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Computational and Mathematical Methods... 2022Adenoid hypertrophy (AH) is a common disease in otorhinolaryngology. Children with chronic snoring and hypoxia are susceptible to long-term nasal obstruction, while...
Adenoid hypertrophy (AH) is a common disease in otorhinolaryngology. Children with chronic snoring and hypoxia are susceptible to long-term nasal obstruction, while long-term open-mouth breathing may cause craniofacial bone development disorders and dull facial expressions, the so-called adenoid face. The purpose of this work is to analyze the influence of AH-induced airway obstruction (AO) on the growth and development of craniomaxillofacial structure and respiratory function (RF) in children. The clinical data of 56 AH children (observation group) and 42 healthy children with physical examination (control group) who visited the Hebei Eye Hospital during the same period were retrospectively analyzed. All children received acoustic rhinometry and X-ray cephalometric measurements. The upper airway structure, sleep disorder score, and / value of nasopharyngeal lateral X-ray images were compared between cases and controls. For AH children, sleep tests were also performed to assess their RF. X-ray cephalometric measurements of facial morphology showed obvious vertical growth, mandibular retrognathia, and enlarged mandibular angle in AH children. AH mainly affects the size of the nasopharyngeal and oropharyngeal airway. AH children presented with higher nasal airway resistance (5.11 ± 1.95 cmHO/L min) and lower nasopharyngeal volume (NPV) (16.86 ± 3.93 cm) than controls. Of the AH children, 45 had abnormal RF, including 4 with obstructive sleep apnea syndrome. The / value of nasopharyngeal lateral X-ray images was significantly higher in AH children than in controls. Besides, worse sleep quality was found in AH children. The above differences were all of statistical significance. The above indicates that AH can affect the size of the nasopharyngeal and oropharyngeal airway, change children's respiratory mode and RF, increase nasal resistance, and decrease NPV, resulting in upper respiratory tract stenosis, as well as craniomaxillofacial and oral malformations, which affects children's normal growth and development.
Topics: Adenoids; Airway Obstruction; Child; Growth and Development; Humans; Hypertrophy; Retrospective Studies
PubMed: 36081428
DOI: 10.1155/2022/5096406 -
AJR. American Journal of Roentgenology May 2016The radiologist plays several important roles in the diagnosis and management of pediatric neck infections and masses. Although the clinical diagnosis of an infection is... (Review)
Review
OBJECTIVE
The radiologist plays several important roles in the diagnosis and management of pediatric neck infections and masses. Although the clinical diagnosis of an infection is often clear, the radiologist should evaluate for an underlying cause and for drainable collections. With neck masses, the radiologist's role is to form a differential diagnosis and evaluate for biopsy of a potentially neoplastic lesion. With both clinical scenarios, the radiologist should also evaluate for complications.
CONCLUSION
The mnemonic device ABCs (airway, blood vessels, and compartments) serves as a useful reminder for potentially critical complications of pediatric neck infections and masses.
Topics: Airway Obstruction; Blood Vessels; Child; Cysts; Diagnosis, Differential; Head and Neck Neoplasms; Humans; Infections; Inflammation; Neck
PubMed: 26959095
DOI: 10.2214/AJR.15.15812 -
Annals of the New York Academy of... Nov 2020Methyl isocyanate (MIC, "Bhopal agent") is a highly reactive, toxic industrial chemical. Inhalation of high levels (500-1000 ppm) of MIC vapor is almost uniformly fatal....
Methyl isocyanate (MIC, "Bhopal agent") is a highly reactive, toxic industrial chemical. Inhalation of high levels (500-1000 ppm) of MIC vapor is almost uniformly fatal. No therapeutic interventions other than supportive care have been described that can delay the onset of illness or death due to MIC. Recently, we found that inhalation of MIC caused the appearance of activated tissue factor in circulation with subsequent activation of the coagulation cascade. Herein, we report that MIC exposure (500 ppm for 30 min, nose-only) caused deposition of fibrin-rich casts in the conducting airways resulting in respiratory failure and death within 24 h in a rat model (LC ). We thus investigated the effect of airway delivery of the fibrinolytic agent tissue plasminogen activator (tPA) on mortality and morbidity in this model. Intratracheal administration of tPA was initiated 11 h post MIC exposure and repeated every 4 h for the duration of the study. Treatment with tPA afforded nearly 60% survival at 24 h post MIC exposure and was associated with decreased airway fibrin casts, stabilization of hypoxemia and respiratory distress, and improved acidosis. This work supports the potential of airway-delivered tPA therapy as a useful countermeasure in stabilizing victims of high-level MIC exposure.
Topics: Airway Obstruction; Animals; Disease Models, Animal; Isocyanates; Male; Rats; Rats, Sprague-Dawley; Tissue Plasminogen Activator
PubMed: 32233099
DOI: 10.1111/nyas.14344 -
Annals of the American Thoracic Society Feb 2022Laryngeal edema is a known complication of endotracheal intubation that may cause airway obstruction upon extubation. The only test available to predict this... (Randomized Controlled Trial)
Randomized Controlled Trial
Laryngeal edema is a known complication of endotracheal intubation that may cause airway obstruction upon extubation. The only test available to predict this complication is the cuff leak test (CLT). Given the uncertainty of the CLT's clinical utility, we conducted the COMIC (uff Leak Test and Airway bstruction in echanically Ventilated U Patients) pilot study to examine the feasibility of undertaking a larger trial. COMIC is a multicentered, parallel-group randomized trial performed in Canada, Saudi Arabia, and Poland. We enrolled mechanically ventilated adults admitted to the intensive care unit who were deemed ready for extubation. Those allocated to the intervention arm had the results of their CLT communicated to the healthcare team, who then decided to proceed with extubation or not. In those randomized to the control arm, the CLT results were not communicated to the healthcare team and patients were extubated, regardless of the CLT result. The primary outcomes focused on feasibility. One hundred patients (56 in the intervention and 44 in the control arm) were enrolled. All feasibility criteria were met, including ) recruitment rate of 7.6 patients/month, ) consent rate of 88.3% (95% confidence interval [CI], 82.1-94.5%), and ) protocol adherence of 98% (95% CI, 95-100%). There were two episodes of clinically significant stridor in the intervention group and four patients who required reintubation in each group. The results of the COMIC pilot trial support the feasibility of a larger trial to determine the effect of the CLT on reintubation and clinically important stridor.Clinical trial registered with www.clinicaltrials.gov (NCT03372707).
Topics: Adult; Airway Extubation; Airway Obstruction; Humans; Intensive Care Units; Intubation, Intratracheal; Pilot Projects; Prospective Studies; Respiration, Artificial
PubMed: 34242140
DOI: 10.1513/AnnalsATS.202103-390OC -
Journal of Veterinary Emergency and... May 2022To describe the clinical characteristics and outcomes in a population of dogs with negative-pressure pulmonary edema (NPPE) and to identify the main causes of the...
OBJECTIVE
To describe the clinical characteristics and outcomes in a population of dogs with negative-pressure pulmonary edema (NPPE) and to identify the main causes of the disease. To evaluate any associations with morbidity and mortality.
DESIGN
Retrospective study.
SETTING
Three university teaching hospitals and 2 private referral centers in the United Kingdom.
ANIMALS
Thirty-five client-owned dogs presented with NPPE.
INTERVENTIONS
None MEASUREMENTS AND MAIN RESULTS: Data collected included patient characteristics, clinical history, clinicopathological abnormalities, radiographic features, treatments, and outcomes. The median age was 4 months (range 2-90) and median weight was 7.1 kg (range 1.7-37.2). There were many causes of NPPE including leash tugs, near hanging, accidental choking, anatomical obstruction to airflow, and purposeful airway obstruction by people. The most common cause of NPPE was accidental choking (40% of cases). Dogs with an anatomical obstruction were older than 24 months. Hypoxemia with an increased alveolar-arterial gradient was common on presentation. The majority of thoracic radiographs (65.7%) showed an alveolar or interstitial pattern in the caudodorsal area as previously described in the literature. Oxygen therapy was administered to 33 (94.3%) dogs. Furosemide was administered to 18 (51.4%) dogs. The median length of hospitalization was 2 days (range 0-14). Twenty-eight (80%) dogs survived to discharge. Seven dogs were mechanically ventilated and only 2 of them (28.6%) survived to discharge. The requirement for mechanical ventilation was the only parameter associated with mortality (P < 0.001).
CONCLUSIONS
Most cases of NPPE occur in juvenile dogs. Different incidents associated with upper airway obstruction can produce an episode of NPPE. Choking on food or toys and near hanging have not been previously described in the veterinary literature as inciting causes of NPPE. The overall prognosis is good.
Topics: Airway Obstruction; Animals; Dog Diseases; Dogs; Humans; Lung; Oxygen Inhalation Therapy; Pulmonary Edema; Retrospective Studies
PubMed: 34850530
DOI: 10.1111/vec.13166 -
Revista de Investigacion Clinica;... 2019Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. While the cut-off point to define airflow obstruction has... (Review)
Review
Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. While the cut-off point to define airflow obstruction has been controversial, it is widely accepted that the spirometry test is vital, as well as performing it after using a bronchodilator. The 6-second spirometry and the forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV/FEV) have demonstrated validity for defining obstruction, and it would be advisable to incorporate them in the definitions of obstruction. Another relevant issue is that spirometry with borderline obstruction can vary over time, changing to above or below the cut-off point. Thus, surveillance should be considered over time, repeating the spirometry to have a greater certainty in the diagnosis. The objective of this article was to conduct an in-depth review of the controversies in the diagnosis of COPD. During the past years, COPD definition has been updated in different times; however, it is now considered more as a complex syndrome with systemic participation, requiring a multidimensional assessment, and not only a spirometry.
Topics: Airway Obstruction; Bronchodilator Agents; Forced Expiratory Volume; Humans; Pulmonary Disease, Chronic Obstructive; Spirometry; Time Factors
PubMed: 30810541
DOI: 10.24875/RIC.18002626 -
Current Opinion in Pulmonary Medicine Jul 2022Malignant central airway obstruction (CAO) is a common complication in cancer and confers significant symptom burden and reduction in quality of life. Multiple... (Review)
Review
PURPOSE OF REVIEW
Malignant central airway obstruction (CAO) is a common complication in cancer and confers significant symptom burden and reduction in quality of life. Multiple bronchoscopic interventions exist for malignant CAO. In this review, we discuss the role of therapeutic bronchoscopy in the management of malignant CAO, emphasizing its impact on symptom control and quality of life while balancing the risks and benefits of intervention.
RECENT FINDINGS
Significant practice variations exist among practitioners of therapeutic bronchoscopy, and limited data exist to guide real-time clinical decision-making. Recent analyses demonstrate that therapeutic bronchoscopy is effective for symptoms associated with malignant CAO with infrequent complications. These studies also show that many of the improvements in symptoms and quality of life are sustained after intervention and are associated with improved overall survival in patients with malignant CAO. Recent data have also shown that the improvement in symptoms associated with therapeutic bronchoscopy may enable more definitive cancer treatment, further improving patient outcomes.
SUMMARY
Therapeutic bronchoscopy is safe and effective at improving patient-centered outcomes in malignant CAO. Research is ongoing to better understand its optimal role in this setting, refine decision-making regarding advanced bronchoscopic interventions, and further improve patient outcomes.
Topics: Airway Obstruction; Bronchoscopy; Humans; Neoplasms; Quality of Life
PubMed: 35749792
DOI: 10.1097/MCP.0000000000000883 -
Radiographics : a Review Publication of... 2014Airway stents are increasingly used to treat symptomatic patients with obstructive tracheobronchial diseases who are not amenable to surgical resection or who have poor... (Review)
Review
Airway stents are increasingly used to treat symptomatic patients with obstructive tracheobronchial diseases who are not amenable to surgical resection or who have poor performance status, precluding them from resection. The most common conditions that are treated with tracheobronchial stents are primary lung cancer and metastatic disease. However, stents have also been used to treat patients with airway stenosis related to a variety of benign conditions, such as tracheobronchomalacia, relapsing polychondritis, postintubation tracheal stenosis, postoperative anastomotic stenosis, and granulomatous diseases. Additionally, airway stents can be used as a barrier method in the management of esophagorespiratory fistulas. Many types of stents are available from different manufacturers. Principally, they are classified as silicone; covered and uncovered metal; or hybrid, which are made of silicone and reinforced by metal rings. The advantages and disadvantages of each type of airway stent are carefully considered when choosing the most appropriate stent for each patient. Multidetector computed tomography plays an important role in determining the cause and assessing the location and extent of airway obstruction. Moreover, it is very accurate in its depiction of complications after airway stent placement.
Topics: Airway Obstruction; Bronchial Diseases; Equipment Design; Humans; Lung Diseases; Multidetector Computed Tomography; Radiographic Image Interpretation, Computer-Assisted; Stents; Tracheal Diseases
PubMed: 25384279
DOI: 10.1148/rg.347130063 -
Pediatric Pulmonology Dec 2023Negative pressure pulmonary edema (NPPE) is a potentially life-threatening complication that develops rapidly following acute upper airway obstruction. The condition is... (Review)
Review
INTRODUCTION
Negative pressure pulmonary edema (NPPE) is a potentially life-threatening complication that develops rapidly following acute upper airway obstruction. The condition is rare, dramatic but resolves quickly. Prompt recognition and appropriate supportive treatment may prevent unnecessary investigations and iatrogenic complications.
METHODS
We describe a spectrum of etiologies and clinical manifestation of pediatric NPPE in our center and review of previous publications.
CONCLUSION
The etiology for the development of NPPE in children has shifted over the years. Although dramatic in presentation, this type of pulmonary edema often resolves quickly with minimal support.
Topics: Humans; Child; Pulmonary Edema; Research; Airway Obstruction
PubMed: 37737464
DOI: 10.1002/ppul.26700 -
Cranio : the Journal of... Jan 2022: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of entheses. When localized in the cervical paravertebral region, typical signs... (Review)
Review
: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of entheses. When localized in the cervical paravertebral region, typical signs and symptoms include stiffness, pain, loss of range of motion, and difficulty swallowing.: The authors present two less typical respiratory manifestations of DISH due to cervical osteophytes protrusion and obstruction of the upper airway. The first patient was treated conservatively (application of CPAP during nighttime), while the second required emergency intubation and a combined ENT-neurosurgical operation for the removal of osteophytes.: Even though dysphagic symptoms are more frequent, DISH may be a cause of airway obstruction and should be included in the differential diagnosis of respiratory distress and OSA.
Topics: Airway Obstruction; Cervical Vertebrae; Deglutition Disorders; Humans; Hyperostosis, Diffuse Idiopathic Skeletal; Osteophyte
PubMed: 31516093
DOI: 10.1080/08869634.2019.1667044