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Lin Chuang Er Bi Yan Hou Tou Jing Wai... Aug 2021To explore the value of CT location of the upper airway obstruction site after inducing sleep on the condition of obstructive sleep apnea(OSA) and its surgical...
To explore the value of CT location of the upper airway obstruction site after inducing sleep on the condition of obstructive sleep apnea(OSA) and its surgical efficacy. Forty patients with moderate-to-severe OSA diagnosed by polysomnography, first performed awake CT scan, then, the patient was slowly injected intravenously with dexmedetomidine to induce sleep, when the patient was apnea during sleep, CT scan of the corresponding part of the upper airway was performed. Compare and measure the cross-sectional area of the upper airway stenosis level in the two states, and evaluate the correlation between the cross-sectional area of the stenosis level after induction of sleep and the patient's AHI, blood oxygen saturation<90% of the time(CT90). According to the change value of the cross-sectional area of each plane, it was divided into 2 groups, 22 cases in first group underwent hypothermia plasma uvulapalatopharyngoplasty, and 18 cases in second group underwent multi-plane combined surgery. After 12 months of follow-up, compare the post-long-term efficacy, changes in cross-sectional area values of various narrow planes before and after surgery, and changes in indicators related to sleep quality between the two groups. Compared with the cross-sectional area of the nasopharyngeal area, posterior soft palate area, the posterior tongue area, and the epiglottis area measured by upper airway CT under awake breathing state, the cross-sectional area of each obstruction plane during sleep state decreased(<0.01). The minimum cross-sectional area of the upper airway plane sleep phase was negatively correlated with AHI and CT90, and the posterior soft palate and the posterior lingual base were highly correlated with AHI and CT90.12 months after treatment, the minimum cross-sectional area of each phase of the sleep phase in the experimental group 1 was significantly improved(<0.01) compared with that before treatment, followed by the posterior tongue area(<0.05). There was no statistical difference between the nasopharyngeal area and the epiglottis area. The differences in nasopharyngeal area, posterior soft palate area, posterior tongue area, and epiglottis area in experimental group 2 after treatment were statistically significant(<0.01 or <0.05), compared with that before treatment. The sleep-related indexes ESS, CT90, AHI, and LSaO₂ of the two groups were better than those before treatment after 12 months of treatment(<0.01). Comparison of experiment group 1 and 2, the effective rates were 72.72% and 95.23%(χ²=10.62, <0.01), the significant efficiency was 58.33% and 80.45%(χ²=8.62, <0.01), and the cure rates were 12.37% and 17.48%(x²=7.62, <0.01). CT examination of OSA patients after drug-induced sleep is safe and feasible, and it has important value for the accurate location of the upper airway obstruction site. 64-slice spiral CT upper airway scanning under induced sleep has guiding significance for the evaluation of OSA patients' condition and long-term surgical efficacy.
Topics: Airway Obstruction; Humans; Polysomnography; Sleep; Sleep Apnea, Obstructive; Tomography, X-Ray Computed
PubMed: 34304526
DOI: 10.13201/j.issn.2096-7993.2021.08.003 -
Physiology (Bethesda, Md.) Sep 2014Optical coherence tomography is a rapidly maturing optical imaging technology, enabling study of the in vivo structure of lung tissue at a scale of tens of micrometers.... (Review)
Review
Optical coherence tomography is a rapidly maturing optical imaging technology, enabling study of the in vivo structure of lung tissue at a scale of tens of micrometers. It has been used to assess the layered structure of airway walls, quantify both airway lumen caliber and compliance, and image individual alveoli. This article provides an overview of the technology and reviews its capability to provide new insights into respiratory disease.
Topics: Airway Obstruction; Animals; Diagnostic Imaging; Humans; Lung; Lung Diseases; Respiratory Physiological Phenomena; Tomography, Optical Coherence
PubMed: 25180266
DOI: 10.1152/physiol.00002.2014 -
Respiratory Physiology & Neurobiology Nov 2021The predictive performance of applying the degree of convexity in expiratory flow-volume (EFV) curves to detect airway obstruction in ventilated patients has yet to be... (Observational Study)
Observational Study
The predictive performance of applying the degree of convexity in expiratory flow-volume (EFV) curves to detect airway obstruction in ventilated patients has yet to be investigated. We enrolled 33 nonsedated and nonparalyzed mechanically ventilated patients and found that the degree of convexity had a significant negative correlation with FEV% predicted. The mean degree of convexity in EFV curves in the chronic obstructive pulmonary disease (COPD) group (n = 18) was significantly higher than that in the non-COPD group (n = 15; 26.37 % ± 11.94 % vs. 17.24 % ± 10.98 %, p = 0.030) at a tidal volume of 12 mL/kg IBW. A degree of convexity in the EFV curve > 16.75 at a tidal volume of 12 mL/kg IBW effectively differentiated COPD from non-COPD (AUC = 0.700, sensitivity = 77.8 %, specificity = 53.3 %, p = 0.051). The degree of convexity calculated from EFV curves may help physicians to identify ventilated patients with airway obstruction.
Topics: Aged; Aged, 80 and over; Airway Obstruction; Exhalation; Female; Humans; Male; Pulmonary Disease, Chronic Obstructive; Pulmonary Ventilation; Respiration, Artificial; Retrospective Studies; Tidal Volume
PubMed: 34245876
DOI: 10.1016/j.resp.2021.103739 -
Ear, Nose, & Throat Journal Nov 2022A 12-year-old male with a family history of inflammatory bowel disease presented with sleep-disordered breathing and was found to have chronic, granulomatous swelling of...
A 12-year-old male with a family history of inflammatory bowel disease presented with sleep-disordered breathing and was found to have chronic, granulomatous swelling of the supraglottic larynx. His airway was managed with tracheostomy, regular interval laryngeal steroid injections, supraglottoplasty, and "pepper pot" CO2 laser resurfacing leading to eventual decannulation. Due to the non-necrotic nature of the granulomatous inflammation, as well as the patient's family history of inflammatory bowel disease, the leading diagnosis was Crohn disease, but isolated laryngeal sarcoidosis could not be ruled out. There are only 13 reported cases of laryngeal manifestations of Crohn disease in the literature, with only 2 cases occurring in pediatric patients. This case report adds to this body of literature and discusses strategies for managing granulomatous supraglottic edema when definitive diagnosis is not fully clear.
Topics: Airway Obstruction; Child; Crohn Disease; Humans; Inflammation; Laryngeal Diseases; Laryngeal Edema; Male; Steroids
PubMed: 33236923
DOI: 10.1177/0145561320973772 -
European Journal of Pediatrics Dec 2023Foreign body airway obstruction (FBAO) is a relatively common emergency and a potential cause of sudden death both in children and older people; bystander immediate...
Foreign body airway obstruction (FBAO) is a relatively common emergency and a potential cause of sudden death both in children and older people; bystander immediate action will determine the victim's outcome. Although many school children's basic life support (BLS) training programs have been implemented in recent years, references to specific training on FBAO are lacking. Therefore, the aim was to assess FBAO-solving knowledge acquisition in 10-13-year-old school children. A quasi-experimental non-controlled simulation study was carried out on 564 ten-to-thirteen-year-old children from 5 schools in Galicia (Spain). Participants received a 60-min training led by their physical education teachers (5 min theory, 15 min demonstration by the teacher, and 30 min hands-on training) on how to help to solve an FBAO event. After the training session, the school children's skills were assessed in a standardized adult's progressive FBAO simulation scenario. The assessment was carried out by proficient researchers utilizing a comprehensive checklist specifically designed to address the variables involved in resolving a FBAO event according with current international guidelines. The assessment of school children's acquired knowledge during the simulated mild FBAO revealed that 62.2% of participants successfully identified the event and promptly encouraged the simulated patient to cough actively. When the obstruction progressed, its severity was recognized by 86.2% and back blows were administered, followed by abdominal thrusts by 90.4%. When the simulated victim became unconscious, 77.1% of children identified the situation and immediately called the emergency medical service and 81.1% initiated chest compressions. No significant differences in performance were detected according to participants' age. Conclusion: A brief focused training contributes to prepare 10-13-year-old school children to perform the recommended FBAO steps in a standardized simulated patient. We consider that FBAO should be included in BLS training programs for school children. What is Known: • Kids Save Lives strategy states that school children should learn basic life support (BLS) skills because of their potential role as first responders. • This BLS training does not include content for resolving a foreign body airway obstruction (FBAO). What is New: • Following a 60-min theoretical-practical training led by physical education teachers, 10-13-year-old school children are able to solve a simulated FBAO situation. • The inclusion of FBAO content in BLS training in schools should be considered.
Topics: Adult; Child; Humans; Aged; Adolescent; Cardiopulmonary Resuscitation; Schools; Foreign Bodies; Airway Obstruction; Educational Measurement
PubMed: 37777603
DOI: 10.1007/s00431-023-05202-x -
PloS One 2017Management of severe central airway obstruction due to advanced cancer is a medical and technical challenge. The impact of airway stenting on the clinical outcome of...
BACKGROUND
Management of severe central airway obstruction due to advanced cancer is a medical and technical challenge. The impact of airway stenting on the clinical outcome of such patients is unclear.
METHOD
This single-center, retrospective study evaluated 21 patients who underwent airway stenting for advanced cancer. We examined predictors of the post-stenting mortality, including age, serum albumin, tracheal diameter, smoking, opioid use, respiratory failure, and performance status (PS). We also compared survival according to the PS.
RESULTS
The mean survival period after stenting was 85.2 days. On univariate analysis, age, albumin, PS before airway stenting, respiratory failure, admission route, and PS grade were the candidates as possible predictors of prognosis after the procedure. On multivariate analysis, PS before airway stenting was identified as possible predictor of prognosis after stenting (HR 1.6180, 95% CI 0.969 to 2.7015, p = 0.066). The mean survival period after stenting was significantly longer in the good PS group, compared to the poor PS group (147.8 days vs. 38.2 days,p = 0.0346).
CONCLUSION
Airway stenting for advanced cancer may be more effective for patients in good general condition than in those with poor performance status.
Topics: Aged; Airway Extubation; Airway Obstruction; Female; Humans; Male; Middle Aged; Neoplasms; Palliative Care; Prognosis; Proportional Hazards Models; Retrospective Studies; Stents; Trachea; Tracheal Stenosis
PubMed: 28651011
DOI: 10.1371/journal.pone.0179795 -
Australian Journal of General Practice Apr 2019Given the often subacute nature of airway foreign bodies (AFB), which may have no or limited symptoms, patients with AFB sometimes present to general practitioners...
BACKGROUND
Given the often subacute nature of airway foreign bodies (AFB), which may have no or limited symptoms, patients with AFB sometimes present to general practitioners (GPs). It is important that AFB are promptly recognised and referred for appropriate tertiary management.
OBJECTIVE
The aim of this paper is to outline how AFB may present in the general practice setting and review the appropriate clinical work-up and tertiary referral. It also outlines the role of GPs in education of parents and caregivers of young children.
DISCUSSION
Paediatric patients with AFB can be asymptomatic or have vague pulmonary or upper airway symptoms after a choking episode when they present to the GP. It is important that historical red flags that mandate immediate specialist review are recognised, even in the otherwise asymptomatic child. Delays in diagnosis can result in severe and occasionally lifelong pulmonary complications with significant morbidity. GPs develop important long-term relationships with parents and caregivers of young children, which makes them uniquely positioned to provide potentially life-saving education regarding both the prevention and acute management of AFB.
Topics: Airway Obstruction; Child, Preschool; Female; Foreign Bodies; Humans; Infant; Male; Medical History Taking; Pediatrics; Referral and Consultation
PubMed: 31256483
DOI: 10.31128/AJGP-11-18-4768 -
European Annals of Otorhinolaryngology,... Apr 2017Surgical results in obstructive sleep apnea syndrome (OSAS) vary greatly, whatever the surgical technique or site treated. Most authors agree that rigorous patient... (Review)
Review
Surgical results in obstructive sleep apnea syndrome (OSAS) vary greatly, whatever the surgical technique or site treated. Most authors agree that rigorous patient selection is logical and mandatory. Drug-induced sleep endoscopy (DISE) was introduced in 1991 and has been rediscovered and used extensively since the 2000s. It mimics sleep in order to observe the upper airway on flexible endoscopy. A review of the DISE literature was performed, and is reported in two parts. The present first part describes the technique: drugs, practical anesthesiologic and ENT modalities, reproducibility, and limitations.
Topics: Airway Obstruction; Endoscopy; Humans; Hypnotics and Sedatives; Patient Selection; Polysomnography; Reference Values; Reproducibility of Results; Sleep; Sleep Apnea, Obstructive
PubMed: 28279631
DOI: 10.1016/j.anorl.2016.11.005 -
Journal of Medical Case Reports Jul 2023Bronchiolar obstruction, which causes airway obstruction in hyperresponsive airways, often results from the contraction of the airway's smooth muscles, increased viscid...
BACKGROUND
Bronchiolar obstruction, which causes airway obstruction in hyperresponsive airways, often results from the contraction of the airway's smooth muscles, increased viscid mucous secretions, and mucosal oedema consequent upon a reduced cyclic 3,5-adenosine monophosphate (c-AMP). These processes respond to bronchodilators. The six cases presented to us, in Edward Francis Small Teaching Hospital (EFSTH), Banjul, The Gambia, in the newborn period with clinical features suggesting obstruction with airway reactivity with response to bronchodilator treatment are presented here. Our capacity-limited literature search did not show any such report in neonates. This report highlights the need for this condition to be sought in neonates, medically managed in resource-poor countries without resorting to high-cost equipment use, and for its possible future classification.
CASE PRESENTATION
We report six cases of Gambian neonates consisting of four males and two females ages 2-27 days who presented to us with histories of fast breathing of a few hours duration and expiratory respiratory distress. All were term babies with rhonchi and demonstrable prolonged expiration with terminal effort. They all had a diagnosis of hyperreactive airway disease with bronchiolar obstruction. Five cases were first-time wheezers, while one was a recurrence. All were eventually treated with bronchodilators and steroids with good results. The median duration for resolution of most symptoms with treatment was two days, with a range of 1-5 days.
CONCLUSION
Clinically determined bronchiolar obstructions in term neonates can be relieved with bronchodilators and steroids, and this treatment modality, if employed where the pathological process can be established, can reduce the demand on scarce resources in resource-poor countries.
Topics: Male; Infant, Newborn; Female; Humans; Bronchodilator Agents; Airway Obstruction; Gambia
PubMed: 37518070
DOI: 10.1186/s13256-023-04035-4 -
Frontiers in Public Health 2022Choking injuries are one of the major causes of death among children ages 0-3, and most of these injuries are related to food. This work provides an overview of the... (Review)
Review
Choking injuries are one of the major causes of death among children ages 0-3, and most of these injuries are related to food. This work provides an overview of the current recommendations for food choking prevention and educational targets as a basis for developing a unified common set of knowledge for primary prevention policies development. Guidelines published by professional membership organizations and national governments in the English language were considered. All of these guidelines provide lists of hazardous food items and recommendations for food preparation to minimize choking hazard. Together with recommendations for food preparation, also recommendations aimed at stakeholders (food manufacturers, health care providers, and public authorities) are provided, underlining that this severe public health problem should be further addressed by adopting integrated public health interventions. Our overview stressed the importance of developing educational and primary prevention policies to sensitize adult supervisors and to regulate dangerous food products in the market.
Topics: Adult; Airway Obstruction; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Public Health
PubMed: 35664124
DOI: 10.3389/fpubh.2022.830876