case study analysis of failure

Handbook of Case Histories in Failure Analysis

This volume examines more than 100 cases of failure and the process by which they were analyzed, diagnosed, and resolved. It provides expert analysis and insight on a variety of materials, failure modes, root causes, and analytical techniques. Included are sections dedicated to specific components, industries, and other factors in transportation and motive power systems, buildings and bridges, petrochemical/chemical processing, mining and manufacturing, mechanical components, failure modes, and processing related failures. Each case history adheres to a standard format that includes background information, how the failure was analyzed, testing procedures and results, and conclusions and recommendations. For information on the print version of Volume 3, ISBN 978-0-87170-239-6, follow this link .

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Handbook of Case Histories in Failure Analysis Edited by: Larry Berardinis https://doi.org/10.31399/asm.fach.v03.9781627082419 ISBN (electronic): 978-1-62708-241-9 Publisher: ASM International Published: 2019

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Table of Contents

• Publication History
• Failure Analyses of Six Cylinder Aircraft Engine Crankshafts By Robert W. Hinton Robert W. Hinton Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001752 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis Case Study on a Fractured Tailwheel Fork By Jonathan Carlos Contreras ; Jonathan Carlos Contreras Search for other works by this author on: This Site Google Scholar Sylvia Lucia Natividad ; Sylvia Lucia Natividad Search for other works by this author on: This Site Google Scholar Stephen William Stafford Stephen William Stafford Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001753 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a Jet Engine Gearbox Drive Gearshaft Ball Bearing By Rodolfo Villa ; Rodolfo Villa Search for other works by this author on: This Site Google Scholar Scot Roswurm Scot Roswurm Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001754 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of an Aero Engine Ball Bearing By N. Ejaz ; N. Ejaz Search for other works by this author on: This Site Google Scholar I. Salam ; I. Salam Search for other works by this author on: This Site Google Scholar A. Tauqir A. Tauqir Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001755 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of HP Turbine Blades in a Low Bypass Turbofan Engine By R. K. Mishra ; R. K. Mishra Search for other works by this author on: This Site Google Scholar Thomas Johney ; Thomas Johney Search for other works by this author on: This Site Google Scholar K. Srinivasan K. Srinivasan Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001756 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure of the J79 Engine Compressor Blade Due to Stall By Kyo-Soo Song ; Kyo-Soo Song Search for other works by this author on: This Site Google Scholar Seon-Gab Kim ; Seon-Gab Kim Search for other works by this author on: This Site Google Scholar Young-Ha Hwang Young-Ha Hwang Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001757 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Stress-Rupture Characterization in Nickel-Based Superalloy Gas Turbine Engine Components By Wesley D. Pridemore Wesley D. Pridemore Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001758 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Analysis of Bearing Cup Assembly Failure in Drive Shaft Assembly By Yogesh Pathak ; Yogesh Pathak Search for other works by this author on: This Site Google Scholar V. S. Aher V. S. Aher Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001759 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a Cracked Gasoline Engine Cylinder Head By M. Azadi ; M. Azadi Search for other works by this author on: This Site Google Scholar A. Mafi ; A. Mafi Search for other works by this author on: This Site Google Scholar M. Roozban ; M. Roozban Search for other works by this author on: This Site Google Scholar F. Moghaddam F. Moghaddam Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001760 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a Vehicle Engine Crankshaft By M. A. Alfares ; M. A. Alfares Search for other works by this author on: This Site Google Scholar A. H. Falah ; A. H. Falah Search for other works by this author on: This Site Google Scholar A. H. Elkholy A. H. Elkholy Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001761 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Induction Hardened Automotive Axles By C. Kendall Clarke ; C. Kendall Clarke Search for other works by this author on: This Site Google Scholar Don Halimunanda Don Halimunanda Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001762 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Reverse Shaft in the Transmission System of All-Terrain Vehicles By Chun-Yuan Lin ; Chun-Yuan Lin Search for other works by this author on: This Site Google Scholar Jui-Pin Hung ; Jui-Pin Hung Search for other works by this author on: This Site Google Scholar Tze-Chi Hsu Tze-Chi Hsu Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001763 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Torsion Fatigue Failure of Bus Drive Shafts By D. H. Duffner D. H. Duffner Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001764 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Corrosion Failure of Bottom Plates of an Aboveground Storage Tank By M. Mobin ; M. Mobin Search for other works by this author on: This Site Google Scholar A.U. Malik ; A.U. Malik Search for other works by this author on: This Site Google Scholar S. Al-Fozan ; S. Al-Fozan Search for other works by this author on: This Site Google Scholar F. Al-Muaili F. Al-Muaili Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001765 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a Temporary Power Line Anchor By M.E. Stevenson ; M.E. Stevenson Search for other works by this author on: This Site Google Scholar M.E. Barkey ; M.E. Barkey Search for other works by this author on: This Site Google Scholar J.L. McDougall ; J.L. McDougall Search for other works by this author on: This Site Google Scholar E.R. Weishaupt E.R. Weishaupt Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001766 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Transformer Brackets By Melissa Kurtz Melissa Kurtz Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001767 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Metallurgical Investigation of a Cracked Splice Plate Used in a Power Transmission Line Tower By S.K. Dhua ; S.K. Dhua Search for other works by this author on: This Site Google Scholar B.B. Patra ; B.B. Patra Search for other works by this author on: This Site Google Scholar P.P. Sarkar ; P.P. Sarkar Search for other works by this author on: This Site Google Scholar B. Singh ; B. Singh Search for other works by this author on: This Site Google Scholar B.K. Jha B.K. Jha Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001768 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Scale Formation by Calcium-Precipitating Bacteria in Cooling Water System By S. Maruthamuthu ; S. Maruthamuthu Search for other works by this author on: This Site Google Scholar P. Dhandapani ; P. Dhandapani Search for other works by this author on: This Site Google Scholar S. Ponmariappan ; S. Ponmariappan Search for other works by this author on: This Site Google Scholar S. Sathiyanarayanan ; S. Sathiyanarayanan Search for other works by this author on: This Site Google Scholar S. Muthukrishnan ; S. Muthukrishnan Search for other works by this author on: This Site Google Scholar N. Palaniswamy N. Palaniswamy Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001769 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of AISI-304 Stainless Steel Styrene Storage Tank By M.S. Ali Asghar ; M.S. Ali Asghar Search for other works by this author on: This Site Google Scholar F. Tariq ; F. Tariq Search for other works by this author on: This Site Google Scholar A. Ali A. Ali Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001770 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Ethylene Cracking Tube By V. Tari ; V. Tari Search for other works by this author on: This Site Google Scholar A. Najafizadeh ; A. Najafizadeh Search for other works by this author on: This Site Google Scholar M.H. Aghaei ; M.H. Aghaei Search for other works by this author on: This Site Google Scholar M.A. Mazloumi M.A. Mazloumi Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001771 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure of Silicon Bronze Impeller from Dealloying Via Desiliconification By Nicholas Bantz Nicholas Bantz Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001772 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Metallurgical Analysis to Evaluate Cracking in a 316L Grade Stainless Steel Spiral Heat Exchanger By Thomas D. Traubert ; Thomas D. Traubert Search for other works by this author on: This Site Google Scholar Tim A. Jur Tim A. Jur Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001773 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Stress Corrosion Cracking of Ring Type Joint of Reactor Pipeline of a Hydrocracker Unit By Poorwa Gore ; Poorwa Gore Search for other works by this author on: This Site Google Scholar M. Sujata ; M. Sujata Search for other works by this author on: This Site Google Scholar S.K. Bhaumik S.K. Bhaumik Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001774 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Stress-Corrosion Cracking of a Monel 400 Tube By A.I. Katsamas ; A.I. Katsamas Search for other works by this author on: This Site Google Scholar G.N. Haidemenopoulos ; G.N. Haidemenopoulos Search for other works by this author on: This Site Google Scholar A.D. Zervak ; A.D. Zervak Search for other works by this author on: This Site Google Scholar I. Melas I. Melas Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001775 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• A Study of Premature Failure of Crusher Jaws By J.O. Olawale ; J.O. Olawale Search for other works by this author on: This Site Google Scholar S.A. Ibitoye ; S.A. Ibitoye Search for other works by this author on: This Site Google Scholar M.D. Shittu ; M.D. Shittu Search for other works by this author on: This Site Google Scholar A.P.I. Popoola A.P.I. Popoola Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001776 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure of a Bucket-Wheel Stacker Reclaimer: Metallographic and Structural Analyses By L.S. Araujo ; L.S. Araujo Search for other works by this author on: This Site Google Scholar L.H. de Almeida ; L.H. de Almeida Search for other works by this author on: This Site Google Scholar E.M. Batista ; E.M. Batista Search for other works by this author on: This Site Google Scholar A. Landesmann A. Landesmann Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001777 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Metallurgical Investigation of Failed Locked Coil Track Ropes Used in a Mining Conveyor By S.K. Dhua ; S.K. Dhua Search for other works by this author on: This Site Google Scholar C.D. Singh ; C.D. Singh Search for other works by this author on: This Site Google Scholar Amitava Ray Amitava Ray Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001778 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Study on Failure Analyses and Material Characterizations of a Damaged Booster Pump By A.A. Shoushtari ; A.A. Shoushtari Search for other works by this author on: This Site Google Scholar K. Ranjbar ; K. Ranjbar Search for other works by this author on: This Site Google Scholar S.M. Mousavi ; S.M. Mousavi Search for other works by this author on: This Site Google Scholar D.A. Yancheshmeh D.A. Yancheshmeh Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001779 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• The Effects of Sulfide Inclusions on Mechanical Properties and Failures of Steel Components By Joseph Maciejewski Joseph Maciejewski Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001780 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis and Mechanical Performance Evaluation of a Cast Aluminum Hybrid-Iron Golf Club Hosel By Christopher A. Walton ; Christopher A. Walton Search for other works by this author on: This Site Google Scholar Benjamin E. Nesbit ; Benjamin E. Nesbit Search for other works by this author on: This Site Google Scholar Henrique M. Candia ; Henrique M. Candia Search for other works by this author on: This Site Google Scholar Zachary A. Myers ; Zachary A. Myers Search for other works by this author on: This Site Google Scholar Wilburn R. Whittington ; Wilburn R. Whittington Search for other works by this author on: This Site Google Scholar Tonya W. Stone Tonya W. Stone Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001781 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a Titanium Golf Club Head By Richard P. Baron ; Richard P. Baron Search for other works by this author on: This Site Google Scholar Raymond J. Claxton Raymond J. Claxton Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001782 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a Crimping Mechanism By Federico Sciammarella ; Federico Sciammarella Search for other works by this author on: This Site Google Scholar Sharmistha Sarangi Sharmistha Sarangi Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001783 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a Fractured Wrench Socket By S. Nasrazadani ; S. Nasrazadani Search for other works by this author on: This Site Google Scholar P. White P. White Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001784 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Open End Wrenches Containing Forging Defects By Hans C. Iwand ; Hans C. Iwand Search for other works by this author on: This Site Google Scholar Jacob A. Wagner Jacob A. Wagner Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001785 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Spline Shaft in Beco Lathe By V. Praveen Kumar ; V. Praveen Kumar Search for other works by this author on: This Site Google Scholar G. Kempulraj ; G. Kempulraj Search for other works by this author on: This Site Google Scholar Shaju K. Albert Shaju K. Albert Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001786 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of the 18CrNi3Mo Steel for Drilling Bit By Sheng Xu ; Sheng Xu Search for other works by this author on: This Site Google Scholar Le-yu Zhou ; Le-yu Zhou Search for other works by this author on: This Site Google Scholar Yong-ming Yan ; Yong-ming Yan Search for other works by this author on: This Site Google Scholar Hong-wu Zhu Hong-wu Zhu Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001787 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Fatigue Failure of Extrusion Dies: Effect of Process Parameters and Design Features on Die Life By S.S. Akhtar ; S.S. Akhtar Search for other works by this author on: This Site Google Scholar A.F.M. Ari A.F.M. Ari Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001788 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• An Environmentally Assisted Cracking Evaluation of UNS C64200 (Al–Si–Bronze) and UNS C63200 (Ni–Al–Bronze) By Michelle Koul ; Michelle Koul Search for other works by this author on: This Site Google Scholar Jennifer Gaies Jennifer Gaies Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001789 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a High-Speed Pinion Shaft By M.E. Stevenson ; M.E. Stevenson Search for other works by this author on: This Site Google Scholar J.L. McDougall ; J.L. McDougall Search for other works by this author on: This Site Google Scholar R.D. Bowman ; R.D. Bowman Search for other works by this author on: This Site Google Scholar R.L. Herman R.L. Herman Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001790 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of an Aqua Tubular Boiler Tube By Cassio Barbosa ; Cassio Barbosa Search for other works by this author on: This Site Google Scholar Simone Kessler de Barros ; Simone Kessler de Barros Search for other works by this author on: This Site Google Scholar Ibrahim de Cerqueira Abud ; Ibrahim de Cerqueira Abud Search for other works by this author on: This Site Google Scholar Joneo Lopes do Nascimento ; Joneo Lopes do Nascimento Search for other works by this author on: This Site Google Scholar Sheyla Santana de Carvalho Sheyla Santana de Carvalho Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001791 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Gearbox and Clutch Shaft from a Marine Engine By S. F. Hassan ; S. F. Hassan Search for other works by this author on: This Site Google Scholar M. R. Alam M. R. Alam Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001792 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure of a Concentric Pipe for a Controllable Pitch Propeller System By L.S. Araujo ; L.S. Araujo Search for other works by this author on: This Site Google Scholar M.C. Mendes ; M.C. Mendes Search for other works by this author on: This Site Google Scholar L.H. de Almeida ; L.H. de Almeida Search for other works by this author on: This Site Google Scholar M.S. Dutra ; M.S. Dutra Search for other works by this author on: This Site Google Scholar D. Cardoso D. Cardoso Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001793 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Fatigue Failure of a Drive Shaft By Marina Banuta ; Marina Banuta Search for other works by this author on: This Site Google Scholar Isabelle Tarquini Isabelle Tarquini Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001794 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Case Study on Failure of Ball Bearing of an Aeroengine By R.R. Bhat ; R.R. Bhat Search for other works by this author on: This Site Google Scholar Vaisakhi Nandi ; Vaisakhi Nandi Search for other works by this author on: This Site Google Scholar V. Manohara ; V. Manohara Search for other works by this author on: This Site Google Scholar S.V. Suresh S.V. Suresh Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001795 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Electrical Fluting Failure of a Tri-Lobe Roller Bearing By Tomasz Didenko ; Tomasz Didenko Search for other works by this author on: This Site Google Scholar Wesley D. Pridemore Wesley D. Pridemore Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001796 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of a Cam–Follower System Affected by a Crack By M. Tounsi ; M. Tounsi Search for other works by this author on: This Site Google Scholar M.S. Abbes ; M.S. Abbes Search for other works by this author on: This Site Google Scholar T. Fakhfakh ; T. Fakhfakh Search for other works by this author on: This Site Google Scholar M. Haddar M. Haddar Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001797 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Epoxy Resin Encapsulant During a Long-Term Storage By Guobin Zhang ; Guobin Zhang Search for other works by this author on: This Site Google Scholar Yusen Wang ; Yusen Wang Search for other works by this author on: This Site Google Scholar Shinian Zhang ; Shinian Zhang Search for other works by this author on: This Site Google Scholar Chunhe Liu Chunhe Liu Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001798 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of High-Speed Pinion Gear Shaft By W. Muhammad ; W. Muhammad Search for other works by this author on: This Site Google Scholar N. Ejaz ; N. Ejaz Search for other works by this author on: This Site Google Scholar S.A. Rizvi S.A. Rizvi Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001799 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Spring Fatigue Fractures Due to Microstructural Changes in Service By J. Maciejewski ; J. Maciejewski Search for other works by this author on: This Site Google Scholar B. Akyuz B. Akyuz Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001800 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Cervical Stent Failure Analysis By Wayne Reitz Wayne Reitz Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001801 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of NiTi Wires Used in Medical Applications By B. James ; B. James Search for other works by this author on: This Site Google Scholar J. Foulds ; J. Foulds Search for other works by this author on: This Site Google Scholar L. Eiselstein L. Eiselstein Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001802 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Metallurgical Failure Analysis of Various Implant Materials Used in Orthopedic Applications By B. Aksakal ; B. Aksakal Search for other works by this author on: This Site Google Scholar O.S. Yildirim ; O.S. Yildirim Search for other works by this author on: This Site Google Scholar H. Gul H. Gul Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001803 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Microscopic Analysis of Fractured Screws Used as Implants in Bone Fixation By Cassio Barbosa ; Cassio Barbosa Search for other works by this author on: This Site Google Scholar Ibrahim de Cerqueira Abud ; Ibrahim de Cerqueira Abud Search for other works by this author on: This Site Google Scholar Tatiana Silva Barros ; Tatiana Silva Barros Search for other works by this author on: This Site Google Scholar Sheyla Santana de Carvalho ; Sheyla Santana de Carvalho Search for other works by this author on: This Site Google Scholar Ieda Maria Vieira Caminha Ieda Maria Vieira Caminha Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001804 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Surgical Tool Failure Analyses By Eric P. Guyer ; Eric P. Guyer Search for other works by this author on: This Site Google Scholar Brad A. James Brad A. James Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001805 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Analysis and Subsequent Testing of Cracked Brass Connector Housings By Tim Mueller ; Tim Mueller Search for other works by this author on: This Site Google Scholar Neil Burns Neil Burns Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001806 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Analysis of Critical Stress for Subsurface Rolling Contact Fatigue Damage Assessment Under Roll/Slide Contact By Xiao-feng Qin ; Xiao-feng Qin Search for other works by this author on: This Site Google Scholar Da-le Sun ; Da-le Sun Search for other works by this author on: This Site Google Scholar Li-yang Xie Li-yang Xie Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001807 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Avoidable MIC-Related Failures By Albert M. Olszewski Albert M. Olszewski Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001808 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Dealloying of a Nickel–Aluminum Bronze Impeller By Albert M. Olszewski Albert M. Olszewski Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001809 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Torsion Bar of Projectile Weaving Machine By Tezcan Sekercioglu Tezcan Sekercioglu Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001810 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure and Stress Analysis of Deformed Steel Tube By A. Nusair Khan ; A. Nusair Khan Search for other works by this author on: This Site Google Scholar M. Mudassar Rauf ; M. Mudassar Rauf Search for other works by this author on: This Site Google Scholar I. Salam ; I. Salam Search for other works by this author on: This Site Google Scholar S.H. Khan S.H. Khan Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001811 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failures of Structures and Components by Metal-Induced Embrittlement By S.P. Lynch S.P. Lynch Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001812 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Graphitization in Low Alloy Steel Pressure Vessels and Piping By Iván Uribe Pérez ; Iván Uribe Pérez Search for other works by this author on: This Site Google Scholar Tito Luiz da Silveira ; Tito Luiz da Silveira Search for other works by this author on: This Site Google Scholar Tito Fernando da Silveira ; Tito Fernando da Silveira Search for other works by this author on: This Site Google Scholar Heloisa Cunha Furtado Heloisa Cunha Furtado Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001813 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
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• Failure Analysis of a Drilling Wire Rope By S. Moradi ; S. Moradi Search for other works by this author on: This Site Google Scholar K. Ranjbar ; K. Ranjbar Search for other works by this author on: This Site Google Scholar H. Makvandi H. Makvandi Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001817 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
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• Failure Analysis: Sulfide Stress Corrosion Cracking and Hydrogen-Induced Cracking of A216-WCC Wellhead Flow Control Valve Body By S.M.R. Ziaei ; S.M.R. Ziaei Search for other works by this author on: This Site Google Scholar A.H. Kokabi ; A.H. Kokabi Search for other works by this author on: This Site Google Scholar J. Mostowfi J. Mostowfi Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001820 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
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• Corrosion Failures in Gas Turbine Hot Components By E. Kosieniak ; E. Kosieniak Search for other works by this author on: This Site Google Scholar K. Biesiada ; K. Biesiada Search for other works by this author on: This Site Google Scholar J. Kaczorowski ; J. Kaczorowski Search for other works by this author on: This Site Google Scholar M. Innocenti M. Innocenti Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001827 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Corrosion Fatigue of a Pump Bearing Journal after Exposure to Two-Phase Flow By A. N. Kumar A. N. Kumar Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001828 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
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• Failure Investigation of the Wind Turbine Blade Root Bolt By Donghuan Liu ; Donghuan Liu Search for other works by this author on: This Site Google Scholar Xinchun Shang Xinchun Shang Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001835 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
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• Failure Analysis of HAZ Cracking in Low C-CrMoV Steel Weldment By Nausheen Naz ; Nausheen Naz Search for other works by this author on: This Site Google Scholar Fawad Tariq ; Fawad Tariq Search for other works by this author on: This Site Google Scholar Rasheed Ahmed Baloch Rasheed Ahmed Baloch Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001837 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Hot Cracking in Inductively Bent Austenitic Stainless Steel Pipes By Andreas Neidel ; Andreas Neidel Search for other works by this author on: This Site Google Scholar Susanne Riesenbeck Susanne Riesenbeck Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001838 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Metallurgical Investigation into the Incidence of Delayed Catastrophic Cracking in Low Nickel Austenitic Stainless Steel Coils By S. Srikanth ; S. Srikanth Search for other works by this author on: This Site Google Scholar S.A.A. Akbari Mousavi ; S.A.A. Akbari Mousavi Search for other works by this author on: This Site Google Scholar S. Sisodia ; S. Sisodia Search for other works by this author on: This Site Google Scholar K. Ravi K. Ravi Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001839 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• The Role of Impact Energy in Failure of Explosive Cladding of Inconel 625 and Steel By H R. Zareie Rajani ; H R. Zareie Rajani Search for other works by this author on: This Site Google Scholar C. McVeigh ; C. McVeigh Search for other works by this author on: This Site Google Scholar S.N. Rosenbloom ; S.N. Rosenbloom Search for other works by this author on: This Site Google Scholar E.P. Guyer ; E.P. Guyer Search for other works by this author on: This Site Google Scholar S.I. Lieberman S.I. Lieberman Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001840 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Ultrasonic Cleaning-Induced Failures in Medical Devices By B.A. James B.A. James Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001841 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Fracture of a Paper Manufacturing Machine Felt Guide Roll By Tim A. Jur ; Tim A. Jur Search for other works by this author on: This Site Google Scholar R. Dean Harris R. Dean Harris Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001842 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• A Tin Pest Failure By Neil Douglas Burns Neil Douglas Burns Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001843 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Brittle Cracking of a Cylindrical Spiral Gear of Axle Gearbox By Yu-zhou Gao ; Yu-zhou Gao Search for other works by this author on: This Site Google Scholar Xiao-lei Xu ; Xiao-lei Xu Search for other works by this author on: This Site Google Scholar Zhi-wei Yu Zhi-wei Yu Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001844 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Analysis of Steady Clamps Used in Electrified Railway By Qiaoling Chu ; Qiaoling Chu Search for other works by this author on: This Site Google Scholar Min Zhang ; Min Zhang Search for other works by this author on: This Site Google Scholar Yinni Chen Yinni Chen Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001845 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Failure Investigation of a Locomotive Turbocharger Main Shaft and Bearing Sleeve By Zhiwei Yu ; Zhiwei Yu Search for other works by this author on: This Site Google Scholar Xiaolei Xu ; Xiaolei Xu Search for other works by this author on: This Site Google Scholar Xiaoyan Guo Xiaoyan Guo Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001846 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Fracture and Wear Failure of a Locomotive Turbocharger-Bearing Sleeve By Xiaolei Xu ; Xiaolei Xu Search for other works by this author on: This Site Google Scholar Zhiwei Yu ; Zhiwei Yu Search for other works by this author on: This Site Google Scholar Yuzhen Chen Yuzhen Chen Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001847 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
• Analysis of Degradation and Failure Mechanisms that Develop in Hot Forging Die By Fayçal Njeh ; Fayçal Njeh Search for other works by this author on: This Site Google Scholar Mohamed Kchaou ; Mohamed Kchaou Search for other works by this author on: This Site Google Scholar Riadh Elleuch ; Riadh Elleuch Search for other works by this author on: This Site Google Scholar Foued El Halouani Foued El Halouani Search for other works by this author on: This Site Google Scholar Doi: https://doi.org/10.31399/asm.fach.v03.c9001848 Published: 01 December 2019 Abstract View Chapter PDF Link PDF
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Information for Faculty

• Bridge Failure Cases
• Dam Failure Cases
• Building Failure Cases
• Other Failure Cases

There is a documented need for failure awareness in the undergraduate engineering curriculum.  Engineering students can learn a lot from failures, and failures play an important role in engineering design.  This need has been expressed in a number of papers and at a number of conferences over the past two decades.  This book is a specific response to that need and will provide (1) much needed access to examples, and (2) a heightened appreciation of the role failure analysis knowledge can play in higher education and public safety.

Many of the key technical principles that civil engineering students should learn can be illustrated through case studies.  For example, the author has discussed the Hyatt Regency walkway collapse, the Tacoma Narrows Bridge failure, and other well-known cases with students in Statics, Mechanics of Materials, and other courses.  These cases help students:

• Grasp difficult technical concepts and begin to acquire an intuitive feel for the behavior of systems and structures,
• Understand how engineering science changes over time as structural performance is observed and lessons are learned,
• Analyze the impacts of engineering decisions on society, and
• Appreciate the importance of ethical considerations in the engineering decision making process.

The main obstacle to integrating case studies and lessons learned from failures into existing courses has been that many faculties does not have time to research and prepare case studies.  Although there are many references available, they are difficult to translate into classroom lectures without considerable added effort on the part of the instructor.

There are three ways to introduce failure analysis and failure case studies into civil engineering education.  A small number of colleges and universities, probably only a few percent, offer courses in forensic engineering or failure case studies. Often, these are at institutions such as the University of Texas, Mississippi State University, or the University of Colorado at Denver that have practicing forensic engineers on the faculty (Delatte and Rens, 2002).  Clearly, this approach depends on the availability of qualified and interested faculty.

Another method is to use case studies in capstone (Senior) design projects (Delatte and Rens, 2002).   This is also dependent on the interested and qualified faculty, as well as on the availability of appropriate projects (which must be sufficiently free of liability concerns).

These two approaches offer great depth in the topic, but due to their inherent limitations, their application is likely to remain limited.  As a result, even at colleges and universities where courses are offered in this area, few undergraduates are likely to be able to take them.  While some might argue for a required stand-alone course in failure analysis for all undergraduate civil engineering students, the argument is likely to fall on deaf ears as programs shrink their credit hour requirements.  However, this book would be an excellent text for a civil engineering failure analysis course.

A more promising approach is to integrate failure case studies into courses throughout the curriculum.  Many professors have done this on an informal basis for years.  The author used this approach at the United States Military Academy (USMA) while teaching two courses in engineering mechanics, Statics and Dynamics and Mechanics of Materials (Delatte, 1997).  He continued the approach in engineering mechanics and civil engineering courses at the University of Alabama at Birmingham (UAB) (Delatte, 2000, Delatte and Rens, 2002, Delatte, 2003) and at Cleveland State University.

Why Study Failures?

In a survey conducted by the ASCE Technical Council on Forensic Engineering (TCFE) Education Committee in December 1989, about a third of the 87 civil engineering schools responding indicated a need for detailed well-documented case studies.  The University of Arizona said ASCE should provide such materials for educational purposes and Swarthmore College suggested ASCE should provide funds for creating monographs on failures that have occurred in the past (Rendon 1993a).

The ASCE TCFE conducted a second survey in 1998, which was sent to all Accreditation Board for Engineering and Technology (ABET) accredited engineering schools throughout the United States (Rens et al, 2000a).  Similar to the 1989 survey, the lack of instructional materials was cited as a reason that failure analysis topics were not being taught.  One of the unprompted written comments in that survey was a selected bibliography is needed on the topic, which could be accessed via the Internet.

The use of case studies is also supported by the latest pedagogical research.  From Analysis to Action ( Center, 1996) refers on page 2 to textbooks lacking in practical examples as an emerging weakness.  Much of this document refers specifically to the breadth of understanding, which may be achieved through case studies.  Another issue addressed (Center, 1996, p. 19) is the need to incorporate historical, social, and ethical issues into courses for engineering majors. The Committee on Undergraduate Science Education in Transforming Undergraduate Education in Science, Mathematics, Engineering, and Technology (Committee, 1999) proposes that as many undergraduate students as possible should undertake original, supervised research.  How People Learn (Bransford et al., 1999, p. 30) refers to the need to organize knowledge meaningfully, in order to aid synthesis and develop expertise.

This work raises the question of whether failure analysis is merely tangential to, or is, in fact, fundamental to, civil engineering education.  Put another way, are failure case studies simply interesting, or should they be an essential component of a civil engineering curriculum?

Failure Case Studies and Accreditation Requirements

ASCE TCFE Education Committee surveys of civil engineering departments reported in 1989 and 1998 (Rendon-Herrero, 1993a, 1993b, Bosela, 1993, Rens et al., 2000) found that many respondents indicated a need for detailed, well-documented case studies.  Some of those replying felt strongly that incorporation of failure case studies should not become part of accreditation evaluations.  However, unless something is specifically mandated by the Accreditation Board for Engineering and Technology (ABET), it is likely to be a low priority for inclusion in a curriculum.

There is certainly an argument to be made that failure analysis should be mandated by ABET.  It may also be argued that, in a sense, it already is.  Under Criterion 3, Program Outcomes and Assessment,

Engineering programs must demonstrate that their students attain:

(a) An ability to apply knowledge of mathematics, science, and engineering

(b) An ability to design and conduct experiments, as well as to analyze and interpret data

(c) An ability to design a system, component, or process to meet desired needs within realistic constraints such as economic, environmental, social, political, ethical, health and safety, manufacturability, and sustainability

(d) An ability to function on multi-disciplinary teams

(e) An ability to identify, formulate, and solve engineering problems

(f) An understanding of professional and ethical responsibility

(g) An ability to communicate effectively

(h) The broad education necessary to understand the impact of engineering solutions in a global, economic, environmental, and societal context

(I) a recognition of the need for, and an ability to engage in life-long learning

(j) A knowledge of contemporary issues

(k) An ability to use the techniques, skills, and modern engineering tools necessary for engineering practice.

Programs often struggle with how to document that their graduates understand the impact of engineering solutions in a global and societal context, engage in life-long learning and demonstrate knowledge of contemporary issues (criteria h, i, and j, respectively).  These outcomes can be difficult to demonstrate.  One method of documenting these particular outcomes is to include case studies of failed engineering works in the curriculum.  Many case studies show the direct societal impact of failures and demonstrate the need for life-long learning by highlighting the evolutionary nature of engineering design procedures.

Case studies also address the revised criterion c, design within realistic constraints.  Case studies and specifically failure case studies illuminate how economic, environmental, social, political, ethical, health and safety, manufacturability, and sustainability impact design, behavior, and performance of engineered systems.

Criteria for civil engineering programs are more specific.  Students must demonstrate an understanding of professional practice issues such as procurement of work, bidding versus quality-based selection processes, how the design professionals and the construction professions interact to construct a project, the importance of professional licensure and continuing education, and/or other professional practice issues.These professional issues are integral to many of the case studies addressed through the workshops.  As an example, some project failures may be traced to poor interaction and communications between the designers and the builders.

Failure Case Studies and the Civil Engineering Body of Knowledge

The ASCE report Civil Engineering Body of Knowledge for the 21st Century: Preparing the Civil Engineer for the Future , prepared by the Body of Knowledge Committee of the Committee on Academic Prerequisites for Professional Practice, goes beyond ABET.  The Body of Knowledge (BOK) defines 12 outcomes.  The first 11 are identical to the ABET a k. BOK outcomes 12-15 are:

• An ability to apply knowledge in a specialized area related to civil engineering.
• An understanding of the elements of project management, construction, and asset management.
• An understanding of business and public policy and administration fundamentals.
• An understanding of the role of the leader and leadership principles and attitudes.

For those failures with complex technical causes, failure case studies may be used to deepen understanding within specialized civil engineering areas (outcome 12).  Failures can expose and highlight the subtleties of structural and system behavior that are the province of the specialist.  Some specialties, such as earthquake and geotechnical engineering, have historically relied heavily on failure case studies to advance the state of the practice.

Outcomes 13, 14, and 15 may also be addressed through failure case studies.  In many failures, the technical issues involved may not be particularly complex or unusual.  Instead, breakdowns may come in the project management and construction processes or in the management of the facility by the owner (outcome 13).  Pressures of business and public interests may encourage engineers to take short cuts, with harmful consequences (outcome 14).  Some failures might have been averted with stronger leadership (outcome 15).  A more thorough discussion of the relationship between failure case studies, ABET, and BOK outcomes is provided in Delatte (2008).

Pedagogical Benefits of Case Studies

Learning that occurs in multiple learning skills domains and exercises higher level learning skills is crucial to successful engineering education.  This must, however, occur efficiently because engineering curricula are already overcrowded.  This is one reason why failure case studies should be an essential part of engineering classes.  The single activity of using a case study as part of a traditional course lesson plan simultaneously fosters learning in three different learning domains, thus making learning more efficient:

1. Affective: The failure is interesting and sometimes dramatic, thus increasing initial acquisition and permanent retention of knowledge from the learning exercise because of the emotional state of the student during the learning process.

2. Cognitive: The failure validates the science, showing that our engineering tools work and thus motivating the students to learn and retain more knowledge.

3. Social: Students discover or rediscover how engineering decisions impact individuals, communities, and society

As a result of case study inclusion, students will demonstrate an ability to process failure analysis, apply ethics in engineering, and demonstrate an understanding of the engineer’s role in and their value to society.  Students will also demonstrate a greater depth of knowledge by developing intuition about the expected behavior of engineered systems, understanding load paths, and better visualizing the interaction of components of engineered systems.  Finally, students should experience a change in attitudes about quality engineering as a result of studying failures of engineered systems.

Use of Cases

Some of the ways to use case studies and a suggested format were reviewed in Delatte and Rens (2002).  These include:

• Introductions to topics use the case to illustrate why a particular failure mode is important.  Often the importance of a particular mode of failure only became widely known after a failure examples include the wind-induced oscillations of the Tacoma Narrows Bridge and the failure of Air Force warehouses in the mid-1950’s that pointed out the need for shear reinforcement in reinforced concrete beams.
• Class discussions link technical issues to ethical and professional considerations.  Add discussions of the standard of care, responsibility, and communications to coverage of technical topics.
• Example problems and homework assignments calculate the forces acting on structural members and compare them to design criteria and accepted the practice.  This can have the added benefit of requiring students to compare design assumptions to actual behavior in the field under service loads and overloads.
• Group and individual projects have students research the cases in depth and report back on them.  This will also help build a database of cases for use in future classes.  Students gain valuable research, synthesis, and communication skills.

Common Threads

The use of case studies as common threads through the curriculum can best be illustrated through an example.  The 1907 collapse of the Quebec Bridge during construction, discussed in Chapter 3, represents a landmark of both engineering practice and forensic engineering.  The Quebec Bridge was the longest cantilever structure attempted until that time.  In its final design, it was 548.6 m (1,800 ft) long.   The bridge project was financially troubled from the beginning.  This caused many setbacks in the design and construction.   Construction began in October 1900.   In August 1907, the bridge collapsed suddenly.  Seventy-five workers were killed in the accident, and there were only eleven survivors from the 86 workers on the span.

A distinguished panel was assembled to investigate the disaster.  The panel’s report found that the main cause of the bridge’s failure was the improper design of the latticing on the compression chords.  The collapse was initiated by the buckling failure of Chord A9L, immediately followed by Chord A9R.  Theodore Cooper had been the consulting engineer for the Quebec Bridge project, and most of the blame for the disaster fell on his shoulders.  He mandated unusually high allowable stresses and failed to require recalculation of the bridge dead load when the span was lengthened.

This case study illustrates a number of important teaching points from engineering courses.

1) Statics truss analysis.  The bridge was a cantilever truss.  As the two arms of the bridge were built out from the pier, the moments on the truss arms increased, and the compressive stresses in the bottom chords of each arm also increased.   Both the method of joints and the method of sections, traditionally taught in statics courses, may be used to analyze the compressive strut forces at the different stages of bridge construction.  See Chapter 2.

2) Mechanics of Materials allowable stresses.  Mr. Cooper increased the allowable stresses for his bridge well beyond the limits of accepted engineering practice, without experimental justification.   He allowed compressive stresses that were considerably higher than that provided by the modern AISC code and were highly unconservative given the state of knowledge at the time.  The compression struts of the truss were too large to be tested by available machinery, so their capacity could not be precisely known.  Development of engineering codes and standards requires tradeoffs between structural safety and economy, and there must be mechanisms for resolving disputes between competing criteria.  See Chapter 3, which has this case study.

3) Mechanics of Materials structural deformation.  The bending of the critical A9L member reached 57 mm (2-inches) and was increasing at the time of the collapse.  The bending was discussed at the site and by Mr. Cooper, attempting to supervise the project from New York, but no action was taken.  In fact, the bending showed that the member was slowly buckling.

4) Mechanics of Materials buckling of columns and bars.  The critical A9L compression member failed by buckling.  It was a composite section, which meant that it required lacing to require the members to bend together.  The moment of inertia, and buckling capacity, of the composite section, may be compared to that of the individual truss members, showing the importance of the latticing system.

5)  Structural Analysis predicting, computing, and correcting dead loads.  One critical error made in the design was that the dead load was greatly underestimated.  When material invoices showed that 17-30 % more steel had gone into parts of the structure than had been planned for in the design, no attempt was made to analyze the bridge for the new loads.  See Chapter 4.

6)The design of Steel Structures analysis and design of built-up members.  This point follows from the discussion of buckling of columns and bars, above.  Many existing steel bridges use built-up members, and engineers involved in assessing and rehabilitating such structures need to know how to evaluate member capacity and likely failure modes.  See Chapter 6.

7)  Engineering Management the requirement for the engineer of record to inspect the work on the site.  Mr. Cooper attempted to supervise the construction of a bridge in Quebec from his office in New York City.  When problems arose, the problems were referred to him for a decision.  The absence of an onsite engineer with authority to stop the work meant that there was no way to head off the impending collapse.  A meeting was held to decide what to do, and the bridge collapsed just as the meeting was breaking up.

8) Engineering Ethics professional responsibility.  Mr. Cooper planned for the Quebec Bridge to be the crowning achievement of an illustrious career as a bridge engineer.  However, by this time his health was poor and he was unable to travel to the site.  He was also poorly compensated for his work.  Following the collapse, organizations such as ASCE began to define better the responsibility of the engineer of record.  Unfortunately, the collapse of the Hyatt Regency Walkways three-quarters of a century later showed that much remains to be done.

As an example, the following problem statement may be used in a structural analysis or capstone design/professionalism course, in conjunction with the Quebec Bridge collapse case study.  The problem should be assigned before the discussion of the case study, probably as an overnight homework.  Following discussion of the case study, students should be better able to identify potential problems with an unusual construction technique.

You are the engineer for a cantilever truss bridge across a major river in North America.  The bridge owner has asked you to prepare specifications, including allowable stresses, and has emphasized that they have a very shaky financial situation.   The bridge was initially intended to be 1,600 feet long to reduce the cost of the piers, they have been moved into shallower water and it will now be 1,800 feet long.  When completed, it will be the longest bridge of this type in the world.

Problem:  list all of the things you can think of that can go wrong during this bridge construction project.

Once the collapse case has been discussed, the problem may be reassigned with the additional assignment to propose communication and quality control measures to ensure against collapse.  Students should refer to the case study in formulating their answers.

The case study materials developed so far have been very well received by faculty across a wide range of civil engineering programs, as well as some other related programs.  To date, however, the benefits identified have been anecdotal (although nevertheless impressive).  There remains a need to identify, quantify, and assess the impact of case studies on teaching and learning.

Surveys have found widespread agreement that faculty consider failure case studies important and useful (Rendon-Herrero, 1993a, 1993b, Bosela, 1993, Rens et al., 2000).  Several of the faculty failure case study workshop participants have reported back that the case studies have been excellent for motivating their students to learn.  So far, the formal assessment of the impact of using case study materials in courses has been limited.  Some assessment methods and results have been published by Delatte et al. (2007, 2008).

Desired student learning outcomes are:

• Improved understanding of technical issues in civil engineering and engineering mechanics
• Improved understanding of ethical, professional, and procedural issues in civil engineering and engineering mechanics

The primary assessment question is: In what ways does the use of failure case studies improve students ability to demonstrate competencies that prepare them to be better professional civil engineers?

The assessment questions are as follows:

• Does the use of failure case studies improve student’s ability to demonstrate competencies that better prepare them as professional engineers for the 21st century?
• How does the implementation of failure case studies encourage deep learning in civil engineering students?
• What has been the time commitment and value-added experience for faculty who integrate failure case studies in the course curriculum that improves student learning of civil engineering concepts?

For Delatte’s papers published in ASEE Conference Proceedings, go the ASEE Proceedings web page, and use the “Author” search on Delatte

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• Open access
• Published: 23 April 2024

Case study observational research: inflammatory cytokines in the bronchial epithelial lining fluid of COVID-19 patients with acute hypoxemic respiratory failure

• Kazuki Sudo 1 , 2 ,
• Mao Kinoshita 1 ,
• Ken Kawaguchi 1 ,
• Kohsuke Kushimoto 1 ,
• Ryogo Yoshii 2 ,
• Keita Inoue 2 ,
• Masaki Yamasaki 2 , 3 ,
• Tasuku Matsuyama 4 ,
• Kunihiko Kooguchi 2 ,
• Yasuo Takashima 5 ,
• Masami Tanaka 5 ,
• Kazumichi Matsumoto 6 ,
• Kei Tashiro 5 ,
• Tohru Inaba 6 , 7 ,
• Bon Ohta 4 &
• Teiji Sawa 1 , 8  

Critical Care volume  28 , Article number:  134 ( 2024 ) Cite this article

194 Accesses

Metrics details

In this study, the concentrations of inflammatory cytokines were measured in the bronchial epithelial lining fluid (ELF) and plasma in patients with acute hypoxemic respiratory failure (AHRF) secondary to severe coronavirus disease 2019 (COVID-19).

We comprehensively analyzed the concentrations of 25 cytokines in the ELF and plasma of 27 COVID-19 AHRF patients. ELF was collected using the bronchial microsampling method through an endotracheal tube just after patients were intubated for mechanical ventilation.

Compared with those in healthy volunteers, the concentrations of interleukin (IL)-6 (median 27.6 pmol/L), IL-8 (1045.1 pmol/L), IL-17A (0.8 pmol/L), IL-25 (1.5 pmol/L), and IL-31 (42.3 pmol/L) were significantly greater in the ELF of COVID-19 patients than in that of volunteers. The concentrations of MCP-1 and MIP-1β were significantly greater in the plasma of COVID-19 patients than in that of volunteers. The ELF/plasma ratio of IL-8 was the highest among the 25 cytokines, with a median of 737, and the ELF/plasma ratio of IL-6 (median: 218), IL-1β (202), IL-31 (169), MCP-1 (81), MIP-1β (55), and TNF-α (47) were lower.

Conclusions

The ELF concentrations of IL-6, IL-8, IL-17A, IL-25, and IL-31 were significantly increased in COVID-19 patients. Although high levels of MIP-1 and MIP-1β were also detected in the blood samples collected simultaneously with the ELF samples, the results indicated that lung inflammation was highly compartmentalized. Our study demonstrated that a comprehensive analysis of cytokines in the ELF is a feasible approach for understanding lung inflammation and systemic interactions in patients with severe pneumonia.

Severe symptoms of coronavirus disease 2019 (COVID-19), such as acute hypoxemic respiratory failure (AHRF) and cytokine release syndrome, often lead to multiorgan failure and death [ 1 ]. Research has mainly focused on analyses of factors in the blood to study the impact of COVID-19 on immune function, especially in AHRF patients, due to the ease of access in using blood samples [ 2 , 3 , 4 , 5 ]. However, recent reports have shown that the bronchoalveolar immune response in COVID-19 patients presents a distinct local profile that significantly diverges from the immune response observed in the blood of these patients [ 6 , 7 , 8 , 9 ]. Notably, COVID-19 patients with AHRF were reported to have lower blood cytokine levels than those with bacterial sepsis [ 10 ]. These findings suggest a more complex and subtle immune mechanism in these patients, implying that a compartmentalized reaction within their lungs plays a significant role in the efficacy of therapeutic interventions [ 11 , 12 ].

In a study of 27 COVID-19 patients with AHRF who required mechanical ventilation (MV), bronchial epithelial lining fluid (ELF) was collected via bronchial microsampling (MS) [ 13 , 14 ]. This study analyzed 25 cytokine concentrations in both the ELF and plasma of COVID-19 patients using a multiplex bead-based assay and explored the relationship between lung injury severity, as depicted in chest computed tomography (CT) images, and disease duration influenced by viral mutations.

Materials and methods

From March 2021 to March 2022, 27 patients who needed MV for COVID-19-related AHRF at Kyoto Prefectural University of Medicine participated in this study. Their treatments, pneumonia severity index (PSI) [ 15 ], Charlson Comorbidity Index (CCI) [ 16 ], and other comorbidities were documented (Additional file 1 : Table S1, Additional file 2 : Table S2). All patients received high-flow nasal cannula therapy before MV. Four patients, including one who received extracorporeal membrane oxygenation (ECMO), did not survive. The control data for both the ELF and plasma cytokine levels were obtained from six healthy volunteers without lung injury who underwent an elective surgery under anesthesia and tracheal intubation.

Bronchial ELF

The bronchial ELF was collected using an MS probe (model BC-402C; Olympus, Tokyo, Japan) immediately after tracheal intubation [ 13 , 14 ] (Fig.  1 A). The probe was inserted into the segmental bronchus of the right lower lobe via an endotracheal tube; approximately 20 μL of ELF was retrieved from each probe; and this procedure was repeated nine times per patient.

A (1) The microsampling probe (model BC-402C, Olympus Tokyo, Japan) used for collecting bronchial epithelial lining fluid (ELF). (2) The probe tip is comprised of a 2.5-mm outer polyethylene sheath and a 1.9-mm inner polyester fiber rod probe, 20 mm in length, attached to a stainless-steel guide wire. (3) The process of extracting ELF by centrifugation. B The study analyzed cytokine concentrations in COVID-19 patients (normal) with acute hypoxemic respiratory failure (AHRF) compared to healthy volunteers (covid). (1) Cytokine concentrations in the ELF and (2) plasma are presented. C The ratio of bronchial ELF/plasma concentrations. The data included a box plot representing the 25th to 75th percentiles (interquartile range, IQR), the median (centerline), and whisker lines extending to the furthest data points within Q1–1.5 × IQR and Q3 + 1.5 × IQR. Outliers were identified beyond these limits. Significant differences (* p  < 0.05) between the normal and COVID-19 patient groups are marked with an asterisk and were assessed using the Kruskal‒Wallis test with Bonferroni correction

Cytokine measurement

To analyze 25 types of cytokines (Additional file 3 : Table S3), a multiplex bead-based assay (Bio-Plex Pro human cytokine GI-17-Plex for granulocyte colony-stimulating factor (G-CSF), granulocyte–macrophage colony-stimulating factor (GM-CSF), interferon-γ (IFN-γ), interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL12p70, monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1β (MIP-1β), and tumor necrosis factor-α (TNF-α), and Th17-15-Plex panels for IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, and soluble CD40 ligand (sCD40L), Bio-Rad, Hercules, CA, USA) was used. Values between zero and less than the manufacturer’s lower limit of quantification (LLOQ) were treated as the LLOQ.

Lung infiltration volume

All 27 patients received CT scans either before transfer or upon admission to the hospital. 3D Slicer software (ver.4.11) was used to calculate the lung infiltration volume (LIV) from chest CT images based on a recently reported method [ 17 , 18 ].

Statistical analyses

This study used SPSS Version 27 for Kruskal–Wallis nonparametric tests and χ 2 tests to compare group medians, with the data presented as medians with interquartile ranges (IQRs).

Cytokine concentrations

The ELF cytokines IL-5, IL-7, IL-12p70, IL-13, and GM-CSF were undetectable in the ELF of 26 patients (Fig.  1 B-1). There were increases in the other cytokines, with median levels of IL-8 at 1045.1 [IQR 178.4–11,688.0] pmol/L and IL-6 at 27.6 [5.2–151.2] pmol/L and measurable levels of IL-17A (0.8 [0.2–2.7] pmol/L), IL-25 (15.3 [0.4–3.9] pmol/L), and IL-31 (42.3 [2.4–85.9] pmol/L). The levels of typical inflammatory cytokines, such as MCP-1, MIP-1β, TNF-α, IL-1β, and IL-10, were not significantly greater in the patients than in healthy individuals.

The cytokines IFN-γ, sCD40L, IL-2, IL-4, IL-17A, IL-17F, IL-23, IL-25, and IL-31 were undetectable in the plasma of the 27 patients, and 26 patients had IL-7, IL-12p70, IL-21, and IL-22 levels that were below the detection limits (Fig.  1 B-2). The detected cytokines included MCP-1, MIP-1β, IL-8, and TNF-α, and only the levels of MCP-1 (2.5 [1.1–5.0] pmol/L) and MIP-1β (0.7 [0.6–1.6] pmol/L) were significantly greater in the patients than in healthy volunteers. Low plasma levels of G-CSF (0.3 [< 0.3–0.4] pmol/L), IL-6 (0.2 [0.0–0.6] pmol/L), IL-10 (0.1 [< 0.1–0.2] pmol/L), IL-13 (0.03 [< 0.03–0.03] pmol/L), and IL-33 (0.24 [< 0.24–0.24] pmol/L) were also detected.

The ratios of cytokine concentrations in the ELF to those in the plasma were calculated (Fig.  1 C). The ELF/plasma ratio was the highest for IL-8, at a median of 737 [IQR 262–11,688] with a detection frequency (%df) of 96.3%, in 27 patients, with the second highest ratios being those of IL-6 (218 [39–1206], %df = 74.1%), IL-1β (202 [21–6434], 3.7%), IL-31 (169 [9–394], 0.0%), MCP-1 (81 [13–323], 96.3%), MIP-1β (55 [0–1121], 96.3%), and TNF-α (47 [7–1560], 81.5%). These ratios underscore the significant disparity in the cytokine concentrations in the ELF and those in the plasma in COVID-19 patients.

Pneumonia severity and cytokine levels

This study assessed 27 COVID-19 patients with AHRF across three pandemic phases in Japan: the 4th wave with the original variant (Mar-Jun 2021), the 5th wave with the Delta variant (Jul–Sep 2021), and the 6th wave with the Omicron variant (Jan-Mar 2022) (Additional file 4 : Table S4, Additional file 5 : Fig. S1). Notably, the CCI and creatinine levels were lower in the patients of the Delta wave than in those of the 4th wave (Additional file 4 : Table S4). The PSI and ferritin levels were greater in the patients of the Omicron wave group than in those of the Delta wave group (Additional file 4 : Table S4, Fig.  2 B-1).

A The pneumonia severity index (PSI), lung infiltration volume (LIV), C-reactive protein (CRP) concentration in the blood, cytokine concentration in the ELF and plasma, provided therapies and comorbidities were recorded for individual patients in order of LIV, including deceased patients (marked by †). B Age, CRP in blood, total cytokine concentration in the ELF and plasma, LIV, and PSI were analyzed. (1) Comparisons among the chronological groups based on when they developed AHRF due to COVID-19. (2) Comparisons among the groups stratified by the severity of pneumonia using the PSI. (3) Comparison among the groups after patients were stratified by the severity of pneumonia using the LIV. The boxplots show the median, individual data points (colored dots), and whisker lines extending to Q1–1.5 × IQR and Q3 + 1.5 × IQR or the last data point within these values. Points outside these limits are considered outliers. Significance († p  < 0.05) was determined using the Kruskal‒Wallis test with Bonferroni correction for multiple comparisons. AHRF Acute hypoxemic respiratory failure, CRP C-reactive protein, ELF Epithelial lining fluid, IQR Interquartile range, LIV Lung infiltration volume (%) [ 17 , 18 ], PSI Pneumonia severity index [ 15 ]

In a study of 27 patients, subgroups were created based on the PSI and LIV. PSI was categorized as mild (PSI < 90), moderate (90  ≦  PSI < 130), or severe (130  ≦  PSI) (Fig. 2 B-2, Additional file 6 : Table S5), while LIV was divided into mild (LIV < 40%), moderate (40%  ≦  LIV < 50%), or severe (50%  ≦  LIV) (Fig. 2 A, B-3, Additional file 7 : Table S6). The present study revealed that there were more female patients in the moderate PSI group and more older patients in the severe PSI group. Interestingly, the sum of the 25 cytokine concentrations in the ELF and plasma samples did not significantly differ among the PSI groups. The severe LIV subgroup had higher C-reactive protein levels than did the moderate LIV subgroup. Notably, the sum of the 25 cytokine concentrations in the ELF was lower in the severe LIV subgroup than in the moderate group, but no significant difference in plasma cytokine concentrations was observed among the LIV subgroups, indicating that there are different patterns of inflammation based on lung injury severity.

In our recent study of 23 COVID-19 patients during Japan's third and fourth waves of the pandemic, including those on ECMO and those with severe AHRF, 109 cytokines were analyzed [ 19 ]. Significant increases in cytokines such as IL-11, M-CSF, stromal cell-derived factor-1 (SDF-1), and soluble tumor necrosis factor receptor 2 (sTNF-R2) were detected, suggesting a link between hematopoietic progenitor cell differentiation and Th1-derived hyperinflammation. Interestingly, the levels of traditional inflammatory cytokines such as IL-1β, IL-6, and TNF-α were not dramatically elevated. These findings indicate that cytokine storms in COVID-19 patients involve different cytokines than those typically associated with inflammation, which highlights the need to understand lung-specific inflammatory responses.

Bronchoscopic MS, a method for directly collecting ELF using a polyester fiber rod probe, was first reported by Ishizaka et al. in 2001 [ 13 ]. This technique has been applied for measuring antibiotics and conducting proteomic analyses of the patients’ ELF samples [ 14 , 20 ]. In this study, we used the MS method for comprehensive cytokine analysis of the ELF in COVID-19 patients. While BAL fluid (BALF) is traditionally used for lung cytokine measurement, obtaining BALF samples carries risks such as pathogen exposure and is challenging in severely ill patients because it can potentially cause hypoxemia and pulmonary edema. MS is less invasive for collecting undiluted ELF, but due to its localized sampling, ELF samples may not reflect all the conditions throughout the lung as comprehensively as BALF samples can.

The cytokine discrepancy between the ELF and blood suggests that the lung inflammation in COVID-19 patients is distinct from that in the systemic circulation of these patients, indicating that there is localized inflammation within the lungs of these patients rather than mere secondary spillover effects. This finding emphasizes the compartmentalization of pulmonary cytokines. However, this study was limited because measurements were taken just once after tracheal intubation, thus preventing observations of the cytokine changes over time. Intriguingly, patients with severe lung disease had lower total cytokine levels in their ELF than patients with other severity levels. Although the Omicron variant is less virulent and causes fewer severe cases, it significantly harms the lungs of immunocompromised elderly individuals. This underscores the inadequacy of solely using a blood cytokine analysis for understanding the pathology of lung injury and systemic manifestations in COVID-19 patients. ELF analysis via MS provides crucial insights into lung-specific inflammation, aiding in comprehending the complex pathology of COVID-19, particularly in patients with AHRF and worsening health.

Abbreviations

Coronavirus disease 2019

Acute hypoxemic respiratory failure

Mechanical ventilation

• Epithelial lining fluid

Microsampling

Computed tomography

Pneumonia severity index

Charlson Comorbidity Index

Extracorporeal membrane oxygenation

Lower limit of quantification

Granulocyte colony-stimulating factor

Granulocyte–macrophage colony-stimulating factor

Interferon-γ

Interleukin

Monocyte chemotactic protein-1

Macrophage inflammatory protein-1β

Tumor necrosis factor-α

Soluble CD40 ligand

Interquartile range

Detection frequency

Bronchoalveolar lavage fluid

Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368:473–4. https://doi.org/10.1126/science.abb8925 .

Article   CAS   PubMed   Google Scholar  

Chen LYC, Quach TTT. COVID-19 cytokine storm syndrome: a threshold concept. Lancet Microbe. 2021;2:e49–50. https://doi.org/10.1016/S2666-5247(20)30223-8 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Silva MJA, Ribeiro LR, Gouveia MIM, Marcelino BDR, Santos CSD, Lima KVB, et al. Hyperinflammatory response in COVID-19: a systematic review. Viruses. 2023. https://doi.org/10.3390/v15020553 .

Article   PubMed   PubMed Central   Google Scholar  

Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 cytokine storm; what we know so far. Front Immunol. 2020;11:1446. https://doi.org/10.3389/fimmu.2020.01446 .

Calabrese F, Lunardi F, Baldasso E, Pezzuto F, Kilitci A, Olteanu GE, et al. Comprehensive bronchoalveolar lavage characterization in COVID-19 associated acute respiratory distress syndrome patients: a prospective cohort study. Respir Res. 2023;24:152. https://doi.org/10.1186/s12931-023-02464-9 .

Zeng HL, Chen D, Yan J, Yang Q, Han QQ, Li SS, et al. Proteomic characteristics of bronchoalveolar lavage fluid in critical COVID-19 patients. FEBS J. 2021;288:5190–200. https://doi.org/10.1111/febs.15609 .

Liao L, Yang GH. Clinical significance of cellular immunity function and inflammatory factors assays in alveolar lavage fluid for severe COVID-19 pneumonia. J Med Virol. 2021;93:2979–87. https://doi.org/10.1002/jmv.26827 .

Saris A, Reijnders TDY, Nossent EJ, Schuurman AR, Verhoeff J, van Asten S, et al. Distinct cellular immune profiles in the airways and blood of critically ill patients with COVID-19. Thorax. 2021;76:1010–9. https://doi.org/10.1136/thoraxjnl-2020-216256 .

Article   PubMed   Google Scholar  

de Brabander J, Boers LS, Kullberg RFJ, Zhang S, Nossent EJ, Heunks LMA, et al. Persistent alveolar inflammatory response in critically ill patients with COVID-19 is associated with mortality. Thorax. 2023;78:912–21. https://doi.org/10.1136/thorax-2023-219989 .

Kox M, Waalders NJB, Kooistra EJ, Gerretsen J, Pickkers P. Cytokine levels in critically ill patients with COVID-19 and other conditions. JAMA. 2020;324:1565–7. https://doi.org/10.1001/jama.2020.17052 .

Bendib I, Beldi-Ferchiou A, Schlemmer F, Surenaud M, Maitre B, Plonquet A, et al. Alveolar compartmentalization of inflammatory and immune cell biomarkers in pneumonia-related ARDS. Crit Care. 2021;25:23. https://doi.org/10.1186/s13054-020-03427-y .

Jouan Y, Baranek T, Si-Tahar M, Paget C, Guillon A. Lung compartmentalization of inflammatory biomarkers in COVID-19-related ARDS. Crit Care. 2021;25:120. https://doi.org/10.1186/s13054-021-03513-9 .

Ishizaka A, Watanabe M, Yamashita T, Ogawa Y, Koh H, Hasegawa N, et al. New bronchoscopic microsample probe to measure the biochemical constituents in epithelial lining fluid of patients with acute respiratory distress syndrome. Crit Care Med. 2001;29:896–8. https://doi.org/10.1097/00003246-200104000-00043 .

Kipnis E, Hansen K, Sawa T, Moriyama K, Zurawel A, Ishizaka A, et al. Proteomic analysis of undiluted lung epithelial lining fluid. Chest. 2008;134:338–45. https://doi.org/10.1378/chest.07-1643 .

Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–50. https://doi.org/10.1056/NEJM199701233360402 .

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. https://doi.org/10.1016/0021-9681(87)90171-8 .

Lanza E, Muglia R, Bolengo I, Santonocito OG, Lisi C, Angelotti G, et al. Quantitative chest CT analysis in COVID-19 to predict the need for oxygenation support and intubation. Eur Radiol. 2020;30:6770–8. https://doi.org/10.1007/s00330-020-07013-2 .

Sudo K, Sawa T, Kushimoto K, Yoshii R, Yuasa K, Inoue K, et al. Choice of respiratory therapy for COVID-19 patients with acute hypoxemic respiratory failure: a retrospective case series study. PeerJ. 2023;11: e15174. https://doi.org/10.7717/peerj.15174 .

Takashima Y, Inaba T, Matsuyama T, Yoshii K, Tanaka M, Matsumoto K, et al. Potential marker subset of blood-circulating cytokines on hematopoietic progenitor-to-Th1 pathway in COVID-19. Front Med. 2024;2024:11. https://doi.org/10.3389/fmed.2024.1319980 .

Article   Google Scholar  

Yamazaki K, Ogura S, Ishizaka A, Oh-hara T, Nishimura M. Bronchoscopic microsampling method for measuring drug concentration in epithelial lining fluid. Am J Respir Crit Care Med. 2003;168:1304–7. https://doi.org/10.1164/rccm.200301-111OC .

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Acknowledgements

On the basis of this clinical study, we would like to express our thanks to the clinicians in the intensive care unit, Infectious Disease Department, and emergency department, as well as the ward nurses and laboratory technicians at KPUM Hospital for their dedicated support in managing COVID-19 patients. We would like to express our gratitude to Prof. Akitoshi Ishizaka, former professor of the Department of Respiratory Medicine at Keio University, who has passed away, and to Prof. Satoru Hashimoto, former manager of the Critical Care Division at KPUM Hospital, for their technical advice on the microsampling method. We also extend our thanks to Dr. J. Ludovic Croxford from Edanz ( https://jp.edanz.com/ac ), Dr. T. Fernanda, and the team from Springer Nature Author Services ( https://authorservices.springernature.com/ ) for editing a draft of this manuscript.

This study was supported in part by the Japan Agency for Medical Research and Development [AMED Grant Number JP20fk0108270].

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Contributions

KS and TS developed the initial idea for this study and were responsible for selecting the survey. KS extracted the data and conducted a comprehensive search of the databases. MK, KKa, KKu, RY, KI, MY, TM, and BO participated in patient management. YT, MT, KM, KT, and TI supported the use of multiplex bead-based assays and laboratory examinations. All the authors contributed to the research design, interpretation of the results, and conception of the writing of the article. K.S. and T.S. analyzed the data and drafted the article. KK, KT, BO, and TI reviewed the article and provided suggestions for improvement. All the authors have carefully examined the manuscript and agreed with the ideas presented. All the authors meet the ICMJE authorship criteria and have read and agreed to the published version of the manuscript.

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Correspondence to Teiji Sawa .

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Ethics approval and consent to participate.

The study was conducted according to the guidelines of the Declaration of Helsinki. This retrospective observational study was conducted in combination with the Kyoto Prefectural University of Medicine (KPUM) COVID-19 Registry Study (ERB-C-1810-3; approved by the Institutional Review Board of KPUM on 3 September 2020), and cytokine concentrations were analyzed in tracheal and bronchial secretions from healthy adults (ERB-C-2179; approved by the Institutional Review Board of KPUM on 1 December 2021). Informed consent was obtained from all participants and/or their legal guardian(s), and all methods were performed according to the relevant guidelines and regulations.

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The dataset (DataSet_SudoK_etal.xlsx) used and/or analyzed during this study is downloadable as Additional file 8 .

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Supplementary Information

Additional file 1: table s1..

Major characteristics of the patients and volunteers.

Additional file 2: Table S2.

Specific medications used in the COVID-19 patients with acute hypoxemic respiratory failure.

Additional file 3: Table S3.

Measurement range and detection sensitivity of cytokines according to examples from the Bio-Rad BioPlex Pro ® manual.

Additional file 4: Table S4.

Major characteristics of the three chronological groups.

Additional file 5: Fig. S1.

The overview of the individual patients in chronological order.

Additional file 6: Table S5.

Major characteristics of the three PSI groups.

Additional file 7: Table S6.

Major characteristics of the three LIV groups.

Additional file 8:

Dataset file.

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Sudo, K., Kinoshita, M., Kawaguchi, K. et al. Case study observational research: inflammatory cytokines in the bronchial epithelial lining fluid of COVID-19 patients with acute hypoxemic respiratory failure. Crit Care 28 , 134 (2024). https://doi.org/10.1186/s13054-024-04921-3

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Cross-Site Analysis and Case Study of STOP Program Grantee Perspectives on Violence Prevention and Mental Health Training Program Implementation

This paper explores STOP Program grantee perspectives on violence prevention and mental health training program implementation.

In this study, researchers examined factors that influence the implementation of violence prevention and mental health training programs in schools, with a particular focus on implementation readiness and school mental health capacity. Several promising results were found that may contribute to ongoing efforts to improve school safety. In response to the Students, Teachers, and Officers Preventing (STOP) School Violence Act of 2018 (H.R. 4909), 128 grantees across the U.S. were awarded funding through the Bureau of Justice Assistance (BJA) in 2018 and 2019 to improve school safety by implementing programs in the Violence Prevention and Mental Health Training category. The major goals of this study were to 1) understand the challenges and facilitators of implementing violence prevention and mental health training programs through a broad cross-site analysis, 2) assess contextual factors influencing implementation, as well as regional and population variances through targeted, comprehensive case studies, and 3) provide evidence to inform program implementation in violence prevention and mental health programs in schools to improve program outcomes and sustainability. Understanding the environment of implementation, grantees’ capacity to carry out planned activities, and the perspectives of implementation team members are critical components to learning what factors support and inhibit implementation and ultimately, the extent to which programming will be replicable and scalable as federal funding continues to support mental health and violence prevention initiatives. The study was conducted at two levels: 1) a cross-site analysis of grantees who have been awarded funding in the Violence Prevention and Mental Health Training category over the two award years (2018 and 2019), and 2) a case study analysis of six grantee sites.

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• Open access
• Published: 24 April 2024

Determinants of difficult laryngoscopy based on upper airway indicators: a prospective observational study

• Jing Yuan 1 ,
• Xiaoxiang Tan 1 ,
• Hui Zhang 1 &
• Jie Sun 1  

BMC Anesthesiology volume  24 , Article number:  157 ( 2024 ) Cite this article

46 Accesses

Metrics details

The main cause of anesthesia-related deaths is the failure to manage difficult airways. Difficult laryngoscopic exposure is a major cause of unsuccessful management of difficult airways. Inadequate preoperative airway assessment hinders the clinical management of difficult airways cases, emphasizing the critical need for accurate identification of difficult airways. Currently, no definitive and reliable indicators are available to predict a difficult airway. Our study aims to predict laryngoscope exposure risk factors by combining ultrasonically measured upper airway anatomic parameters with physical examination indicators.

Patients aged 18 to 75 years, classified as American Standards Association (ASA) I-III, and scheduled for elective general anesthesia with endotracheal intubation were included. All patients received the upper airway and ultrasonographic measurements. After anesthesia induction, laryngoscope exposure was analyzed using the Cormack-Lehane grading system, with Grades III and IV as indicative of difficult laryngoscopy. Univariate and multivariate logistic regression analyses were performed to identify reliable indicators for predicting difficult laryngoscopy. Receiver Operating Characteristic (ROC) curve analysis was utilized to assess the predictive performance of each indicator.

A total of 1120 patients finished the study, with 710 cases found in Grade I laryngoscopic exposure group, 360 cases in Grade II group, and 50 cases in Grade III group. There was no case observed in Grade IV group, thereby resulting in an incidence of difficult laryngoscopy of 4.46%. Univariate logistic regression analysis revealed that several parameters including age, Body Mass Index (BMI), neck circumference, neck mobility, snoring intensity, as well as ultrasound measurements of the pre-epiglottic space and thyromental distance were identified as significant risk factors for difficult laryngoscopy ( P  < 0.05). Among these, BMI, and neck circumference exhibited notable predictive value, with Area Under The Curve (AUC) values of 0.746 (95%CI 0.649–0.842) and 0.732 (95%CI 0.638–0.827), respectively. Neck mobility was also identified as an independent risk factor for predicting difficult laryngoscopy ( P  = 0.009) in multivariate logistic regression analysis, with an AUC of 0.672 (0.562–0.782) in the ROC curve.

Conclusions

Our findings revealed a direct correlation between difficult laryngoscopy and age, BMI, neck circumference, neck mobility, snoring intensity, as well as ultrasound measurements of the pre-epiglottic space and thyromental distance. Furthermore, neck mobility was identified as an independent predictive factor.

Trial registration

The trial was registered prior to patient enrollment at clinicaltrials.gov (register no. ChiCTR2100053826, Date of registration: November 30, 2021).

Peer Review reports

Introduction

Difficult airway management failure is the primary cause of anesthesia-related fatalities [ 1 , 2 , 3 , 4 ]. Challenging airway scenarios include difficulties in mask ventilation, supraglottic airway ventilation, supraglottic tool insertion, laryngoscopic exposure, difficult tracheal intubation and recurrent intubation failures [ 3 ]. Notably, difficult laryngoscopic exposure has emerged as a key factor leading to unsuccessful management of difficult airways. Difficult laryngoscopy hinges on several factors, including the patient’s airway anatomy, airway management tools, and the anesthesia provider’s expertise with patient related factors acting as uncontrollable variables. Inadequate preoperative airway assessment hinders the clinical management of difficult airways cases, emphasizing the critical need for accurate identification of difficult airways.

Currently, no definitive and reliable indicators are available to predict a difficult airway. The eleven traditional indicators recommended by the American Standards Association (ASA) for airway assessment can effectively predict less than 10% of difficult airways [ 5 ]. Furthermore, recognizing the limitations of each method, it becomes imperative to combine the various assessment approaches to enhance the accuracy and sensitivity of predictions [ 6 ]. In recent years, ultrasound technology has gained substantial popularity in the field of anesthesia. It is possible to achieve real-time, dynamic airway imaging by placing an ultrasound probe in various positions in the anterior neck. In addition, by measuring relevant anatomical structures, ultrasound can predict the risk of difficult airways, thereby complementing conventional assessment methods.

The objective of this study is to determine the effective predictors of difficult laryngoscopic exposure through a comprehensive approach that integrates medical history analysis, physical examination, and ultrasound examination of the upper airway. The aim was to provide clinicians with novel and reliable predictive methods for assessing difficult laryngoscopy, thereby enhancing patient safety and the efficacy of airway management.

Study subjects

This study was approved by the Ethics Committee of Zhongda Hospital, Southeast University (Approval No: 2021ZDSYLL205-P01) and written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at clinicaltrials.gov ( https://www.chictr.org.cn/showproj.html?proj=129056 , Principal investigator: Jing Yuan, Date of registration: November 30, 2021).

The study included patients between the ages of 18 and 75 who were undergoing general anesthesia with endotracheal intubation. They were also classified as ASA grade I to III. However, patients with pre-existing conditions such as head and neck facial trauma, tumors of the maxillofacial region and upper airway, restricted cervical spine mobility, as well as with history of difficult airways were excluded from the study.

Assessment indicators

Medical history and upper airway physical examination indicators.

The demographic data including gender, age, height, weight, snoring intensity, and results of upper and lower lip bite tests were recorded. The measurements were collected for the neck circumference, neck mobility, mouth opening capacity, modified Mallampati classification, and hyomental distance.

Snoring intensity (None/Mild/Moderate/Severe): Snoring was categorized into three levels based on frequency and volume [ 7 ]. No snoring; Mild: Frequency ≤ 2 times/week, volume louder than breathing or similar to speaking; Moderate: Frequency 3–5 times/week, volume louder than speaking; Severe: Frequency 6–7 times/week, audible even through a closed door.

Upper and lower lip bite test (1/2/3): Biting the upper lip with lower incisors extending beyond the upper lip in a calm state without any foreign objects in the mouth was classified as grade 1; lower incisors can touch the upper lip, but should remain below the upper lip line as grade 2; inability of the lower incisors to touch the upper lip is grade 3.

Neck circumference (cm): It was measured from the upper edge of the seventh cervical vertebra at the back to below the thyroid cartilage at the front.

Neck mobility (< 80°/≥80°): It refers to the degree of motion in the cervical spine and the occipito-atlanto joint. The normal range of motion for the neck in the combined extension and flexion ranges is at least 80 degrees or larger.

Thyromental distance ratio (cm/cm): The ratio of distance from the midpoint of the patient’s thyroid cartilage to chin was measured during the neutral and maximum head extension.

Modified Mallampati classification (1/2/3/4): The patient was instructed to open the mouth and extend the tongue as far as possible. Thereafter, classification was performed based on the visibility of pharyngeal structures: Grade I: Soft palate, uvula, and faucial pillars were visible. Grade II: Soft palate, uvula, and partial view of the faucial pillars were obscured by the base of the tongue. Grade III: Only the soft palate was visible. Grade IV: Soft palate was not visible.

Ultrasound measurement of upper airway parameters

Patients were positioned supine without a pillow upon entering the operating room. An ultrasound of the upper airway was performed using a SonoSite Edge ultrasound machine before induction of anesthesia. A convex array transducer was used to measure the tongue width, tongue thickness, and tongue root distance. A linear array transducer was employed to measure epiglottis depth, epiglottis anterior area, ratio of the thyroid hyoid membrane distance, and mandibular joint mobility.The collection of ultrasound data was performed by a trained physician.

Tongue width (cm): The convex array transducer was placed in the coronal position below the patient’s mandible, both sides of the lingual arteries were scanned, and the maximum distance between the two lingual arteries was measured (Fig.  1 ).

Tongue width. Transverse view of the tongue with low frequency linear transducer in the coronal position below the patient’s mandible, both sides of the lingual arteries were scanned. The maximum distance between the two lingual arteries was measured, as indicated by the dotted line. GG – Genioglossus muscle, TS – Dorsal tongue surface

Tongue thickness (cm) : The convex array transducer was placed in the sagittal position below the neck’s mandible for measuring the distance from the neck’s skin to the farthest end of the tongue (Fig.  2 ).

Tongue root distance and Tongue thickness .Sagittal view of the suprahyoid structures using low frequency transducer, placed in the submandibular area behind the mentum. Tongue root distance was measured from the neck’s skin to the tongue root, as indicated by the dotted line. Tongue thickness was measured from the neck’s skin to the farthest end of the tongue, as indicated by the dotted line. GH – Geniohyoid muscle, GG – Genioglossus muscle, TS – Dorsal tongue surface

Tongue root distance (cm) : The convex array transducer was placed in the sagittal position below the neck’s mandible for measuring the distance from the neck’s skin to the tongue root (Fig.  2 ).

Epiglottis depth and Pre-epiglottic Space Area (cm 2 ): The linear array transducer was positioned in the coronal plane on the patient’s neck. Thereafter, scanning from the mandible towards the neck, epiglottis was located and the distance from the midline of the epiglottis to the skin surface and the area of the anterior gap of the epiglottis was measured (Fig.  3 ).

Epiglottis depth and Epiglottis Anterior Area. Transverse view of the epiglottis with high frequency linear transducer over the thyrohyoid area. Epiglottis depth was measured from the midline of the epiglottis to the skin surface, as indicated by the dotted line. Epiglottis Anterior Area was measured, as shown in the graph. PES - Pre-epiglottic space

Thyromental Distance (cm) : The linear array transducer was placed in the mid-sagittal position of the neck for locating the hyoid bone and thyroid cartilage. The bright line between them represented the level of the thyroid hyoid membrane. The distance from the bright line to the skin surface was then measured(Fig.  4 ).

Thyroid hyoid membrane distance. Parasagittal view of the thyrohyoid membrane with high frequency linear transducer. The distance from the bright line to the skin surface was measured, as indicated by the dotted line

Mentohyoid Distance Ratio (cm/cm): The transducer was placed in front of the patient’s ear, with one end aligning with the external auditory canal and the other end pointing towards the tip of the nose or the philtrum. The patient was instructed to perform an opening movement while maintaining the transducer stationary relative to the patient’s skin. The image of the condylar prominence (high-pointed arc-shaped echo) was captured during the mouth opening and closing. The frozen images were compared between the open and closed positions and the distance of condylar prominence sliding was measured(Fig.  5 ).

The view of the mandibular joint with high frequency linear transducer. The image of the condylar prominence (high-pointed arc-shaped echo) was captured during mouth opening and closing. The frozen images were compared between the open and closed positions and the distance of condylar prominence sliding was measured

Anesthesia induction

After entering the room, all patients received intravenous access and electrocardiography, heart rate, blood pressure, and pulse oxygen saturation monitoring. Every patient received pre-oxygenation for 3 min before anesthesia induction. General anesthesia was induced by i.v. midazolam 2 mg, sufentanil 0.3 to 0.5 µg/kg, propofol 1.5 to 2 mg/kg, and rocuronium bromide 0.6 mg/kg. After the patient’s spontaneous breathing diminished, visual laryngoscope (model: TD-C-III, Taizhou Hanchuang Medical Instruments Technology Co., Ltd.) was used to assess laryngoscopic exposure. During laryngoscopy exposure, the head position is allowed to move and the cricoid cartilage is pressurized to obtain optimal laryngoscopy exposure. The anesthesiologist who performed endotracheal intubation and evaluated laryngoscope exposure was blinded to the airway evaluation results.

Modified Cormack-Lehane grading of laryngoscopy

An anesthesiologist, more than 3 years of experience, conducted visual laryngoscope and assess laryngoscopic exposure by Modified Cormack-Lehane grading score [ 8 ]. The grading system relies on the level of visibility of laryngeal structures, with Grade I indicating full visualization of the vocal cords, Grade II showing visibility of the epiglottis and posterior part of the vocal cords, Grade III indicating only the visibility of the epiglottis, and Grade IV denoting no visibility of the epiglottis. Grades I-II represent uncomplicated laryngoscopic exposure, whereas Grades III-IV indicate difficult laryngoscopic exposure.

Statistical analysis

The analysis conducted was binary logistic regression. The dependent variable is the result of laryngoscope exposure, which is a binary variable. Covariates are observed upper airway indicators. First, a univariate logistic regression analysis was conducted to identify various risk factors. After that, indicators with significant results were included in the multivariate logistic regression analysis to determine independent risk factors. ROC curves were used to validate the predictive performance.

The sample size was calculated using PASS version 15.0. The study determined the sample size based on a 5% incidence of difficult laryngoscopy exposure, a 20% dropout rate, bilateral alpha set at 0.05, and beta set at 0.2. SPSS version 22.0 was employed for the statistical analysis. A significance level of P  < 0.05 was considered as statistically significant difference. In multivariate logistic regression analysis, the likelihood ratio test was used to evaluate the model hypothesis. Collinearity analysis was used to test for interaction among the factors.

We prospectively enrolled 1128 patients scheduled for elective general anesthesia with endotracheal intubation. Five patients were excluded by exclusion criteria. Three patients declined to participate in the study. The study involved 1120 patients ultimately, and their laryngoscopic exposure was classified as grade I in 710 cases, grade II in 360 cases, grade III in 50 cases, and grade IV in 0 cases (Fig.  6 ). This resulted in a 4.46% incidence of difficult laryngoscopy. Patients with difficult laryngoscopic exposure were more likely to be older and fatter and to have a history of hypertension (Table  1 ). All patients were subjected to tracheal intubation successfully. However, in the difficult laryngoscopy group, 8 patients required a second intubation attempt, while 2 patients required three attempts to achieve successful intubation.

Study flow diagram

The results of univariate logistic regression analysis indicated that several parameters, including patient age, BMI, neck circumference, neck mobility, snoring intensity, and ultrasound measurements of the pre-epiglottic space area and thyromental distance, were significant risk factors for difficult laryngoscopic exposure ( P  < 0.05) (Table  2 ). BMI and neck circumference exhibited good predictive performance, with AUCs of 0.746 (0.649–0.842) and 0.732 (0.638–0.827), respectively (Fig.  7 ).

ROC curves for the various risk factors

The multivariate logistic regression model’s likelihood ratio test showed statistical significance ( P  = 0.00), indicating at least one covariate was predictive. The collinearity test of multivariate logistic regression analysis revealed no significant interaction among covariates ( P  = 0.70) (Table  3 ). Interestingly, multivariate logistic regression analysis identified neck mobility as an independent predictor of difficult laryngoscopic exposure ( P  = 0.009), with an AUC of 0.672 (0.562–0.782) (Table  4 ).

The study results showed that the incidence of laryngoscope exposure difficulties was 4.46%, which is consistent with previous reports.The frequency of difficult airways during the perioperative period is reported to be between 1.5% and 13% [ 9 ]. According to ASA statistics from 1970 to 2007, out of 8,984 anesthesia-related cases, difficult intubation was observed in 466 instances, thereby constituting an estimated incidence of 5% for difficult laryngoscopic exposure. All cases were classified as Cormack-Lehane grade III, with no cases classified as grade IV. This may be potentially attributed to the enhanced visibility offered by the visual laryngoscope, featuring a broader angle at the front of the blade for easier epiglottis elevation and glottis exposure.

Neck ultrasound examination can provide clear visualization of upper airway anatomical structures, including the tongue, hard palate, epiglottis, uvula, vocal cords, cricoid membrane, cricoid cartilage, and the anterior wall of tracheal cartilage rings [ 10 ]. However, due to the inability of ultrasound to penetrate the gases, various structures located behind the gas in the airway cannot be effectively visualized, including the posterior pharyngeal wall, posterior commissure, and the posterior tracheal wall [ 11 ]. Ultrasound measurements have demonstrated greater accuracy in predicting difficult airways compared to conventional methods, exhibiting higher sensitivity and specificity [ 12 ]. We have measured various parameters such as tongue width, tongue thickness, tongue root distance, epiglottis depth, pre-epiglottic space area, distance to the hyoid membrane, and the ratio of mandibular joint mobility, which are considered as indicators potentially related to difficult airways. The findings related to ultrasound measurements of soft tissue thickness at distinct positions in the anterior neck for predicting difficult airways are rather inconsistent. For instance, in obese patients (with BMI > 35), Ezril et al. [ 13 ] reported that patients with difficult laryngoscopic exposure had greater thickness of horizontal anterior neck soft tissue compared to those with non-difficult exposure, but the results reported by Komatsu et al. [ 14 ] were contrasting in nature. In addition, Adhikari et al. [ 15 ] found that the distance to the hyoid membrane could effectively predict difficult laryngoscopic exposure. Moreover, Pinto et al. [ 16 ] observed a significant correlation between pre-epiglottic space depth and difficult laryngoscopic exposure, with an accuracy of 74.3%, sensitivity of 64.7%, and specificity of 77.1%. When combined with the Mallampati grade, the predictive power improved even further. In our study, pre-epiglottic space area and distance to the hyoid membrane emerged as potential risk factors for difficult laryngoscopic exposure, although their effectiveness in predicting such difficulty is relatively limited.

Obese patients, characterized by a high BMI, often exhibit fat accumulation around the neck, resulting in an increased neck circumference. Additionally, obesity may cause hypertrophy of the tongue, narrowing of the pharyngeal airway and the occurrence of snoring symptoms of different intensities. Consequently, obese patients have a higher likelihood of experiencing difficult airways. Our study investigated various indicators associated with obesity such as BMI, neck circumference and the degree of snoring as potential risk factors for difficult laryngoscopic exposure. Among these, BMI, and neck circumference demonstrated relatively good predictive efficacy. however, there was no correlation found between difficult laryngoscopic exposure and ultrasound measurements of tongue width, thickness, and root distance. Thus, it is possible that these indicators could be more relevant to difficulties in mask ventilation.

Both the upper lip bite test and ultrasound measurements of mandibular joint mobility reflect the ability of the mandible’s movement capability. It has been reported that restricted mandibular mobility increases the likelihood of difficult laryngoscopic exposure [ 17 ]. While previous studies found that the upper lip bite test could accurately predict the risk of difficult laryngoscopic exposure [ 18 ], our study did not observe a potential correlation between difficult laryngoscopic exposure and either of these indicators. This may be attributed to the use of a visual laryngoscope with a larger angle at the front end of the blade in our study, effectively overcoming the challenges posed by restricted mandibular mobility.

Our findings suggest that age is also a relevant factor in difficult laryngoscopic exposure, likely due to the increased probability of obesity with age. Additionally, aging is associated with bone proliferation, causing ligament calcification and a reduction in cervical joint mobility. This can lead to the restricted neck movement, thus resulting in an increased probability of difficult laryngoscopic exposure. Age is therefore a manifestation of the combined effects of several factors.

The ratio of the thyromental distance measured at the neutral head position and the maximum head extension is regarded a traditional indicator for predicting difficult airways using surface measurements. Both the ultrasound-measured tongue-mentum distance ratio and the thyromental distance ratio effectively reflect neck mobility. For instance, Wojtczak in his study observed six patients with a history of difficult laryngoscopic exposure and observed a significant difference in their tongue-mentum distance ratio in comparison to patients without exposure difficulties ( P  < 0.002) [ 19 ]. Our findings indicate that reduced neck mobility can serve as a potential risk factor for difficult laryngoscopic exposure, and is an independent predictive factor. However, we did not observe a correlation between the thyromental distance ratio, tongue-mentum distance ratio, and difficult laryngoscopic exposure. This result was consistent with clinical observations, demonstrating that restricted neck movement in conditions like ankylosing spondylitis and fusion of cervical facet joints can often lead to difficult laryngoscopic exposure.

It should be noted that this study only included participants from the normal general population. Special groups, such as patients with obesity or limited neck mobility, may be more susceptible to difficulties during laryngoscopy. It would be useful to perform stratified analysis on these groups, expanding the sample size, in order to achieve more clinical significance in the future.

Recognizing a difficult airway is crucial for effectively managing the difficult airways and predicting difficult airways could be an enduring as well as challenging task for anesthesiologists. The ongoing evolution of ultrasound technology offers substantial promise in predicting difficult airways, and its integration with conventional approaches can markedly improve the accuracy of predictions. Further research involving larger sample sizes and multicenter studies is needed to validate the prediction of difficult airways. This would involve the examination of diverse indicators in order to provide more comprehensive guidance for clinical practice.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

American Standards Association

Body Mass Index

Area Under The Curve

Receiver Operating Characteristic

Cooper RM. Preparation for and management of failed Laryngoscopy and/or intubation. Anesthesiology. 2019;130:833–49.

Article   PubMed   Google Scholar  

Ongkasuwan J, Devore D, Hollas S, Jones J, Tran B. Laryngeal ultrasound and pediatric vocalfold nodules. Laryngoscope. 2017;127:676–8.

Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway:an updated report by the American society of anesthesiologistst taskforce on management of the difficult airway. Anesthesiology. 2013;118:251–70.

Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Majorcomplications of airway managementin the UK:results of the Fourth National Audit Project of the RoyalCollege of Anaesthetistsand the Difficult Airway Society. Br J Anaesth. 2011;106:617–31.

Article   CAS   PubMed   Google Scholar  

Okabe T, Terashima H, Sakamoto A. Determinants of liquid gastric emptying: comparisons between milk and isocalorically adjusted clear fluids. Br J Anaesth. 2015;114:77–82.

Crosby ET, Cooper RM, Douglas MJ, Doyle DJ, Hung OR, Labrecque P, et al. The unanticipated difficult airway with recommendations for management. Can J Anesth. 1998;45:757–76.

Sleep disordered breathing Group, Respiratory Society, Chinese Medical Association. Guidelines for diagnosis and treatment of sleep apnea hypopnea syndrome (2011). Chin J Tuberc Respi Dis. 2012;35(1):9–12.

Google Scholar  

Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39:1105–11.

Randall T. Prediction of difficult intubation. Acta Anaesthesiol Scand. 1996;40:1016–23.

Article   Google Scholar  

Choudhary G, Boparai A, Singh G, Singh R. Value of ultrasound in understanding laryngeal anatomy: pictorial review. Pak J Radiol. 2012;22:4–7.

Singh M, Chin KJ, Chan VW, Wong DT, Prasad GA, Yu E. Use of sonography for airway assessment: an observational study. J Ultrasound Med. 2010;29:79–85.

Hui CM, Tsui BC. Sublingual ultrasound as an assessment method for predicting difficult intubation: a pilot study. Anaesthesia. 2014;69:314–9.

Ezri T, Gewürtz G, Sessler DI, Medalion B, Szmuk P, Hagberg C, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58:1111–4.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Komatsu R, Sengupta P, Wadhwa A, Akça O, Sessler DI, Ezri T, et al. Ultrasound quantification of anterior softtissue thickness fails to predict difficult laryngoscopy in obese patients. Anaesth Intensive Care. 2007;35:32–7.

Adhikari S, Zeger W, Schmier C, Crum T, Craven A, Frrokaj I, et al. Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy. Acad Emerg Med. 2011;18:754–8.

Pinto J, Cordeiro L, Pereira C, Gama R, Fernandes HL, Assunção J. Predicting difficult laryngoscopy using ultrasound measurement of distance from skinto epiglottis. J Crit Care. 2016;33:26–31.

Chinese Society of Anesthesiology. Expert consensus on difficult airway management. J Clin Anesthesiol. 2009;25:200–3.

Naguib M, Scamman FL, O’Sullivan C, Aker J, Ross AF, Kosmach S, et al. Predictive performance of three multivariate difficult tracheal intubation models: a double-blind, case-controlled study. Aneasth Analg. 2006;102:818–24.

Wojtczak JA. Assessment of hyomental distances and ratio, tongue size, and floor of the mouth musculature using portable sonography. J Ultrasound Med. 2012;31:523–8.

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Disclosure This work was supported by Nanjing Municipal Special Fund for Health Science and Technology Development (Project Number: YKK20239).

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All authors have approved the final version of the manuscript. JS conceptualized and designed the study, and supervised the overall research process. JY searched the literature, prepared the data, wrote the first draft and revised the manuscript. HY and XXT prepared the data. HZ conducted statistical analyses.

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Yuan, J., Ye, H., Tan, X. et al. Determinants of difficult laryngoscopy based on upper airway indicators: a prospective observational study. BMC Anesthesiol 24 , 157 (2024). https://doi.org/10.1186/s12871-024-02543-4

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Fatigue Failure Analysis Case Studies

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Fatigue fracture can occur in many components such as fasteners and tubular pole structures. In this paper, fatigue failure mechanisms have been described and the application of the principles for failure analysis for each case will be presented. Cyclic loading at stresses above the fatigue limit of the material can initiate cracks at the surface or at internal defects. Macroscopic and microscopic observations of fatigue crack initiation and approaches for characterization of fatigue failures have been described. Two case studies present application of laboratory analysis techniques to determine primary causes and modes of failures.

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Analysis of fatigue failure causes of machine components.

Fatigue Failures, With Special Reference to Fracture Characteristics

Comparison of fatigue verification procedures at a thick-walled welded component, bibliography.

S. Suresh, Fatigue of Materials , 2nd edn. (Cambridge University Press, Cambridge, 1998)

Book   Google Scholar  

J. Schijve, Fatigue of Structures and Materials (Kluwer Academic Publishers, Dordrecht, 2001)

Google Scholar  

ASM International, Fatigue and Fracture, ASM Handbook Online , vol. 19 (ASM International, Materials Park, 1996)

R.I. Stephens, A. Fatemi, R.R. Stephens, H.O. Fuchs, Metal Fatigue in Engineering , 2nd edn. (Wiley, New York, 2001)

Y. Murakami, K.J. Miller, What is fatigue damage? A view point from the observation of low cycle fatigue process. Int. J. Fatigue 27 (8), 991–1005 (2005)

Article   Google Scholar  

ASM International, Fractography, ASM Handbook , vol. 12, 9th edn. (ASM International, Materials Park, 1987)

D. Hall, Fractography (Cambridge University Press, Cambridge, 1999)

M. Zamanzadeh, C. Kempkes, D. Aichinger, and D. Riley, Laboratory and field corrosion investigation of galvanized utility poles, Electrical transmission line and substation structures: 2006, pp. 235–249

M. Zamanzadeh, A. Gilpin-Jackson, Corrosion risk strategies for below-grade foundations of transmission and distribution structures. Mater. Perform. 35 , 54–57 (2014)

R.W. Thompson, Evaluation of High-Level Lighting Poles Subjected to Fatigue Loading, Theses and Dissertations, 2012

M. Dawood, R. Goyal, H. Dhonde, T. Bradberry, Fatigue life assessment of cracked high mast illumination poles. J. Perform. Constr. 28 , 311–320 (2014)

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Zamanzadeh, M., Larkin, E. & Mirshams, R. Fatigue Failure Analysis Case Studies. J Fail. Anal. and Preven. 15 , 803–809 (2015). https://doi.org/10.1007/s11668-015-0044-3

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