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Scientific Reports Mar 2023Central airway obstruction caused by neck and chest tumors is a very dangerous oncological emergency with high mortality. Unfortunately, there is few literature to...
Central airway obstruction caused by neck and chest tumors is a very dangerous oncological emergency with high mortality. Unfortunately, there is few literature to discuss an effective way for this life-threating condition. Providing effective airway managements, adequate ventilation and emergency surgical interventions are very important. However, traditional airway managements and respiratory support has only limited effect. In our center, using extracorporeal membrane oxygenation (ECMO) as a novel approach to manage patient with central airway obstruction caused by neck and chest tumors has been adopted. We aimed to show the feasibility: using early ECMO to manage difficult airway, provide oxygenation and support surgical procedure for patients with critical airway stenosis caused by neck and chest tumors. We designed a single-center, small sample size retrospective study based on real-world. We identified 3 patients with central airway obstruction caused by neck and chest tumors. ECMO was used to ensure adequate ventilation to emergency surgery. Control group cannot be established. Because traditional manner very likely led to death of such patients. Details of clinical characteristics, ECMO, surgery and survival outcomes were recorded. Acute dyspnea and cyanosis were the most frequent symptoms. All patients (3/3) showed descending arterial partial pressure of oxygen (PaO). Computed tomography (CT) revealed severe central airway obstruction caused by neck and chest tumors in all cases (3/3). All patients (3/3) had definite difficult airway. All cases (3/3) received ECMO support and emergency surgical procedure. Venovenous ECMO was the common mode for all cases. 3 patients weaned off ECMO successfully without any ECMO-related complications. Mean duration of ECMO was 3 h (range: 1.5-4.5 h). Under ECMO support, difficult airway management and emergency surgical procedure were finished successfully for all cases (3/3). The mean ICU stay was 3.3 days (range: 1-7 days), and the mean general ward stay was 3.3 days (range: 2-4 days). Pathology demonstrated the tumor dignity for 3 patients including 2 malignant cases and 1 benign case. All patients (3/3) were discharged from hospital successfully. We showed that early ECMO initiation was a safe and feasible approach to manage difficult airway for patients with severe central airway obstruction caused by neck and chest tumors. Meanwhile, early ECMO initiation could ensure security for airway surgical procedure.
Topics: Humans; Extracorporeal Membrane Oxygenation; Retrospective Studies; Airway Obstruction; Airway Management; Dendritic Spines
PubMed: 36878956
DOI: 10.1038/s41598-023-30665-1 -
Critical Care Clinics Jul 2000Direct laryngoscopy is the direct visualization of the larynx while using a rigid laryngoscope to distract the structures of the upper airway. This article reviews the... (Review)
Review
Direct laryngoscopy is the direct visualization of the larynx while using a rigid laryngoscope to distract the structures of the upper airway. This article reviews the anatomy relevant to laryngoscopy and then presents a stepwise approach to the procedure. Alternative intubation techniques, positioning, laryngoscopy blades, and stylets are then covered. Pharmacologic adjuncts are discussed briefly as they relate to the difficult airway and incorporation into overall airway management.
Topics: Airway Obstruction; Critical Care; Humans; Hypopharynx; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Larynx; Neuromuscular Blocking Agents; Oxygen Inhalation Therapy; Posture; Respiration, Artificial
PubMed: 10941579
DOI: 10.1016/s0749-0704(05)70118-4 -
European Archives of... Apr 2017Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This review of the literature... (Review)
Review
Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This review of the literature provides an overview of the current understanding of the definition, epidemiology, diagnosis and management of EILO. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines the Cochrane, Embase, Ovid MEDLINE and PubMed databases were searched. Four search domains "exercise", "induced", "laryngeal" and "obstruction" were used. Primary searching found 469 records, 308 were excluded following screening of titles and citation. 100 were duplicates, a further 47 studies were excluded after applying inclusion and exclusion criteria. Two studies were identified following cross-referencing. A total of 15 studies were included. The last search date was 6/06/15. Average prevalence in the general adolescent population and athletes was 7.1 and 35.2 %, respectively. Dyspnoea was reported in 96.5, 99 and 100 % of three EILO patient cohorts. Two studies (n = 107) reported continuous laryngoscopy during exercise (CLE) testing could differentiate between patients and controls. In two studies (n = 33) the visual analogue scale (VAS) showed a beneficial effect of endoscopic supraglottoplasty (ES). Thirty-eight out of 43 patients who received two or more laryngeal control therapy sessions (LCT) had improvement or resolution of EILO symptoms. Exercise induced dyspnoea is the most common EILO symptom. EILO has a high occurrence in adolescents and athletes. The CLE test is the current gold standard for EILO diagnostics. Management of EILO includes both surgical and non-surgical interventions.
Topics: Adolescent; Airway Obstruction; Asthma, Exercise-Induced; Diagnosis, Differential; Dyspnea; Exercise; Female; Humans; Laryngeal Diseases; Laryngoscopy; Male; Prevalence; Vocal Cord Dysfunction
PubMed: 27730324
DOI: 10.1007/s00405-016-4338-1 -
Anaesthesia Dec 2011There is no consensus as to the ideal approach for the anaesthetic management of the adult obstructed airway and there are advocates of awake fibreoptic intubation,... (Review)
Review
There is no consensus as to the ideal approach for the anaesthetic management of the adult obstructed airway and there are advocates of awake fibreoptic intubation, inhalational induction and intravenous induction techniques. This review considers the different options available for obstruction at different anatomical levels. Decisions must also be made on the urgency of the required intervention. Particular controversies revolve around the role of inhalational vs intravenous induction of anaesthesia, the use or avoidance of neuromuscular blockade and the employment of cannula cricothyroidotomy vs surgical tracheostomy.
Topics: Airway Management; Airway Obstruction; Anesthesia, Inhalation; Anesthesia, Intravenous; Fiber Optic Technology; Humans; Intubation, Intratracheal; Mediastinal Neoplasms; Neuromuscular Blockade; Wakefulness
PubMed: 22074083
DOI: 10.1111/j.1365-2044.2011.06938.x -
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 -
Respiratory Care Oct 2007The rationale for airway clearance therapy and basic principles of its application are identical for children and adults, but there are important differences in... (Review)
Review
The rationale for airway clearance therapy and basic principles of its application are identical for children and adults, but there are important differences in physiology (regarding airway mucus characteristics and airway mechanics) and pathological processes in children, as well as other considerations unique to the pediatric population. The major obstacle in reviewing the evidence for efficacy of airway clearance therapy in pediatrics is the lack of data from well-performed, adequately powered clinical trials. This problem is partially alleviated by the use of published meta-analyses. A review of pediatric studies suggests that airway clearance therapy is of clear and proven benefit in the routine care of cystic fibrosis, and that no specific airway-clearance technique is clearly superior, but for any individual patient the technique that is most likely to maximize patient adherence to treatment is preferred. Airway clearance therapy appears likely to be of benefit in the routine care of children with neuromuscular disease and cerebral palsy, and is probably of benefit in treating atelectasis in children on mechanical ventilation. Airway clearance therapy may be of benefit in preventing post-extubation atelectasis in neonates. Airway clearance therapy appears to be of minimal to no benefit in the treatment of children with acute asthma, bronchiolitis, hyaline membrane disease, and those on mechanical ventilation for respiratory failure in the pediatric intensive care unit, and it is not effective in preventing atelectasis in children immediately following surgery. All in all, however, given that these conclusions are based on very little data, future well-performed clinical trials might change the weight of evidence to contradict these current conclusions.
Topics: Age Factors; Airway Obstruction; Child; Child, Preschool; Humans; Infant; Mucus; Physical Therapy Modalities
PubMed: 17894905
DOI: No ID Found -
Seminars in Pediatric Neurology Mar 1996The obstructive sleep apnea syndrome is a common cause of morbidity during childhood. Childhood obstructive sleep apnea syndrome is usually secondary to adenotonsillar... (Review)
Review
The obstructive sleep apnea syndrome is a common cause of morbidity during childhood. Childhood obstructive sleep apnea syndrome is usually secondary to adenotonsillar hypertrophy. Other risk factors include craniofacial anomalies, obesity, and neuromuscular disease. Symptoms include snoring and difficulty breathing during sleep. Definitive diagnosis is made by polysomnography. Normative polysomnographic parameters vary with age; thus age-appropriate norms must be used. In contrast to adults, children often manifest a pattern of persistent partial airway obstruction during sleep, rather than cyclical, discrete obstructive apneas. Most children are cured by tonsillectomy and adenoidectomy. However, some children require further therapy, such as continuous positive airway pressure.
Topics: Adolescent; Adult; Airway Obstruction; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Male; Polysomnography; Risk Factors; Sleep Apnea Syndromes
PubMed: 8795838
DOI: 10.1016/s1071-9091(96)80025-8 -
Acta Clinica Croatica Aug 2023Congenital laryngeal cysts are rare lesions that may occur in newborns, characterized by symptoms of respiratory obstruction and severe dyspnea. The aim of this study...
Congenital laryngeal cysts are rare lesions that may occur in newborns, characterized by symptoms of respiratory obstruction and severe dyspnea. The aim of this study was to indicate optimal surgical treatment of congenital laryngeal cysts in newborns. We present a case series of five neonates treated for congenital laryngeal cysts during the 2011-2017 period at our pediatric tertiary care hospital. Patient age ranged from one day to 14 days. All patients had unilateral cysts. After surgical excision, burning of the walls of the cysts was performed by a CO2 laser. In one case, after four months, a recurrent cyst appeared, and re-operation was performed. Our relatively small case series indicates that symptoms such as stridor and labored breathing can occur already during the first days of life and potentially endanger the patient's life. Complete excision of the cyst and burning of its walls with CO2 laser leads to complete cure and prevent recurrence of the lesion.
Topics: Humans; Infant, Newborn; Airway Obstruction; Cysts; Laryngeal Diseases; Laryngoscopy; Paresthesia; Respiratory Sounds
PubMed: 38549606
DOI: 10.20471/acc.2023.62.02.08 -
The Bulletin of Tokyo Dental College Dec 2021A minitracheostomy (MTS) is performed after surgery for oral cancer at our institution in patients who are at risk of postoperative airway obstruction. The aim of this...
A minitracheostomy (MTS) is performed after surgery for oral cancer at our institution in patients who are at risk of postoperative airway obstruction. The aim of this study was to evaluate outcomes of preventive airway management with this procedure. A total of 105 patients undergoing preventive airway management with a Seldinger MTS kit after oral cancer surgery between October 2014 and March 2020 were enrolled. Information on patient characteristics, time required for the MTS, duration of tracheal cannula placement, and MTS-related complications was obtained from both the medical and anesthesia records. In addition, the numbers of postoperative instances of tracheotomy between April 2009 and September 2014 and extubation between October 2014 and March 2020 were also counted for a comparison. The time required for an MTS was 3.2±2.6 min. Minor complications, including mild subcutaneous or mediastinal emphysema and bleeding, were found in 5 patients, but all recovered in a short time. The median duration of tracheal cannula placement was 2 days, with a range of from 0 to 8 days. A total of 348 oral cancer surgeries were performed between April 2009 and September 2014. Among patients undergoing these procedures, 111 underwent a tracheostomy (32%), 235 extubation (68%), and 2 sustained intubation. A total of 580 oral cancer surgeries were performed between October 2014 and March 2020. Here, 121 patients underwent a tracheostomy (21%), 105 an MTS (18%), and 354 extubation (61%). The results suggest that an MTS can be performed safely and smoothly with no significant complications. They also suggest that an MTS reduces the need for a full tracheostomy and the risk of airway obstruction after extubation. We conclude that airway management strategy with an MTS is a useful option in preventing airway obstruction following oral cancer surgery.
Topics: Airway Management; Airway Obstruction; Humans; Intubation, Intratracheal; Mouth Neoplasms; Retrospective Studies
PubMed: 34776476
DOI: 10.2209/tdcpublication.2021-0007 -
Minerva Anestesiologica May 2002Pulmonary gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. This results in decreased oxygenation of blood. Major causes are... (Review)
Review
Pulmonary gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. This results in decreased oxygenation of blood. Major causes are collapse of lung tissue (atelectasis) and airway closure. Collapsed lung tissue is present in 90% of all subjects, both during spontaneous breathing and after muscle paralysis, and whether intravenous or inhalational anaesthetics are used. Airway closure is also common and increases in magnitude with increasing age of the patient. There are correlation between the amount of atelectasis and pulmonary shunt and between airway closure and perfusion of poorly ventilated lung regions (low VA/Q). Atelectasis and airway closure explain as much as 74% of gas exchange impairment in routine anaesthesia. A major cause of atelectasis is the pre-oxygenation during induction of anaesthesia. Lowering the inspired O2 concentration to 80% suffices to avoid almost all atelectasis. Airway closure and low VA/Q can only be prevented by raising the FRC level by PEEP or by other means.
Topics: Airway Obstruction; Anesthesia; Humans; Pulmonary Atelectasis; Pulmonary Gas Exchange
PubMed: 12029240
DOI: No ID Found