-
A&A Practice Jun 2023Airway obstruction during anesthesia is a common occurrence with potentially serious outcomes. Increasingly, patients are older, heavier, and more likely to have...
Airway obstruction during anesthesia is a common occurrence with potentially serious outcomes. Increasingly, patients are older, heavier, and more likely to have obstructive sleep apnea-all heightened risk factors for airway complications. These patients undergo procedures where distal pharyngeal tissues can relax, obstructing the airway. As a result, there is a need for airway devices that can stent open distal pharyngeal tissues to maintain adequate ventilation. To physically address this problem, the new distal pharyngeal airway (DPA) prevents airway obstruction and enables providers to maintain ventilation.
Topics: Humans; Pharynx; Sleep Apnea, Obstructive; Respiration; Airway Obstruction; Anesthesia
PubMed: 37335861
DOI: 10.1213/XAA.0000000000001691 -
Clinical Rheumatology Apr 2021This study aims to assess the prevalence and clinical correlates of small airway obstruction (SAO) in patients with systemic sclerosis (SSc).
OBJECTIVES
This study aims to assess the prevalence and clinical correlates of small airway obstruction (SAO) in patients with systemic sclerosis (SSc).
METHODS
Sixty-nine consecutive patients with SSc (63 women and 6 men) were included. Lung function tests, including assessment of lung diffusing capacity, were performed in all patients. Patients were considered to have SAO when the maximal expiratory flow at 25% of the forced vital capacity (MEF) was lower than 60% as predicted. High-resolution computed tomography (HRCT) of the lung was performed in all patients with MEF < 60%. We assessed the relationship of SAO in our patients with large airway obstruction, decreased lung diffusing capacity, HRCT findings, disease duration, disease subtype, scleroderma-specific antibodies, and smoking.
RESULTS
SAO was noticed in 46/69 (66.6%) of patients with SSc. Restrictive lung disease was found in 4/69 (5.8%), obstruction of large airways in 18/69 (26.1%), and decreased lung diffusing capacity in 47/69 (68.1%) of patients. No difference in gender, age, disease duration, disease subtype, and scleroderma-specific antibodies was found between patients with and without SAO. Eighteen out of forty-six (39.1%) patients with SAO had decreased forced expiratory volume in 1 sec (FEV) and the Tiffeneau-Pinelli index, indicating presence of coexistent large airway obstruction. Twenty out of forty-six (43.5%) patients with SAO had associated decreased lung diffusing capacity, while 8/46 (17.4%) of patients had isolated SAO. HRCT patterns of interstitial lung disease (ILD) were found more frequently in patients with SAO and decreased lung diffusing capacity, compared with patients with SAO and normal diffusing capacity (75% vs 11.5%, p = 0.008). We have noticed that tobacco smokers among SSc patients with SAO have more common associated obstructive lung disease on spirometry (58.8% vs 15.4%, p = 0.004). On the other hand, isolated SAO and SAO associated with impaired diffusing capacity were equally frequent among smokers and non-smokers.
CONCLUSION
Patients with SSc have commonly SAO. It can be considered clinical feature of undiagnosed asthma or chronic obstructive pulmonary disease (COPD), if isolated or associated with large airway obstruction, especially in tobacco smokers. On the other hand, SAO associated with decreased lung diffusing capacity was found to be not related to smoking, and may indicate a possible prominent bronchiolar involvement within SSc-related interstitial lung disease Key Points • Small airway obstruction in patients with systemic sclerosis can be considered a clinical feature of undiagnosed obstructive lung disease, if isolated or associated with large airway obstruction, especially in tobacco smokers. • Obstruction of small airways, associated with decreased lung diffusing capacity, may indicate a possible prominent bronchiolar involvement within systemic sclerosis-related interstitial lung disease.
Topics: Airway Obstruction; Female; Humans; Lung; Male; Prevalence; Pulmonary Diffusing Capacity; Scleroderma, Systemic; Vital Capacity
PubMed: 32827283
DOI: 10.1007/s10067-020-05353-4 -
Journal of Pediatric Orthopedics Apr 2020Obstructive lung disease occurs in 30% of children with early onset scoliosis (EOS); changes in degree of airway obstruction over time have not been reported.
BACKGROUND
Obstructive lung disease occurs in 30% of children with early onset scoliosis (EOS); changes in degree of airway obstruction over time have not been reported.
METHODS
Longitudinal patterns of incidental, persistent, and progressive airway obstruction were retrospectively analyzed in a cohort of children with EOS with at least 1 forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) value <85% on serial spirometric assessments over a ≥3-year observation period. The prevalence of clinical features and the severity of coronal and sagittal spine deformities for each group at the beginning and end of the study period were compared.
RESULTS
Airway obstruction was incidental in 12 (24%) and persistent in 37 (76%) of 49 children with EOS. Twenty of 37 (54%) of those with persistent obstruction developed progressive airway obstruction. The decline in FEV1/FVC over 6±2 years was insignificant in the incidental group (4%±2%) and the persistent nonprogressive group (7%±4%) but significant in the progressive group (13%±4%, t test; P=0.002). In total, 29% of the 49 children at the onset and 57% at the end of the study had airway obstruction. The incidental, persistent nonprogressive, and progressive groups did not differ with regard to age, diagnosis distribution, or sex. The initial coronal curve size, apex, direction of the curve, and degree of kyphosis were statistically similar among the 3 groups. Coronal curve magnitude inversely correlated with FEV1/FVC at the end but not the beginning of the study (r=-0.19, P=0.002). Six of 19 responded to bronchodilator treatment, suggesting concurrent asthma. Airway obstruction did not relate to restrictive pulmonary abnormalities measured by FVC at first or last timepoints [slope=-0.076 (95% confidence interval, -0.99 to 0.038; P=0.19)]. Changes in degrees of airway obstruction and restrictive lung disease over time did not correlate [slope=-0.125 (95% confidence interval, -0.294 to 0.044; P=0.14)].
CONCLUSIONS
Children with EOS and progressive airway obstruction represent an important subgroup which may require new surgical and nonsurgical treatment strategies to prevent loss of lung function over time.
Topics: Adolescent; Age of Onset; Airway Obstruction; Child; Disease Progression; Female; Humans; Male; Prevalence; Respiratory Function Tests; Retrospective Studies; Scoliosis; Severity of Illness Index; United States
PubMed: 32132449
DOI: 10.1097/BPO.0000000000001262 -
Current Opinion in Pulmonary Medicine Jan 2024This review provides an overview of the evolving field of airway stenting (AS), highlighting its relevance in the management of central airway obstruction (CAO). It... (Review)
Review
PURPOSE OF REVIEW
This review provides an overview of the evolving field of airway stenting (AS), highlighting its relevance in the management of central airway obstruction (CAO). It discusses recent advancements, including 3D-printed silicone stents (3DPSS), metallic stents, biodegradable stents (BS), and drug-eluting stents (DES), which are transforming clinical practice. The review underscores the ongoing challenges in patient selection, stent choice, and long-term management in the context of an evolving landscape.
RECENT FINDINGS
Innovations, particularly 3DPSS, have shown promise in providing patient-specific solutions. These stents offer improved symptom relief, enhanced quality of life, and lower complication rates, especially for complex airway diseases. The use of BS and DES is explored, raising prospects for future applications.
SUMMARY
The evolution of AS reflects a deepening understanding of airway obstructions. Recent innovations, such as 3DPSS, BS, and DES, show considerable promise in addressing the limitations of conventional stents. However, challenges related to complications, patient selection, and long-term management persist, demanding further research. Wide practice variations in the management of AS highlight the need for more clinical data and standardized guidelines. The search for the ideal stent continues, driven by the pursuit of better outcomes for patients with CAO.
Topics: Humans; Quality of Life; Stents; Airway Obstruction; Treatment Outcome
PubMed: 37937587
DOI: 10.1097/MCP.0000000000001032 -
Clinics in Chest Medicine Mar 2018Interventional pulmonology has grown significantly over the last 2 decades and is now seen as an essential component in thoracic oncology care. The rigid bronchoscope... (Review)
Review
Interventional pulmonology has grown significantly over the last 2 decades and is now seen as an essential component in thoracic oncology care. The rigid bronchoscope occupies a central role in this specialty and offers many important advantages over the flexible scope when performing therapeutic procedures on central airways. Although stenting practices have evolved, it is generally accepted that stents offer an important treatment option for selected patients with benign and malignant airway diseases. This article discusses rigid bronchoscopy and stenting, future challenges, complications of the procedure and stents, and future directions.
Topics: Airway Obstruction; Bronchoscopy; Humans; Stents
PubMed: 29433711
DOI: 10.1016/j.ccm.2017.11.011 -
Thoracic Surgery Clinics Aug 2018Recognizing and acting early on airway compromise reduces morbidity and mortality in patients with airway obstruction. Causes include foreign bodies, toxic/hot fumes,... (Review)
Review
Recognizing and acting early on airway compromise reduces morbidity and mortality in patients with airway obstruction. Causes include foreign bodies, toxic/hot fumes, difficult intubation, laryngeal spasm, and tumors. Before definitive control of the airway is possible, provide 100% oxygen with a tightly fitting mask to optimize body oxygen stores. Pulse oximetry is a poor indicator of airway compromise; a decreasing arterial hemoglobin oxygen saturation is a late sign of impending hypoxemia. Basic airway maneuvers improve the patency of an obstructed airway. Getting help from an anesthetist early is a priority.
Topics: Airway Obstruction; Humans; Intubation, Intratracheal; Reflex; Respiratory Physiological Phenomena; Respiratory System; Trachea
PubMed: 30054079
DOI: 10.1016/j.thorsurg.2018.05.006 -
Paediatric Respiratory Reviews Jan 2017Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large,... (Review)
Review
Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large, heterogeneous and vastly understudied group of patients. The symptoms are too often confused with those of asthma. Laryngoscopy performed as symptoms evolve during increasing exercise is pivotal, since the larynx plays an important role in symptomatology for the majority. Abnormalities vary between patients, and laryngoscopic findings are important for correct treatment and handling. The simplistic view that all EIIS is due to vocal cord dysfunction [VCD] still hampers science and patient management. Causal mechanisms are poorly understood. Most treatment options are based on weak evidence, but most patients seem to benefit from individualised information and guidance. The place of surgery has not been settled, but supraglottoplasty may cure well-defined severe cases. A systematic clinical approach, more and better research and randomised controlled treatment trials are of utmost importance in this field of respiratory medicine.
Topics: Airway Obstruction; Breathing Exercises; Exercise; Exercise Test; Humans; Laryngeal Diseases; Laryngoplasty; Laryngoscopy; Patient Education as Topic; Respiratory Therapy
PubMed: 27492717
DOI: 10.1016/j.prrv.2016.07.003 -
Pediatrics in Review Feb 2015
Review
Topics: Airway Obstruction; Child; Child, Preschool; Diagnosis, Differential; Humans; Infant
PubMed: 25646310
DOI: 10.1542/pir.36-2-62 -
Journal of Bronchology & Interventional... Apr 2022
Topics: Airway Obstruction; Bronchoscopy; Humans; Trachea
PubMed: 35318985
DOI: 10.1097/LBR.0000000000000824 -
Chest Sep 2017Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2% to 4%. The incidence of lethal and... (Review)
Review
Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2% to 4%. The incidence of lethal and nonlethal airway complications has decreased since the early experiences with double- and single-lung transplantation. The most common risk factor associated with post-lung transplantation airway complications is anastomotic ischemia. Airway complications include the development of exophytic granulation tissue, bronchial stenosis, bronchomalacia, airway fistula, endobronchial infection, and anastomotic dehiscence. The broadening array of bronchoscopic therapies has enhanced treatment options for lung transplant recipients with airway complications. This article reviews the risk factors, clinical manifestations, and treatments of airway complications following lung transplantation and provides our expert opinion when evidence is lacking.
Topics: Airway Obstruction; Bronchial Diseases; Granulation Tissue; Humans; Lung Diseases; Lung Transplantation; Postoperative Complications
PubMed: 28274791
DOI: 10.1016/j.chest.2017.02.021