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Indian Journal of Critical Care... Jan 2021Acute viral bronchiolitis (AVB) is a very frequent disease that affects the lower airways of young children increasing the inspiratory and expiratory resistance in...
BACKGROUND
Acute viral bronchiolitis (AVB) is a very frequent disease that affects the lower airways of young children increasing the inspiratory and expiratory resistance in variable degree as well as reducing the pulmonary compliance. It would be desirable to know whether these variables are associated with the outcome.
OBJECTIVES
To evaluate the respiratory mechanics in infants with AVB requiring mechanical ventilation (MV) support and to evaluate if respiratory mechanics predict outcomes in children with AVB supported on MV. To evaluate the respiratory mechanics in infants with AVB submitted to MV.
MATERIALS AND METHODS
A prospective observational study was conducted in two pediatric intensive care units (PICUs) between February 2016 and March 2017. Included were infants (1 month to 1 year old) admitted with AVB and requiring MV for >48 hours. Auto-PEEP, dynamic compliance (Cdyn), static compliance (Cstat), expiratory resistance (ExRes), and inspiratory resistance (InRes) were evaluated once daily on the second and third day of MV.
RESULTS
A total of 64 infants (median age of 2.8 months and a mean weight of 4.8 ± 1.7 kg) were evaluated. A mean positive inspiratory pressure (PIP) of 31.5 ± 5.2 cmHO, positive end-expiratory pressure (PEEP) of 5.5 ± 1.4 cmHO, resulting in a mean airway pressure (MAP) of 12.5 ± 2.2 cmHO and delta pressure of 22.5 ± 4.4 cmHO without difference between the two hospitals. Measurements of respiratory mechanics showed high values of InRes and ExRes (median 142 [IQ 106-180] cmHO/L/s and 158 [IQ 130-195.3] cmHO/L/s, respectively), accompanied by decreased Cdyn and Cstat (0.46 ± 0.19 and 0.81 ± 0.25 mL/kg/cmHO, respectively). None of the variables was associated with mortality, length of MV, or length of PICU stay.
CONCLUSION
Infants with AVB requiring MV support present very high InRes and ExRes values. These findings might be the reason for the aggressive ventilatory parameters, especially PIP, required to ventilate this group of children with lower airway obstruction.
CLINICAL SIGNIFICANCE
Monitoring respiratory mechanics could represent a useful tool to guide the ventilatory strategy to be adopted in patients with AVB.
HOW TO CITE THIS ARTICLE
Andreolio C, Piva JP, Bruno F, da Rocha TS, Garcia PCR. Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support. Indian J Crit Care Med 2021;25(1):88-93.
PubMed: 33603308
DOI: 10.5005/jp-journals-10071-23594 -
Medicine Oct 2022There are different results on the effect of endotracheal tube (ETT) size on respiratory mechanics in patients undergoing mechanical ventilation, and there are few...
There are different results on the effect of endotracheal tube (ETT) size on respiratory mechanics in patients undergoing mechanical ventilation, and there are few reports in adult laparoscopic surgery. The aim of this study was to investigate the effect of ETT size on airway resistance (RAW) and dynamic lung compliance (COMPL) in patients undergoing laparoscopic colorectal surgery. Seventy-two patients undergoing laparoscopic radical surgery for colorectal cancer under general anesthesia with endotracheal intubation were selected and divided into 3 groups (n = 24) using the random number table method Group A (ETT ID 7.0), Group B (ETT ID 7.5), and Group C (ETT ID 8.0). After mechanical ventilation, intraoperative RAW and COMPL were monitored in each of the 3 groups. In the non-pneumoperitoneal state, RAW in group ID7.0 is significantly higher than this in group ID7.5 and group ID8.0 (P < .05); the RAW between the 2 groups with ID7.5 and ID8.0 was not statistically significant (P > .05). The difference of COMPL between the 3 groups was statistically significant (P < .05); the COMPL of Group ID7.0 is lower than Group ID7.5, and Group ID7.5 is lower than Group ID8.0. In the pneumoperitoneal state, the RAW between ID7.0 group and ID8.0 group was statistically significant, the RAW difference between ID7.0 group and ID7.5 group, ID7.5 group and ID8.0 group not statistically significant (P > .05);the COMPL between the 3 groups was not statistically significant (P > .05). In the non-pneumoperitoneal state, the smaller the ETT internal diameter within a certain range, the higher RAW and the lower COMPL; in the pneumoperitoneal state, the RAW with the ID7.0 ETT was higher than that with the ID8.0 ETT, and the ETT size within a certain range had no effect on COMPL.
Topics: Adult; Humans; Airway Resistance; Lung Compliance; Intubation, Intratracheal; Respiration, Artificial; Respiratory Mechanics
PubMed: 36316839
DOI: 10.1097/MD.0000000000031410 -
The Journal of the Association of... Mar 2020Allergic rhinitis (AR) and asthma are closely linked atopic conditions, often termed as one airway one disease. Nasal airflow obstruction is a cardinal symptom of AR and...
INTRODUCTION
Allergic rhinitis (AR) and asthma are closely linked atopic conditions, often termed as one airway one disease. Nasal airflow obstruction is a cardinal symptom of AR and objective assessment of resistance to nasal airflow in rhinitis can be measured by active anterior rhinomanometry. This study was aimed at correlating the degree of resistance to nasal airflow (NAR) with the clinical severity of allergic rhinitis. In addition, it aimed at determining the proportion of patients with latent lower airway involvement in AR and studying the impact of ARIA severity grade and NAR on this value.
MATERIALS AND METHODS
A prospective prevalence study was conducted wherein 32 patients diagnosed with allergic rhinitis underwent determination of nasal airway resistance by active anterior rhinomanometry and lung function evaluation by spirometry. If spirometry was normal; histamine challenge test was performed to check for bronchial hyper-reactivity.
RESULTS
94% of patients with moderate- severe allergic rhinitis had significantly elevated nasal airway resistance compared to 56% of patients with mild rhinitis. (p=0.014). 71.9% of patients with allergic rhinitis but no symptoms of asthma had bronchial hyper-reactivity with a positive histamine challenge or airflow obstruction on lung functions. 87.5% patients with significantly elevated nasal airway resistance compared to 25% with lower values had lower airway involvement. (p=0.001). 94% of patients with moderate - severe rhinitis and 83% of patients with persistent rhinitis compared to 50% patients with mild and 44% with intermittent symptoms had lower airways involved. (p<0.05).
CONCLUSION
Significantly greater proportion of patients with moderate-severe and persistent allergic rhinitis had elevated nasal airway resistance values. 72% patients with allergic rhinitis had lower airway involvement despite having no symptoms of asthma, prevalence being greater in patients with severe and persistent disease. Proportion of patients with lower airway hyper-responsiveness is significantly higher among patients with raised nasal airway resistance as determined by rhinomanometry. This study thus concludes that measurement of nasal airway resistance determined by active anterior rhinomanometry is a good objective tool to measure severity of nasal obstruction in allergic rhinitis with good correlation with the ARIA clinical severity grade .It may also be a promising tool to identify allergic rhinitis patients who are at a higher risk of having latent lower airway involvement.
Topics: Airway Resistance; Humans; Nasal Obstruction; Prospective Studies; Rhinitis; Rhinitis, Allergic; Rhinomanometry
PubMed: 32138483
DOI: No ID Found -
Facial Plastic Surgery : FPS Jun 2024Assessing patients with complaints of nasal obstruction has traditionally been done by evaluation of the nasal airway looking for fixed or dynamic obstructive locations...
Assessing patients with complaints of nasal obstruction has traditionally been done by evaluation of the nasal airway looking for fixed or dynamic obstructive locations that could impair nasal airflow. Not infrequently, however, symptoms of nasal obstruction do not match the clinical examination of the nasal airway. Addressing this subset of patients may be a challenge to the surgeon. Evaluation of patients with symptoms of nasal obstruction should include a combination of a patient-reported assessment of nasal breathing and at least one objective method for measuring nasal airflow or nasal airway resistance or dimensions. This will allow distinction between patients with symptoms of nasal obstruction and low airflow or high nasal airway resistance and patients with similar symptoms but whose objective evaluation demonstrates normal nasal airflow or normal airway dimensions or resistance. Patients with low nasal airflow or high nasal airway resistance will require treatment to increase nasal airflow as a necessary step to improve symptoms, whereas patients with normal nasal airflow or nasal airway resistance will require a multidimensional assessment looking for less obvious causes of impaired nasal breathing sensation.
Topics: Humans; Nasal Obstruction; Airway Resistance; Algorithms; Rhinomanometry
PubMed: 38301716
DOI: 10.1055/s-0044-1779483 -
Journal of Clinical Sleep Medicine :... May 2022To evaluate the health-related quality of life (HRQoL) in patients with upper airway respiratory syndrome (UARS) and obstructive sleep apnea (OSA) compared to the...
STUDY OBJECTIVES
To evaluate the health-related quality of life (HRQoL) in patients with upper airway respiratory syndrome (UARS) and obstructive sleep apnea (OSA) compared to the general population (GP) in Lima, Peru, and to explore the variables associated with differences in HRQoL in patients with UARS.
METHODS
This was a retrospective study of medical and polysomnography records from 2009-2014 in a referral sleep medicine center for patients aged 18-64 years. UARS was defined by polysomnography as follows: apnea-hypopnea index < 5 events/h, oxygen saturation ≥ 92%, respiratory effort-related arousal index ≥ 5. HRQoL was assessed using the 36-Item Short Form Survey (version 1) questionnaire validated in Peru. The GP HRQoL was obtained from a population-based survey. Linear and logistic regression analyses were conducted.
RESULTS
We reviewed 1,329 polysomnograms and selected 888. UARS and OSA were diagnosed in 93 and 795 participants, respectively. The GP cohort consisted of 641 participants. Total HRQoL mean scores (95% confidence interval) in patients with UARS, patients with OSA, and the GP were 67.4 (63.7-71.1), 66.9 (65.4-68.4), and 82.9 (81.6-84.3), respectively. Patients with UARS and patients with OSA had a 5.5 times (95% confidence interval, 3.3-9.2) and 6.2 times (95% confidence interval, 4.6-8.4) greater probability of having a low total HRQoL score compared to patients in the GP, respectively. In patients with UARS, muscle pain, use of psychotropic medication, obesity, and depression were negatively correlated with the total HRQoL score.
CONCLUSIONS
The impact of OSA and UARS on HRQoL is similar between disease groups and markedly worse when compared to the impact in the GP. In patients with UARS, the presence of muscle pain, obesity, female sex, depression, and use of psychotropic medication negatively impacted HRQoL.
CITATION
Vizcarra-Escobar D, Duque KR, Barbagelata-Agüero F, Vizcarra JA. Quality of life in upper airway resistance syndrome. 2022;18(5):1263-1270.
Topics: Airway Resistance; Female; Humans; Myalgia; Obesity; Quality of Life; Retrospective Studies; Sleep Apnea, Obstructive; Syndrome
PubMed: 34931609
DOI: 10.5664/jcsm.9838 -
Respiratory Research Oct 2023Deep inspiration (DI) has been shown to induce bronchodilation and bronchoprotection in bronchochallenged healthy subjects, but not in asthmatics. Strain-induced... (Review)
Review
BACKGROUND
Deep inspiration (DI) has been shown to induce bronchodilation and bronchoprotection in bronchochallenged healthy subjects, but not in asthmatics. Strain-induced relaxation of airway smooth muscle (ASM) is considered one of the factors responsible for these effects. Other factors include the release or redistribution of pulmonary surfactant, alteration in mucus plugs, and changes in airway heterogeneity.
MAIN BODY
The present review is focused on the DI effect on ASM function, based on recent findings from ex vivo sheep lung experiments showing a large change in airway diameter during a DI. The amount of stretch on the airways, when applied to isolated airway rings in vitro, caused a substantial decrease in ASM contractility that takes many minutes to recover. When challenged with a bronchoconstrictor, the increase in pulmonary resistance in the ex vivo ovine lungs is mostly due to the increase in airway resistance.
CONCLUSIONS
Although non-ASM related factors cannot be excluded, the large strain on the airways associated with a DI substantially reduces ASM contractility and thus can account for most of the bronchodilatory and bronchoprotective effects of DI.
Topics: Humans; Animals; Sheep; Bronchi; Lung; Asthma; Inhalation; Muscle, Smooth
PubMed: 37853472
DOI: 10.1186/s12931-023-02538-8 -
Journal of Oral & Maxillofacial Research 2022Sleep apnea and periodontitis have high incidences in general population. They share common risk factors such as obesity, smoking, and aging. As cone-beam computed...
OBJECTIVES
Sleep apnea and periodontitis have high incidences in general population. They share common risk factors such as obesity, smoking, and aging. As cone-beam computed tomography becomes popular in dentistry, airway analysis is very accessible to dentists. However, not many studies have investigated the correlations between airway volume and risk of sleep apnea and periodontitis. The purpose of this retrospective study was to investigate the association between airway volume and the occurrence of sleep apnea and periodontitis.
MATERIAL AND METHODS
Overall, 258 patients were enrolled (male: 118, female: 140, age from 13 to 88). axiUm was used to collect demographical/physical information and the status of sleep apnea and periodontitis. Invivo™ software was utilized to measure airway dimensions. One-way ANOVA followed by Tukey's HSD post-hoc test and Pearson analysis were run to determine statistical difference in airway volumes among patients with various demographic and health status, and association of airway dimensions with their sleep apnea and periodontal conditions.
RESULTS
Sleep apnea patients had significantly higher body weight, body mass index, and significantly smaller airway compared to non-apnea patients (P < 0.05). Old age, male, and diabetes were found to be positively correlated with sleep apnea. No association between airway dimension and periodontal status was identified.
CONCLUSIONS
Patients with high body mass index are at higher risk of developing constricted airway and sleep apnea. There appears to be no association between restricted airway and occurrence of periodontitis. Cone-beam computed tomography plays a critical role in identifying narrow airway and necessitating proper referral.
PubMed: 35949545
DOI: 10.5037/jomr.2022.13205 -
ERJ Open Research Jan 2022Exercise-induced laryngeal obstruction is an important cause of exertional dyspnoea. The diagnosis rests on visual judgement of relative changes of the laryngeal inlet...
OBJECTIVE
Exercise-induced laryngeal obstruction is an important cause of exertional dyspnoea. The diagnosis rests on visual judgement of relative changes of the laryngeal inlet during continuous laryngoscopy exercise (CLE) tests, but we lack objective measures that reflect functional consequences. We aimed to investigate repeatability and normal values of translaryngeal airway resistance measured at maximal intensity exercise.
METHODS
31 healthy nonsmokers without exercise-related breathing problems were recruited. Participants performed two CLE tests with verified positioning of two pressure sensors, one at the tip of the epiglottis (supraglottic) and one by the fifth tracheal ring (subglottic). Airway pressure and flow data were continuously collected breath-by-breath and used to calculate translaryngeal resistance at peak exercise. Laryngeal obstruction was assessed according to a standardised CLE score system.
RESULTS
Data from 26 participants (16 females) with two successful tests and equal CLE scores on both test sessions were included in the translaryngeal resistance repeatability analyses. The coefficient of repeatability (CR) was 0.62 cmHO·L·s, corresponding to a CR% of 21%. Mean±sd translaryngeal airway resistance (cmHO·L·s) in participants with no laryngeal obstruction (n=15) was 2.88±0.50 in females and 2.18±0.50 in males. Higher CLE scores correlated with higher translaryngeal resistance in females (r=0.81, p<0.001).
CONCLUSIONS
This study establishes translaryngeal airway resistance obtained during exercise as a reliable parameter in respiratory medicine, opening the door for more informed treatment decisions and future research on the role of the larynx in health and disease.
PubMed: 35309036
DOI: 10.1183/23120541.00581-2021 -
Journal of Intensive Care Medicine Jun 2021Many patients with coronavirus disease 2019 (COVID-19) need mechanical ventilation secondary to acute respiratory distress syndrome. Information on the respiratory...
OBJECTIVE
Many patients with coronavirus disease 2019 (COVID-19) need mechanical ventilation secondary to acute respiratory distress syndrome. Information on the respiratory system mechanical characteristics of this disease is limited. The aim of this study is to describe the respiratory system mechanical properties of ventilated COVID-19 patients.
DESIGN, SETTING, AND PATIENTS
Patients consecutively admitted to the medical intensive care unit at the University of Iowa Hospitals and Clinics in Iowa City, USA, from April 19 to May 1, 2020, were prospectively studied; final date of follow-up was May 1, 2020.
MEASUREMENTS
At the time of first patient contact, ventilator information was collected including mode, settings, peak airway pressure, plateau pressure, and total positive end expiratory pressure. Indices of airflow resistance and respiratory system compliance were calculated and analyzed.
MAIN RESULTS
The mean age of the patients was 58 years. 6 out of 12 (50%) patients were female. Of the 21 laboratory-confirmed COVID-19 patients on invasive mechanical ventilation, 9 patients who were actively breathing on the ventilator were excluded. All the patients included were on volume-control mode. Mean [±standard deviation] ventilator indices were: resistive pressure 19 [±4] cmHO, airway resistance 20 [±4] cmHO/L/s, and respiratory system static compliance 39 [±16] ml/cmHO. These values are consistent with abnormally elevated resistance to airflow and reduced respiratory system compliance. Analysis of flow waveform graphics revealed a pattern consistent with airflow obstruction in all patients.
CONCLUSIONS
Severe respiratory failure due to COVID-19 is regularly associated with airflow obstruction.
Topics: Adult; Aged; Airway Obstruction; Airway Resistance; COVID-19; Cohort Studies; Critical Care; Female; Humans; Male; Middle Aged; Pulmonary Ventilation; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 33706592
DOI: 10.1177/08850666211000601 -
Sleep Medicine Reviews Feb 2023This review aims to provide current knowledge about the efficacy, mechanism, and multidisciplinary collaboration of rapid maxillary expansion (RME) treatment in... (Review)
Review
This review aims to provide current knowledge about the efficacy, mechanism, and multidisciplinary collaboration of rapid maxillary expansion (RME) treatment in pediatric obstructive sleep apnea (OSA). OSA is a chronic disease characterized by progressively increasing upper airway resistance, with various symptoms and signs. Increasingly the evidence indicates that RME is a non-invasive and effective therapy option for children with OSA. Besides, the therapeutic mechanism of RME includes increasing upper airway volume, reducing nasal resistance, and changing tongue posture. Recent clinical researches and case reports also show that a multidisciplinary approach improves sleep-disordered breathing in children. Applied with adenotonsillectomy, mandibular advancement, continuous positive airway pressure, and comprehensive orthodontic treatment, RME can be more effective in recurrent or residual OSA.
Topics: Humans; Child; Palatal Expansion Technique; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Mandibular Advancement; Nose
PubMed: 36566679
DOI: 10.1016/j.smrv.2022.101733