the chosen technique was successful.

Conclusions: Three-dimensional printing of a model of the airway of a small child aided planning of bronchial intubation and single-lung ventilation. Three-dimensional printing of airway structures may have wider application in anaesthesia practice.

Keywords: airway management; models, anatomical; one-lung ventilation.

Publication types

Case Reports

MeSH terms

Bronchi
Bronchography
Child
Female
Humans
Imaging, Three-Dimensional / methods*
Models, Anatomic*
One-Lung Ventilation / instrumentation*
One-Lung Ventilation / methods
Tomography, X-Ray Computed*
Trachea / diagnostic imaging*

Grants and funding

NIHR-CS-012-002/DH_/Department of Health/United Kingdom