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Annals of the American Thoracic Society Nov 2018Autopsy studies in fatal asthma have clearly documented the central role of airway plugging with pathologic mucus in the pathophysiology of death from asthma, but the... (Review)
Review
Autopsy studies in fatal asthma have clearly documented the central role of airway plugging with pathologic mucus in the pathophysiology of death from asthma, but the role of mucus plugs in chronic severe asthma has been less well understood. Recently, multidetector computerized tomography imaging of the lungs has emerged as a valuable method to visualize mucus plugs in asthma. These multidetector computerized tomography data have revealed mucus plugs as a common occurrence in severe forms of asthma. In addition, an image-based mucus plug scoring system shows that mucus plugs are strongly associated with measures of airflow obstruction and with biomarkers of type 2 cytokine and eosinophilic inflammation. These data provide a rationale for treating airflow obstruction in severe asthma with mucolytics, and they also raise the possibility that treatments that target type 2 inflammation may decrease mucus plugs in asthma.
Topics: Airway Obstruction; Asthma; Autopsy; Cytokines; Eosinophils; Humans; Mucus; Multidetector Computed Tomography
PubMed: 30431352
DOI: 10.1513/AnnalsATS.201807-485AW -
Respiratory Medicine Dec 2022Subjects with obesity show an increased prevalence of airway obstruction but it is not clear in each case whether this reflects genuine lung disease. Via intentional...
BACKGROUND
Subjects with obesity show an increased prevalence of airway obstruction but it is not clear in each case whether this reflects genuine lung disease. Via intentional increase in end-expiratory lung volume we studied the detection of obesity-induced airway obstruction in lung-healthy obese subjects.
METHODS
The primary study population comprised 66 lung-healthy obese subjects and 23 normal weight subjects. Measurements were performed in a body plethysmograph allowing for recording and quantification of breathing loops in terms of specific airway resistance at both normal and intentionally elevated end-expiratory lung volume. The change in volume was documented by a shutter maneuver.
RESULTS
The voluntary increase of lung volume led to a significant reduction of expiratory airway resistance in 11 of the 66 obese subjects. This reduction could be quantified by a change of total expiratory resistance (sRtEX) of >1 kPa*s but was also clearly visible in the breathing loops. sRtEX showed the largest change among all resistance parameters. The loops of normal weight subjects remained virtually unaffected by the change in lung volume. Moreover, those of 5 obese patients with COPD who were measured for comparison partially showed a reduction of resistance but airway obstruction remained.
CONCLUSION
The proposed breathing maneuver was simple to perform and allowed for a quantitative and qualitative detection of obesity-induced airway obstruction. This might help in reducing the likelihood of misdiagnosis and overtreatment of obese patients.
Topics: Humans; Lung; Airway Resistance; Airway Obstruction; Respiratory Function Tests; Obesity
PubMed: 36399895
DOI: 10.1016/j.rmed.2022.107025 -
BMJ Case Reports Mar 2015Dwarfism is defined as a failure to attain a height of 148 cm in adulthood. Achondroplasia is the most common form of short-limbed dwarfism. Although this condition is... (Review)
Review
Dwarfism is defined as a failure to attain a height of 148 cm in adulthood. Achondroplasia is the most common form of short-limbed dwarfism. Although this condition is relatively rare, with an incidence of 0.5-1.5 per 10,000 live births, most medical professionals will come across the achondroplastic dwarf (AD) during their career. Faulty endochondral ossification produces the characteristic short stature phenotype, as well as severe craniofacial, central nervous system, spinal, respiratory and cardiac anomalies. These unusual characteristics may present airway management difficulties in elective as well as emergency situations. Within the literature there is very little information regarding the emergency insertion of a surgical airway in an adult AD. We present our experience of this situation in the form of a case report and a review of the relevant literature.
Topics: Achondroplasia; Aged; Airway Obstruction; Female; Humans; Neck; Trachea; Tracheostomy
PubMed: 25827920
DOI: 10.1136/bcr-2015-209614 -
Jornal de Pediatria 2023Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods.
METHODS
Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) - group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05).
RESULTS
130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05).
CONCLUSION
Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.
Topics: Female; Humans; Infant; Airway Obstruction; Breast Feeding; Feeding Behavior; Feeding Methods; Gagging; Infant Food; Infant Nutritional Physiological Phenomena; Weaning; Infant, Newborn
PubMed: 37400061
DOI: 10.1016/j.jped.2023.05.011 -
Interactive Cardiovascular and Thoracic... Jun 2022In patients with extrinsic tracheal stenosis caused by a mediastinal mass, an airway stent is a palliative measure to relieve airway obstruction. However, the...
In patients with extrinsic tracheal stenosis caused by a mediastinal mass, an airway stent is a palliative measure to relieve airway obstruction. However, the self-expanding force of the stent may be insufficient to force a rigid stenosis. Our goal was to report a simple strategy to indirectly estimate the rigidity of the stenosis and predict airway patency after inserting the stent. Before the procedure, the inspiratory and expiratory flows and their ratio were evaluated under spontaneous breathing and after positive pressure ventilation generated by a facial mask. In patients with stenosis successfully treated with a stent (n = 11), we found significant changes in expiratory (2.3 ± 0.7 vs 2.8 ± 0.7; p = 0.03) and inspiratory (1.5 ± 0.6 vs 2.5 ± 0.9; p = 0.001) flows and a reduction of their ratio (1.4 ± 0.3 vs 1.1 ± 0.2; p = 0.01) whereas no significant changes were observed in patients (n = 2) whose stent failed to force the stenosis. In these cases, a tracheostomy was performed to assure ventilation. Our simple strategy may help physicians predict airway patency after stenting or plan alternative treatments in patients with rigid stenosis difficult to force by stenting.
Topics: Airway Obstruction; Constriction, Pathologic; Humans; Positive-Pressure Respiration; Stents; Tracheal Stenosis
PubMed: 35237813
DOI: 10.1093/icvts/ivac044 -
British Journal of Anaesthesia Jul 2020During induction of general anaesthesia, patients frequently experience apnoea, which can lead to dangerous hypoxaemia. An obstructed upper airway can impede attempts to...
BACKGROUND
During induction of general anaesthesia, patients frequently experience apnoea, which can lead to dangerous hypoxaemia. An obstructed upper airway can impede attempts to provide ventilation. Although unrelieved apnoea is rare, it continues to cause deaths. Clinical investigation of management strategies for such scenarios is effectively impossible because of ethical and practical considerations.
METHODS
A population-representative cohort of 100 virtual (in silico) subjects was configured using a high-fidelity computational model of the pulmonary and cardiovascular systems. Each subject breathed 100% oxygen for 3 min and then became apnoeic, with an obstructed upper airway, during induction of general anaesthesia. Apnoea continued throughout the protocol. When arterial oxygen saturation (Sao) reached 20%, 40%, or 60%, airway obstruction was relieved. We examined the effect of varying supraglottic oxygen fraction (Fo) on the degree of passive re-oxygenation occurring without tidal ventilation.
RESULTS
Relief of airway obstruction during apnoea produced a single, passive inhalation (caused by intrathoracic hypobaric pressure) in all cases. The degree of re-oxygenation after airway opening was markedly influenced by the supraglottic Fo, with a supraglottic Fo of 100% providing significant and sustained re-oxygenation (post-rescue Pao 42.3 [4.4] kPa, when the airway rescue occurred after desaturation to Sao 60%).
CONCLUSIONS
Supraglottic oxygen supplementation before relieving upper airway obstruction improves the effectiveness of simulated airway rescue. Management strategies should be implemented to assure a substantially increased pharyngeal Fo during difficult airway management.
Topics: Airway Management; Airway Obstruction; Apnea; Computer Simulation; Humans; Models, Theoretical; Oxygen Inhalation Therapy; Respiration; Simulation Training
PubMed: 32008701
DOI: 10.1016/j.bja.2020.01.004 -
Critical Care (London, England) 2007Intubation of the airway can lead to laryngotracheal injury, resulting in extubation failure from upper airway obstruction (UAO). A number of factors can help to...
Intubation of the airway can lead to laryngotracheal injury, resulting in extubation failure from upper airway obstruction (UAO). A number of factors can help to identify patients who are at greatest risk for postextubation UAO. Three randomized controlled trials demonstrate that prophylactic corticosteroids decrease the risk for postextubation UAO and probably the need for re-intubation.
Topics: Adrenal Cortex Hormones; Airway Obstruction; Anti-Inflammatory Agents; Dexamethasone; Humans; Intubation, Intratracheal; Treatment Outcome
PubMed: 17705879
DOI: 10.1186/cc5976 -
Andes Pediatrica : Revista Chilena de... Aug 2022Upper airway obstruction after extubation is a serious complication that can lead to extubation fai lure and other unfavorable outcomes in children. (Observational Study)
Observational Study
UNLABELLED
Upper airway obstruction after extubation is a serious complication that can lead to extubation fai lure and other unfavorable outcomes in children.
OBJECTIVE
to describe the incidence and risk fac tors associated with post-extubation upper airway obstruction in critically ill children.
PATIENTS AND METHOD
A prospective descriptive observational study was carried out in a pediatric intensive care unit in Argentina over two years. Patients older than 1 month and younger than 18 years, receiving mechanical ventilatory support (MV) for more than 24 hours through an endotracheal tube (ETT) and with at least one programmed extubation were included.
RESULTS
Of 260 patients, 65 (25%) de veloped post-extubation upper obstruction. Of them, 37 were females (56.9%), with a median age of 14 months and 10 kg weight. The PIM3 score was 2.8 and the most frequent reason for admission was acute lower respiratory infection in 38 (43.1%) patients, among whom 36 (55.4%) had at least one complex chronic condition. Twenty-seven (41.5%) failed extubation and 5 (7.7%) required tracheos tomy. A multiple logistic regression analysis was performed to determine the relationship between different variables with the dependent variable. Independent risk factors explaining post-extubation upper obstruction were age ≤ 24 months and MV support for ≤ 3 days.
CONCLUSION
Post-extubation upper airway obstruction is frequent in the pediatric intensive care unit. We found that infants and mechanical ventilation duration less than or equal to 3 days are independent risk factors for its pre sentation.
Topics: Infant; Female; Humans; Child; Child, Preschool; Male; Airway Extubation; Critical Illness; Respiration, Artificial; Intubation, Intratracheal; Respiratory Tract Infections; Airway Obstruction
PubMed: 37906853
DOI: 10.32641/andespediatr.v93i4.4155 -
International Journal of Pediatric... Jan 2022In patients with mandibular hypoplasia, mandibular distraction osteogenesis (MDO) aims to relieve tongue-based airway obstruction. Drug-induced sleep endoscopy (DISE)...
OBJECTIVES
In patients with mandibular hypoplasia, mandibular distraction osteogenesis (MDO) aims to relieve tongue-based airway obstruction. Drug-induced sleep endoscopy (DISE) provides a dynamic assessment of the upper airway and visualizes anatomical site and cause of airway obstruction. The aim of this study was to evaluate the effect of MDO on tongue-based airway obstruction found by DISE within a non-isolated patient population with severe upper airway obstruction (UAO). Furthermore, we aimed to assess the additional value of DISE in clinical decision making by correlating DISE findings to functional airway outcomes after MDO.
METHODS
Findings on DISE in children who underwent MDO were retrospectively gathered and evaluated. According to DISE findings, severity of tongue-based obstruction was scored using a 4-step classification similar to the one that is used by Bravo et al.. Intubation conditions were scored according to the Cormack Lehane score (CLS). Pre-and postoperative DISE findings were compared and correlated with functional airway outcomes following MDO.
RESULTS
In 19 out of 28 MDO procedures, both a pre-and postoperative DISE was available. Tongue-based obstruction scores improved in 13 procedures, which correlated to a functional improvement in seven. Postoperative tongue-based obstruction differed significantly between patients with successful MDO and patients treated unsuccessfully (2.00 ((Interquartile range (IQR) 1.00-2.00) vs. 3.00 (IQR 2.00-4.00), p = 0.028), whereas this difference was not significant for the CLS (1.00 (IQR 1.00-1.50) vs. 2.00 (IQR 1.00-4.00), p = 0.066). If no improvement of tongue-based obstruction was seen, MDO is very unlikely to be successful on the functional airway.
CONCLUSIONS
DISE provides information on the site and nature of airway obstruction and can visualize the effect of MDO on the severity of tongue-based airway obstruction. Therefore, it can be of additional value in understanding the differences in functional airway outcomes after MDO and aids in deciding appropriate and targeted treatment. Hence, standardized use of DISE, in addition to the clinical assessment of mandibular position and a polysomnography, during MDO management is highly recommended.
Topics: Airway Obstruction; Child; Decision Making; Endoscopy; Humans; Pharmaceutical Preparations; Retrospective Studies; Sleep
PubMed: 34861552
DOI: 10.1016/j.ijporl.2021.110968 -
Journal of Korean Medical Science Aug 2023Although bronchoscopic cryotherapy (BC) is a pragmatic modality for recanalization of central airway obstruction (CAO), the risk of complications, such as bleeding,... (Review)
Review
BACKGROUND
Although bronchoscopic cryotherapy (BC) is a pragmatic modality for recanalization of central airway obstruction (CAO), the risk of complications, such as bleeding, remains a concern. This study aimed to present the clinical outcomes of BC and evaluate the factors associated with its complications.
METHODS
In this retrospective study, we reviewed the medical records of patients who underwent BC for CAO at the Asan Medical Center, South Korea. Most sessions were conducted via flexible bronchoscopy under moderate sedation. A multivariate logistic regression analysis was used to identify the factors associated with the success rate and complications.
RESULTS
BC was performed in 262 sessions in 208 patients between January 2009 and December 2020. The most common cause of cryotherapy was recanalization of the endobronchial tumor related CAO (233/262, 88.9%). More than partial re-establishment of airway patency was achieved in 211 of 233 (90.6%) sessions. The success rate did not differ significantly in the multivariate logistic regression analysis. The most common complication was intrabronchial bleeding (78/233, 35.5%); however, severe bleeding occurred only in one case (0.4%). Univariate and multivariate logistic regression analyses revealed that diabetes mellitus (odds ratio [OR] = 2.820, = 0.011), respiratory failure before BC (OR = 3.546, = 0.028), and presence of distal airway atelectasis (OR = 0.417, = 0.021) were independently associated with moderate to severe intrabronchial bleeding, while the histologic type of tumor was not related to bleeding. BC for CAO caused by blood clot or foreign body was successful in most cases, and there were no complications.
CONCLUSION
BC is an efficient and relatively safe intervention for patients with CAO. Our findings suggest that diabetes, respiratory failure before BC, and the absence of distal airway atelectasis may be risk factors of moderate to severe intrabronchial bleeding.
Topics: Humans; Adult; Retrospective Studies; Cryotherapy; Bronchoscopy; Airway Obstruction; Pulmonary Atelectasis
PubMed: 37582494
DOI: 10.3346/jkms.2023.38.e244