-
Ear, Nose, & Throat Journal Dec 2020Upper airway foreign body is one of the most encountered clinical situations in otolaryngology practice. In rare conditions, a living organism may be a foreign body in...
PURPOSE
Upper airway foreign body is one of the most encountered clinical situations in otolaryngology practice. In rare conditions, a living organism may be a foreign body in the upper airway. In this study, we demonstrate 19 patients with leech infestations in nose, nasopharynx, and larynx.
METHODS
This study was enrolled with 19 patients between 2012 and 2016 in a regional state hospital. All of the patients were admitted to clinic with these complaints: epistaxis, hemoptysis, coughing, foreign body sensation, and bloody stool.
RESULTS
There were 12 male and 7 female patients. The leech was in the nose in 12 patients, in nasopharynx in 6 patients, and in the larynx in only 1 patient. All leeches are removed under local anesthesia (except laryngeal presentation). No bleeding and complication were seen after extraction of leech.
CONCLUSION
Leech can be easily diagnosed and managed in the upper aero-digestive tract without any complication and leech-associated disease.
Topics: Adolescent; Adult; Airway Obstruction; Animals; Child; Child, Preschool; Female; Foreign Bodies; Humans; Larynx; Leeches; Male; Middle Aged; Nasopharynx; Nose; Retrospective Studies; Young Adult
PubMed: 31266401
DOI: 10.1177/0145561319860527 -
Minerva Anestesiologica Dec 2015Maxillofacial trauma poses a challenge for the anesthesiologist because injuries can often compromise the patient's airways. Airway maintenance is the first step in the... (Review)
Review
Maxillofacial trauma poses a challenge for the anesthesiologist because injuries can often compromise the patient's airways. Airway maintenance is the first step in the American College of Surgeons Advance Trauma Life Support (ATLS®) protocol. However, clinical dilemmas may arise about the best way to manage a potentially life-threatening injury. There are no recommendations about the best time to intubate, the warning signs for deciding to intubate, or which device should be used when difficulty is expected. In this context the ATLS® approach is important but not sufficient. It is also necessary to recognize and be able to manage specific problems in this scenario where clinical priorities may be conflicting, may suddenly change or may be hidden. This clinical review discusses the complexity of this scenario, providing an overview of the conditions at greatest risk for airway obstruction and the options for airway management, on the basis of the recent literature. Clinicians must recognize the milestones and pitfalls of this topic in order to adopt a systematic approach for airway management, to identify specific characteristics associated with it, and to establish the utility of different instruments for airway management.
Topics: Airway Management; Airway Obstruction; Emergency Service, Hospital; Humans; Maxillofacial Injuries
PubMed: 26426159
DOI: No ID Found -
British Journal of Sports Medicine Jun 2022Exercise-induced laryngeal obstruction (EILO) is caused by paradoxical inspiratory adduction of laryngeal structures during exercise. EILO is an important cause of upper... (Review)
Review
Exercise-induced laryngeal obstruction (EILO) is caused by paradoxical inspiratory adduction of laryngeal structures during exercise. EILO is an important cause of upper airway dysfunction in young individuals and athletes, can impair exercise performance and mimic lower airway dysfunction, such as asthma and/or exercise-induced bronchoconstriction. Over the past two decades, there has been considerable progress in the recognition and assessment of EILO in sports medicine. EILO is a highly prevalent cause of unexplained dyspnoea and wheeze in athletes. The preferred diagnostic approach is continuous visualisation of the larynx (via laryngoscopy) during high-intensity exercise. Recent data suggest that EILO consists of different subtypes, possibly caused via different mechanisms. Several therapeutic interventions for EILO are now in widespread use, but to date, no randomised clinical trials have been performed to assess their efficacy or inform robust management strategies. The aim of this review is to provide a state-of-the-art overview of EILO and guidance for clinicians evaluating and treating suspected cases of EILO in athletes. Specifically, this review examines the pathophysiology of EILO, outlines a diagnostic approach and presents current therapeutic algorithms. The key unmet needs and future priorities for research in this area are also covered.
Topics: Airway Obstruction; Asthma, Exercise-Induced; Athletes; Consensus; Humans; Laryngeal Diseases; Laryngoscopy
PubMed: 35193856
DOI: 10.1136/bjsports-2021-104704 -
BMJ Open Respiratory Research 2019Central airway obstruction (CAO) is a life-threatening complication of lung cancer. The prevalence of CAO in lung cancer patients is unknown. We audited CAO burden to...
INTRODUCTION
Central airway obstruction (CAO) is a life-threatening complication of lung cancer. The prevalence of CAO in lung cancer patients is unknown. We audited CAO burden to inform our local cancer service.
METHODS
This is a cohort review of all new lung cancer diagnoses between 1 November 2014 and 30 November 2015. CAO was defined by CT appearance. CT scans and routine patient records were followed up to 30 November 2018 to determine the prevalence of CAO at diagnosis; the characteristics of patients with prevalent CAO; mortality (using survival analysis); and incident CAO over follow-up.
RESULTS
Of 342 new lung cancer diagnoses, CAO prevalence was 13% (95% CI 10% to 17%; n=45/342). Dedicated CT scan review identified missed CAO in 14/45 (31%) cases. In patients with prevalent CAO, 27/44 (61%) had a performance status of ≤2, 23/45 (51%) were diagnosed during an acute admission and 36/44 (82%) reported symptoms. Treatments were offered to 32/45 (71%); therapeutic bronchoscopy was performed in only 8/31 (26%) eligible patients. Median survival of patients with prevalent CAO was 94 (IQR 33-274) days. Multivariate analysis, adjusting for age, gender and disease stage, found CAO on index CT scan was independently associated with an increased hazard of death (adjusted HR 1.78 (95% CI 1.27 to 2.48); p=0.001). In total, 15/297 (5%) developed CAO during follow-up (median onset 340 (IQR 114-551) days). Over the audit period, 60/342 (18%; 95% CI 14% to 22%) had or developed CAO.
DISCUSSIONS
This is the first description of CAO prevalence in 40 years. Patients with prevalent CAO had a higher mortality. Our data provide a benchmark for service planning.
Topics: Aged; Aged, 80 and over; Airway Obstruction; Bronchoscopy; Cost of Illness; Female; Follow-Up Studies; Humans; Incidence; Kaplan-Meier Estimate; Lung Neoplasms; Male; Middle Aged; Prevalence; United Kingdom
PubMed: 31673363
DOI: 10.1136/bmjresp-2019-000429 -
Veterinary Medicine and Science Sep 2023The objective of this study was to describe a case of epiglottic entrapment in a cat.
OBJECTIVE
The objective of this study was to describe a case of epiglottic entrapment in a cat.
CASE SUMMARY
A 5-month-old male neutered Russian Blue cat was evaluated for progressive stertorous upper airway sounds, acute onset vestibulopathy and abnormal laryngeal anatomy. Endotracheal intubation was only able to be achieved using videoscopic guidance and identified concern for severe nasopharyngeal stenosis. A computerized tomography scan revealed otitis interna, narrowed nasopharynx and no definitive cause for the stertorous breathing. The cat recovered very slowly from anaesthesia due to concern for airway obstruction following extubation. It was discharged the following day and then passed away at home 2 weeks later. Necropsy revealed that the epiglottis was obscured by 2 cm of redundant mucosal tissue extending from the base of the tongue to the larynx resulting in epiglottic entrapment. Also noted was chronic, severe otitis interna and externa. Upper airway obstruction is suspected to be the cause of sudden death.
NEW OR UNIQUE INFORMATION
To the authors' knowledge, this is the first report of these oropharyngeal anatomic abnormalities in a cat.
Topics: Male; Cats; Animals; Labyrinthitis; Laryngeal Diseases; Epiglottis; Intubation, Intratracheal; Airway Obstruction; Cat Diseases
PubMed: 37465985
DOI: 10.1002/vms3.1211 -
Zhongguo Fei Ai Za Zhi = Chinese... Jun 2020Airway stent placement is the effective regimen for central airway obstruction (CAO), while its application scenarios varied. This study aimed to make clinical... (Comparative Study)
Comparative Study
BACKGROUND
Airway stent placement is the effective regimen for central airway obstruction (CAO), while its application scenarios varied. This study aimed to make clinical comparison of airway stent placement in the intervention room and operating room.
METHODS
Patients underwent airway stent placement between 2014 and 2018 were included in this retrospective case-control study. Clinical performance of airway stent placement in intervention room and operating room were compared.
RESULTS
82 patients were included in this study, including 39 in the intervention room and 43 in the operating room. Patients treated in the intervention room had lower Charlson comorbidity index (CCI) (P=0.018) and received less Y-shaped stents (P<0.001). Better clinical response (P=0.026), more stents placed (P<0.001) and longer length of stent (P<0.001) were observed in operating room, while there was no significantly statistical difference of stent-related complications and post-stent survival rate between the two groups. Extracorporeal membrane oxygenation (ECMO) supported airway stent placement procedures were performed in the operating room, which provided definitive safety support for high-risk intervention.
CONCLUSIONS
Patients with CAO could benefit from the operating room scenario, and airway stent placement in the operating room is more suitable for patients with higher CCI scores and receiving more complicated procedures.
Topics: Airway Obstruction; Bronchoscopy; Case-Control Studies; Female; Humans; Male; Middle Aged; Operating Rooms; Retrospective Studies; Stents; Survival Rate; Treatment Outcome
PubMed: 32517449
DOI: 10.3779/j.issn.1009-3419.2020.104.09 -
BMJ Open Respiratory Research Mar 2024While heated tobacco products (HTPs) may affect pulmonary function, the evidence supporting the utility of screening for HTP use in clinical settings is insufficient. We... (Observational Study)
Observational Study
BACKGROUND
While heated tobacco products (HTPs) may affect pulmonary function, the evidence supporting the utility of screening for HTP use in clinical settings is insufficient. We examined the association between HTP use and airway obstruction after switching from cigarettes.
METHOD
The study subjects were patients aged ≥20 years undergoing surgery from December 2021 to September 2022 who completed spirometry and reported tobacco (cigarette and HTP) use status during the preoperative assessment. Airway obstruction was defined as forced expiratory volume in 1 s to forced vital capacity ratio below the lower limit of normal. Current tobacco use was defined as past-30-day use. Multivariable Poisson regression analysis was performed to examine the associations between HTP use and airway obstruction by adjusting for demographic characteristics, lifetime cigarette smoking (pack-year) and duration of smoking cessation.
RESULTS
Overall (N=2850, 55.4% women, mean age 62.4), 4.6% and 10.7% reported current HTP use and cigarette smoking, respectively. 16.8% had airway obstruction. Airway obstruction was more common among current HTP-only users (adjusted prevalence ratio (APR)=2.32), current cigarette-only smokers (APR=2.57) and current dual users (APR=2.82) than never-tobacco users. Among current tobacco users (N=398), the prevalence of airway obstruction was not significantly different between HTP-only users and cigarette-only smokers. Among former cigarette smokers (>30-day cigarette quitters) (N=1077), current HTP users had 1.42 times the increased prevalence of airway obstruction than never-HTP users after adjusting for cigarette pack-year; a stronger association was observed when the analysis was restricted to ≥5-year cigarette quitters (N=772) (APR=1.96, vs never HTP users).
CONCLUSION
Current HTP use was associated with airway obstruction among patients with cancer who had completely switched from cigarettes even after quitting smoking for a long period. Patients should be routinely screened for HTP use and advised to quit any tobacco.
Topics: Female; Humans; Male; Middle Aged; Airway Obstruction; Cigarette Smoking; Japan; Tobacco Products
PubMed: 38460973
DOI: 10.1136/bmjresp-2023-001793 -
British Journal of Anaesthesia Nov 2021Tracheal intubation is among the most frequently performed manoeuvres in the critical care setting, and can be life-saving in critical illness, though also associated...
Tracheal intubation is among the most frequently performed manoeuvres in the critical care setting, and can be life-saving in critical illness, though also associated with serious adverse events such as oesophageal intubation or tracheal tube obstruction, displacement, or disconnection from the ventilator. A key finding of the 4th National Audit Project (NAP4) was identification of waveform capnography as the single intervention with the highest potential for reducing morbidity and mortality during tracheal intubation and maintenance of an artificial airway. In the INTUBE study, penetration of capnography into ICUs was low, and was not in use in 70% of the episodes of oesophageal intubation. To reduce harm and avoidable death, there is a need for a global initiative to increase access to and use of capnography in ICUs.
Topics: Airway Obstruction; Capnography; Critical Care; Health Services Accessibility; Humans; Intensive Care Units; Intubation, Intratracheal
PubMed: 34503831
DOI: 10.1016/j.bja.2021.08.010 -
Jornal Brasileiro de Pneumologia :... 2022The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC... (Observational Study)
Observational Study
OBJECTIVE
The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC ratio < 70%-to define obstruction, although other guidelines suggest that a post-bronchodilator FEV1/FVC ratio < the lower limit of normal (LLN) is the most accurate criterion.
METHODS
This was an observational study of individuals ≥ 40 years of age with risk factors for COPD who were referred to our pulmonary function laboratory for spirometry. Respiratory symptoms were also recorded. We calculated the prevalence of airway obstruction and of no airway obstruction, according to the GOLD criterion (GOLD+ and GOLD-, respectively) and according to the LLN criterion (LLN+ and LLN-, respectively). We also evaluated the level of agreement between the two criteria.
RESULTS
A total of 241 individuals were included. Airway obstruction was identified according to the GOLD criterion in 42 individuals (17.4%) and according to the LLN criterion in 23 (9.5%). The overall level of agreement between the two criteria was good (k = 0.67; 95% CI: 0.52-0.81), although it was lower among the individuals ≥ 70 years of age (k = 0.42; 95% CI: 0.12-0.72). The proportion of obese individuals was lower in the GOLD+/LLN+ category than in the GOLD+/LLN- category (p = 0.03), as was the median DLCO (p = 0.04).
CONCLUSIONS
The use of the GOLD criterion appears to be associated with a higher prevalence of COPD. The agreement between the GOLD and LLN criteria also appears to be good, albeit weaker in older individuals. The use of different criteria to define airway obstruction seems to identify individuals with different characteristics. It is essential to understand the clinical meaning of discordance between such criteria. Until more data are available, we recommend a holistic, individualized approach to, as well as close follow-up of, patients with discordant results for airway obstruction.
Topics: Aged; Airway Obstruction; Forced Expiratory Volume; Humans; Pulmonary Disease, Chronic Obstructive; Risk Factors; Spirometry; Vital Capacity
PubMed: 35019054
DOI: 10.36416/1806-3756/e20210124 -
European Annals of Otorhinolaryngology,... Feb 2018Quantitative evaluation of upper airway obstruction cannot be commonly performed under acute dyspnea, especially in head and neck cancer (HNC); the decision whether or... (Observational Study)
Observational Study
OBJECTIVES
Quantitative evaluation of upper airway obstruction cannot be commonly performed under acute dyspnea, especially in head and neck cancer (HNC); the decision whether or not to perform airway control surgery may be difficult to reach. Peak inspiratory flow (PIF) has been previously demonstrated to be a useful tool to decide on decannulation after HNC surgery. The aim of the present study was to assess the role of PIF as a standardized non-invasive tool in quantifying severe inspiratory dyspnea requiring emergency tracheostomy.
MATERIALS AND METHODS
A single-center prospective observational pilot study analyzed PIF measurements in 22 patients exhibiting acute dyspnea due to upper airway obstruction.
MAIN OUTCOME MEASURES
The decision whether or not to perform tracheotomy was taken prior to PIF measurement. PIF was measured with a hand-held PIF meter (In-Check method), and laryngeal fiberoscopy was then performed. Obstruction severity was defined by PIF values.
RESULTS
PIF could be measured prior to tracheotomy (imminent in 21 cases, postponed in 1) in all cases. PIF values below 53.1 L/min (i.e., 18.3% of theoretic value) correlated with necessity for emergency tracheotomy. This threshold is concordant with that previously found for the feasibility of decannulation (60L/min).
CONCLUSIONS
PIF is a non-invasive quantitative parameter assessing severity of upper airway obstruction, that may be helpful in decision-making for tracheostomy. Testing is simple, quick and reproducible.
Topics: Adult; Aged; Airway Obstruction; Female; Head and Neck Neoplasms; Humans; Inspiratory Capacity; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Tracheotomy; Treatment Outcome; Ventilator Weaning
PubMed: 28673655
DOI: 10.1016/j.anorl.2017.06.009