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British Medical Journal Sep 1970Obstructing lesions of the trachea and larynx which cause a predominantly inspiratory obstruction can be satisfactorily diagnosed by measuring both F.I.V.(1) and...
Obstructing lesions of the trachea and larynx which cause a predominantly inspiratory obstruction can be satisfactorily diagnosed by measuring both F.I.V.(1) and F.E.V.(1). Chronic airways obstruction involving intrathoracic airways produces a much lower F.E.V.(1)/F.I.V.(1) percentage than normal, whereas obstruction to larynx and trachea causes a raised F.E.V.(1)/F.I.V.(1) percentage. If flow-volume measurements are not available the F.E.V.(1)/F.I.V.(1) percentage should provide a simple and useful method for diagnosis of upper airways obstruction.In one of the patients reported a predominantly inspiratory obstruction caused CO(2) retention. In patients with airways obstruction the correlation between Pco(2) and F.I.V.(1) was found to be the same as between Pco(2) and F.E.V.(1). This suggests that respiratory failure can be caused by either inspiratory or expiratory airways obstruction and that neither is of greater importance in producing CO(2) retention.
Topics: Adult; Airway Resistance; Carbon Dioxide; Diagnosis, Differential; Female; Humans; Laryngeal Diseases; Male; Respiratory Insufficiency; Spirometry; Tracheal Diseases
PubMed: 5470115
DOI: 10.1136/bmj.3.5724.682 -
American Journal of Respiratory and... Apr 2012Obstructive sleep apnea in infants has a distinctive pathophysiology, natural history, and treatment compared with that of older children and adults. Infants have both... (Comparative Study)
Comparative Study Review
Obstructive sleep apnea in infants has a distinctive pathophysiology, natural history, and treatment compared with that of older children and adults. Infants have both anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities; including a superiorly placed larynx, increased chest wall compliance, ventilation-perfusion mismatching, and ventilatory control instability. Congenital abnormalities of the airway, such as laryngomalacia, hemangiomas, pyriform aperture stenosis, choanal atresia, and laryngeal webs, may also have adverse effects on airway patency. Additional exacerbating factors predisposing infants toward airway collapse include neck flexion, airway secretions, gastroesophageal reflux, and sleep deprivation. Obstructive sleep apnea in infants has been associated with failure to thrive, behavioral deficits, and sudden infant death. The proper interpretation of infant polysomnography requires an understanding of normative data related to gestation and postconceptual age for apnea, arousal, and oxygenation. Direct visualization of the upper airway is an important diagnostic modality in infants with obstructive apnea. Treatment options for infant obstructive sleep apnea are predicated on the underlying etiology, including supraglottoplasty for severe laryngomalacia, mandibular distraction for micrognathia, tonsillectomy and/or adenoidectomy, choanal atresia repair, and/or treatment of gastroesophageal reflux.
Topics: Adenoids; Adult; Age Factors; Combined Modality Therapy; Craniofacial Abnormalities; Female; Follow-Up Studies; Humans; Hypertrophy; Incidence; Infant; Laryngomalacia; Larynx; Male; Micrognathism; Palatine Tonsil; Polysomnography; Risk Assessment; Severity of Illness Index; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 22135346
DOI: 10.1164/rccm.201108-1455CI -
Frontiers in Physiology 2019Dynamic obstructions of the larynx are a set of disorders that occur during exercise in equines and humans. There are a number of similarities in presentation,...
Dynamic obstructions of the larynx are a set of disorders that occur during exercise in equines and humans. There are a number of similarities in presentation, diagnosis, pathophysiology and treatment. Both equines and humans present with exercise intolerance secondary to dyspnea. During laryngoscopy at rest, the larynx appears to function normally. Abnormalities are only revealed during laryngoscopy at exercise, seemingly triggered by increased ventilatory demands, and quickly resolve after cessation of exercise. Lower airway disease (asthma being the most prevalent condition), cardiac disease and lack of fitness are the major differentials in both species. Laryngoscopic examination during exercise should be performed from rest to peak exertion to allow for a comprehensive diagnosis, including where the airway collapse begins, and thereafter how it progresses. Dynamic disorders with most visual similarity between humans and equines are: aryepiglottic fold collapse (both species); equine dynamic laryngeal collapse (DLC) relative to some forms of human combined supraglottic/glottic collapse; and epiglottic retroversion (both species). Quantitative grading techniques, such as airway pressure measurement, that have proven effective in veterinary research are currently being piloted in human studies. Conditions that appear visually similar are treated in comparable ways. The similarities of anatomy and certain types of dynamic collapse would suggest that the equine larynx provides a good model for human upper respiratory tract obstruction during exercise. Thus, close collaboration between veterinarians and medical personal may lead to further advancements in understanding pathophysiologic processes, and enhance the development of improved diagnostic tests and treatments that will benefit both species.
PubMed: 31736771
DOI: 10.3389/fphys.2019.01333 -
Anesthesiology Apr 2017Since cricoid pressure was introduced into clinical practice, controversial issues have arisen, including necessity, effectiveness in preventing aspiration, quantifying... (Review)
Review
Since cricoid pressure was introduced into clinical practice, controversial issues have arisen, including necessity, effectiveness in preventing aspiration, quantifying the cricoid force, and its reliability in certain clinical entities and in the presence of gastric tubes. Cricoid pressure-associated complications have also been alleged, such as airway obstruction leading to interference with manual ventilation, laryngeal visualization, tracheal intubation, placement of supraglottic devices, and relaxation of the lower esophageal sphincter. This review synthesizes available information to identify, address, and attempt to resolve the controversies related to cricoid pressure. The effective use of cricoid pressure requires that the applied force is sufficient to occlude the esophageal entrance while avoiding airway-related complications. Most of these complications are caused by excessive or inadequate force or by misapplication of cricoid pressure. Because a simple-to-use and reliable cricoid pressure device is not commercially available, regular training of personnel, using technology-enhanced cricoid pressure simulation, is required. The current status of cricoid pressure and objectives for future cricoid pressure-related research are also discussed.
Topics: Airway Obstruction; Cricoid Cartilage; Humans; Intubation, Intratracheal; Pneumonia, Aspiration; Pressure; Reproducibility of Results
PubMed: 28045709
DOI: 10.1097/ALN.0000000000001489 -
Respirology (Carlton, Vic.) Jul 2023Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal... (Review)
Review
Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO), is a common condition characterized by breathlessness associated with inappropriate laryngeal narrowing. Important questions remain unresolved, and to improve collaboration and harmonization in the field, we convened an international Roundtable conference on VCD/ILO in Melbourne, Australia. The aims were to delineate a consistent approach to VCD/ILO diagnosis, appraise disease pathogenesis, outline current management and model(s) of care and identify key research questions. This report summarizes discussions, frames key questions and details recommendations. Participants discussed clinical, research and conceptual advances in the context of recent evidence. The condition presents in a heterogenous manner, and diagnosis is often delayed. Definitive diagnosis of VCD/ILO conventionally utilizes laryngoscopy demonstrating inspiratory vocal fold narrowing >50%. Computed tomography of the larynx is a new technology with potential for swift diagnosis that requires validation in clinical pathways. Disease pathogenesis and multimorbidity interactions are complex reflecting a multi-factorial, complex condition, with no single overarching disease mechanism. Currently there is no evidence-based standard of care since randomized trials for treatment are non-existent. Recent multidisciplinary models of care need to be clearly articulated and prospectively investigated. Patient impact and healthcare utilization can be formidable but have largely escaped inquiry and patient perspectives have not been explored. Roundtable participants expressed optimism as collective understanding of this complex condition evolves. The Melbourne VCD/ILO Roundtable 2022 identified clear priorities and future directions for this impactful condition.
Topics: Humans; Vocal Cord Dysfunction; Laryngeal Diseases; Airway Obstruction; Vocal Cords; Laryngoscopy; Diagnosis, Differential
PubMed: 37221142
DOI: 10.1111/resp.14518 -
Chemical Senses Dec 2020The larynx plays a key role in airway protection via the laryngeal chemoreflex (LCR). This involuntary reflex can be evoked when hazardous substances activate mucosal... (Review)
Review
The larynx plays a key role in airway protection via the laryngeal chemoreflex (LCR). This involuntary reflex can be evoked when hazardous substances activate mucosal receptors, which send signals to be processed within the brainstem. Although the LCR is meant to be protective, the reflex can become hyperstimulated, even to benign stimuli, which can result in pathological disorders, such as chronic cough and inducible laryngeal obstruction. In this review, we will outline the mechanism of the LCR and its associated pathological disorders.
Topics: Airway Obstruction; Animals; Apnea; Brain Stem; Chemoreceptor Cells; Cough; Humans; Laryngeal Nerves; Larynx; Reflex; Respiration Disorders
PubMed: 33247587
DOI: 10.1093/chemse/bjaa069 -
Forensic Science, Medicine, and... Dec 2022An 86-year-old woman with Alzheimer disease collapsed in her nursing home and was not able to be resuscitated. At autopsy, the major findings were in the larynx where a...
An 86-year-old woman with Alzheimer disease collapsed in her nursing home and was not able to be resuscitated. At autopsy, the major findings were in the larynx where a pedunculated oncocytic cystadenoma had occluded the glottis. Oncocytic cysts or cystadenomas of the larynx are rare histologically benign lesions that account for only 0.1-1% of laryngeal lesions. While the usual presentation is of a sensation of a mass in the throat, hoarseness, or stridor, very occasionally, there may be acute airway compromise and sudden death. Oncocytic cystadenoma should, therefore, be included in the differential diagnosis of potentially lethal obstructive laryngeal lesions.
Topics: Humans; Female; Aged, 80 and over; Laryngeal Neoplasms; Larynx; Cystadenoma; Glottis; Death, Sudden; Laryngeal Diseases
PubMed: 36136290
DOI: 10.1007/s12024-022-00530-0 -
Critical Care Clinics Jul 2000Airway management in the pediatric patient requires an understanding and knowledge of the differences and characteristics unique to the child and infant. New and... (Review)
Review
Airway management in the pediatric patient requires an understanding and knowledge of the differences and characteristics unique to the child and infant. New and exciting techniques are currently being explored and developed for management of the pediatric airway. Technology in the area of imaging has allowed clinicians to better visualize the airway and aberrations of it. Presently, there are many different modes and routes of ventilation and oxygenation that are being applied to the pediatric patient for different disease states. Work continues to probe for methods and ways that will allow us to take care of infants and children better and to provide the safest and most effective means of delivering that care. No doubt, there will be more advances and exciting ideas to come that lead to better management of the pediatric airway.
Topics: Age Factors; Airway Obstruction; Algorithms; Body Weight; Burns, Inhalation; Child; Child, Preschool; Croup; Decision Trees; Epiglottitis; Equipment Design; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Laryngeal Masks; Pediatrics; Radiography; Resuscitation
PubMed: 10941587
DOI: 10.1016/s0749-0704(05)70126-3 -
Anesthesiology Jan 2016There is a lack of evidence-based approach regarding the best practice for airway management in patients with a traumatized airway. General recommendations for the... (Review)
Review
There is a lack of evidence-based approach regarding the best practice for airway management in patients with a traumatized airway. General recommendations for the management of the traumatized airway are summarized in table 5. Airway trauma may not be readily apparent, and its evaluation requires a high level of suspicion for airway disruption and compression. For patients with facial trauma, control of the airway may be significantly impacted by edema, bleeding, inability to clear secretions, loss of bony support, and difficulty with face mask ventilation. With the airway compression from neck swelling or hematoma, intubation attempts can further compromise the airway due to expanding hematoma. For patients with airway disruption, the goal is to pass the tube across the injured area without disrupting it or to insert the airway distal to the injury using a surgical approach. If airway injury is extensive, a surgical airway distal to the site of injury may be the best initial approach. Alternatively, if orotracheal intubation is chosen, spontaneous ventilation may be maintained or RSI may be performed. RSI is a common approach. Thus, some of the patients intubated may subsequently require tracheostomy. A stable patient with limited injuries may not require intubation but should be watched carefully for at least several hours. Because of a paucity of evidence-based data, the choice between these approaches and the techniques utilized is a clinical decision depending on the patient's condition, clinical setting, injuries to airway and other organs, and available personnel, expertise, and equipment. Inability to obtain a definitive airway is always an absolute indication for an emergency cricothyroidotomy or surgical tracheostomy.
Topics: Airway Management; Airway Obstruction; Emergency Service, Hospital; Humans; Larynx; Maxillofacial Injuries; Neck Injuries
PubMed: 26517857
DOI: 10.1097/ALN.0000000000000903 -
BMJ Case Reports Aug 2021We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise....
We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise. She had no preceding illness or other objective signs/symptoms on presentation, had a history of Chronic Obstructive Pulmonary Disease (COPD) and a previous opioid addiction. Following failed endotracheal intubation, the airway was secured with an emergency surgical tracheostomy. Subsequent direct laryngoscopy revealed a severely diseased glottis and supraglottic area, from which biopsy samples revealed a multiple drug-resistant strain of requiring specialist microbiology input and antifungal treatment. We describe the presentation, investigation, management and outcome of this rare case, along with a literature review of the subject.
Topics: Adult; Airway Obstruction; Candidiasis; Female; Humans; Intubation, Intratracheal; Laryngoscopy; Larynx; Tracheostomy
PubMed: 34353829
DOI: 10.1136/bcr-2021-242910