Mouth and nose resistance in newborn kittens and puppies

1981 ◽  
Vol 51 (3) ◽  
pp. 641-645 ◽  
Author(s):  
J. P. Mortola ◽  
J. T. Fisher
Keyword(s):  
Mechanical Properties ◽  
Airway Obstruction ◽  
Flow Rate ◽  
Muscle Tone ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Upper Airways ◽  
Airway Patency ◽  
The Difference ◽  
Adult Cats

Newborn mammals, including infants, have difficulties in mouth breathing when the nasal passages are occluded. In this study we examined the possibility that differences in the passive mechanical properties of the upper airways could fully explain this behavior. Steady inspiratory flows through the upper airways in anesthetized supine newborn kittens and puppies resulted in upper airway obstruction, even at flows less than those occurring during resting breathing, suggesting that in the unanesthetized condition muscle tone plays an important role in maintaining upper airway patency. Mouth (Rm) and nose (Rn) resistances have been measured during steady expiratory flows with nostrils closed and mouth passively open or nostrils open and mouth closed. In all the newborns, Rn was substantially smaller than Rm. In contrast, the Rn/Rm in adult dogs is greater than unity. In adult cats Rn/Rm is above or below unity depending upon the flow rate, but the ratio is always larger than in newborn kittens. The difference between newborns and adults is entirely due to the small Rn of the newborn, as Rm is not greater in the newborn than in the adult. We conclude that the obligatory nose breathing behavior of newborns is not fully explained by the passive mechanical properties of the upper airways.

Upper airway obstruction induced by negative-pressure ventilation in awake healthy subjects

1993 ◽  
Vol 75 (2) ◽  
pp. 546-552 ◽  
Author(s):  
A. Sanna ◽  
C. Veriter ◽  
D. Stanescu
Keyword(s):  
Airway Obstruction ◽  
Negative Pressure ◽  
Healthy Subjects ◽  
Fiber Optic ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Bipolar Electrode ◽  
Upper Airways ◽  
Negative Pressure Ventilation ◽  
Zero Values

Negative-pressure ventilation (NPV) induces sleep-related upper airway obstruction. However, the precise mechanism and site of upper airway obstruction during NPV have not been worked out. We studied seven awake healthy volunteers (23–30 yr old) in an Emerson tank respirator. Subjects had the head outside the iron lung and breathed through a pneumotachograph, which yielded the airflow (V) signal. Supraglottic pressure (Psg) was measured with a catheter with the tip at the retroepiglottic level. Diaphragmatic electromyograms (EMGdi) were obtained from an esophageal bipolar electrode. Tidal volume was measured with an inductance plethysmograph. Measurements were done at -10, -20, and -30 cmH2O. At each pressure run subjects were asked to repeatedly relax or to actively breathe in phase with the respirator. Subjects had been previously trained to relax during NPV. During the relax runs there was no EMGdi activity. Stridor or wheezing occurred in all seven subjects during the relax runs but not during the active runs. Two patterns were associated with NPV during relax runs. One pattern was decreases in both V and Psg followed by zero values of these indexes, which corresponded to an inspiratory narrowing and closure of the glottis. These changes were visualized by fiber-optic bronchoscopy in one subject. The second pattern was a decrease in V and increase in Psg, which corresponded to an inspiratory supraglottic obstruction. In five subjects a supraglottic pattern was observed, whereas in two subjects glottic closure was seen. We conclude that muscular relaxation during NPV produces a decrease in the caliber of the upper airways at the glottic or supraglottic level. An uncoupling of upper airway muscle activity and the diaphragm might be the mechanism responsible for these changes.

scholarly journals Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Macario Camacho ◽  
Justin M. Wei ◽  
Lauren K. Reckley ◽  
Sungjin A. Song
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Nasal Surgery ◽  
Upper Airways ◽  
Obstructive Sleep

Objectives. During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place. Materials and Methods. The authors describe techniques (Double Barrel Technique and Modified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep apnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients). Results. The technique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps prevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when there are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen desaturations. Conclusions. The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to upper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified Double Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal splints in place.

Neuromechanical control of upper airway patency during sleep

2007 ◽  
Vol 102 (2) ◽  
pp. 547-556 ◽  
Author(s):  
Susheel P. Patil ◽  
Hartmut Schneider ◽  
Jason J. Marx ◽  
Elizabeth Gladmon ◽  
Alan R. Schwartz ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Critical Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Dynamic Responses ◽  
Airway Patency ◽  
Mechanical Loads ◽  
Obstructive Sleep

Obstructive sleep apnea is caused by pharyngeal occlusion due to alterations in upper airway mechanical properties and/or disturbances in neuromuscular control. The objective of the study was to determine the relative contribution of mechanical loads and dynamic neuromuscular responses to pharyngeal collapse during sleep. Sixteen obstructive sleep apnea patients and sixteen normal subjects were matched on age, sex, and body mass index. Pharyngeal collapsibility, defined by the critical pressure, was measured during sleep. The critical pressure was partitioned between its passive mechanical properties (passive critical pressure) and active dynamic responses to upper airway obstruction (active critical pressure). Compared with normal subjects, sleep apnea patients demonstrated elevated mechanical loads as demonstrated by higher passive critical pressures [−0.05 (SD 2.4) vs. −4.5 cmH2O (SD 3.0), P = 0.0003]. Dynamic responses were depressed in sleep apnea patients, as suggested by failure to lower their active critical pressures [−1.6 (SD 3.5) vs. −11.1 cmH2O (SD 5.3), P < 0.0001] in response to upper airway obstruction. Moreover, elevated mechanical loads placed some normal individuals at risk for sleep apnea. In this subset, dynamic responses to upper airway obstruction compensated for mechanical loads and maintained airway patency by lowering the active critical pressure. The present study suggests that increased mechanical loads and blunted neuromuscular responses are both required for the development of obstructive sleep apnea.

scholarly journals Nasopharyngeal Tuberculosis in a Patient Presenting With Upper Airway Obstruction

2010 ◽  
Vol 25 (1) ◽  
pp. 20-22
Author(s):  
Cristina S. Nieves ◽  
Rubiliza D. Onofre ◽  
Fortuna Corazon A. Aberin-Roldan ◽  
Rene Louie C. Gutierrez
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Rare Case ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Government Hospital ◽  
Keywords Tuberculosis ◽  
Design Case ◽  
The Difference ◽  
Nasopharyngeal Masses

Objective:  To report a rare case of upper airway obstruction from multiple pharyngeal masses due to nasopharyngeal tuberculosis in a 22-year-old male. Methods: Design:  Case Report Setting:  Tertiary Government Hospital Patient:  One   Result: A 22-year-old Filipino male with upper airway obstruction from multiple pharyngeal masses was diagnosed to have nasopharyngeal tuberculosis by histopathology. He improved after six months of anti-tuberculosis medications. Conclusion: Tuberculosis should not be overlooked in the differential diagnoses of nasopharyngeal masses because of the difference in its management, and swift and adequate cure, compared to other nasopharyngeal pathologies. Keywords:  tuberculosis, nasopharynx, mycobacteria, hypopharyngeal mass, upper airway obstruction

scholarly journals Unusual presentation of ectopic thyroid causing respiratory distress

2020 ◽  
Vol 6 (6) ◽  
pp. 1188
Author(s):  
Sunil Kathuria ◽  
Chikku Sunny
Keyword(s):  
Airway Obstruction ◽  
English Literature ◽  
Thyroid Tissue ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Ectopic Thyroid ◽  
Respiratory Obstruction ◽  
Upper Airways ◽  
Ectopic Thyroid Tissue ◽  
Foreign Body Inhalation

<p>Internal obstruction of the upper airways can be due to infection, anaphylactic reaction, congenital anomaly, foreign body inhalation or mass. The endoluminal presence of thyroid tissue in the trachea is a rare cause of airway obstruction. Only 14 well documented cases of intratracheal ectopic thyroid tissue have been reported in English literature since 1966. These lesions are mostly benign and nearly all patient present with symptoms of respiratory obstruction. This case report is of a lady who presented with upper airway obstruction due to subglottic ectopic thyroid tissue. An ectopic thyroid gland can develop if its normal migration is halted along this tract during embryogenesis. Subglottic location of ectopic thyroid is extremely rare. However, ectopic thyroid tissue in the larynx should be considered as a possible diagnosis causing upper airway obstruction.</p>

scholarly journals Coexistence of Upper Airway Obstruction and Primary and Secondary Enuresis Nocturna in Children and the Effect of Surgical Treatment for the Resolution of Enuresis Nocturna

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Gül Soylu Özler ◽  
Serkan Özler
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Strong Relationship ◽  
Upper Airway Obstruction ◽  
Etiologic Factor ◽  
Enuresis Nocturna ◽  
Improvement Rate ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Objective.The aim of this study is to investigate the coexistence of upper airway obstruction (UAO) and primary enuresis nocturna (PEN) and secondary enuresis nocturna (SEN) in children. Besides, the efficacy of surgery on resolution of enuresis nocturna is evaluated.Materials and Methods.The children with PEN and SEN were included in the first group and investigated for UAO in the Department of Otorhinolaryngology. During the same period, children who had been planned for an operation to treat UAO over 5 years old were included in the second group and were evaluated in the Department of Urology for PEN and SEN before the operation.Results.A hundred patients completed the study (50 patients in Group 1, 50 patients in Group 2). According to the otolaryngologic examination, 20 of 25 PEN patients and 9 of 25 SEN patients also had UAO. The difference was statistically different (P<0.05). The second group consisted of fifty patients on the surgery list for upper airway obstructive pathologies. Coexistence of PEN and SEN is found in 12 and 3 of children, respectively. These ratios were statistically significant (P<0.05). The improvement rate of PEN and SEN after operation in the second group was 83.3% and 33.3%, respectively. The difference was statistically significant (P<0.05).Conclusion.There is a strong relationship between PEN and UAO, but it cannot be declared for SEN patients. UAO should be kept in mind as a possible etiologic factor for PEN.

scholarly journals Lingual Hematoma: A Rare Cause of Upper Airway Obstruction

2015 ◽  
Vol 6 (1) ◽  
pp. 41-44
Author(s):  
Eurico Costa ◽  
Hugo Estibeiro ◽  
Miguel Magalhães
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Lymphoblastic Leukemia ◽  
Upper Airway ◽  
Lower Gastrointestinal Bleeding ◽  
Upper Airway Obstruction ◽  
Airway Patency ◽  
Cytomegalovirus Colitis ◽  
Head Neck ◽  
Therapy Intervention

ABSTRACT Introduction The authors present a case report of a patient with a lingual hematoma treated in the otolaryngology department of portuguese institute of oncology, lisbon, followed by a brief literature review. Case report A case of a 43 years old female with a diagnosis of acute lymphoblastic leukemia since 2007, submitted to allograft bone marrow transplantation in 2008 at the Portuguese Oncology Institute, Lisbon. With diagnosis of recurrence since May 2011, she was hospitalized in october 2011, due to a lower gastrointestinal bleeding in the context of a cytomegalovirus colitis associated with pancytopenia. During hospitalization, the patient experienced a tonicclonic seizure. less than 12 hours after this episode, the patient developed a massive lingual hematoma. Despite exuberant macroglossia and tongue proptosis, the patient showed no signs of active bleeding or severe dyspnea and was submitted to conservative medical treatment. Discussion Lingual hematoma has many causes, being trauma and hemorrhagic dyscrasias among the most frequent. The first therapeutic objective should be evaluated and gua ranted upper airway patency. once the airway is secured, hemorrhage and hematoma should be treated according to its etiology. This can be achieved with conservative medical therapy, intervention radiology or surgery. Conclusion Lingual hematoma is as rare as potentially fatal. prompt recognition and management is critical for a favorable outcome. How to cite this article Costa E, Estibeiro H, Magalhães M. Lingual Hematoma: A Rare Cause of Upper Airway Obstruction. Int J Head Neck Surg 2015;6(1):41-44.

Assessment of upper airway obstruction by measuring peak oral and nasal inspiratory flow

2015 ◽  
Vol 129 (5) ◽  
pp. 473-477 ◽  
Author(s):  
S Bathala ◽  
R Eccles
Keyword(s):  
Airway Obstruction ◽  
Phase Ii ◽  
Flow Rate ◽  
Upper Airway ◽  
Inspiratory Flow ◽  
Upper Airway Obstruction ◽  
University Hospital ◽  
Inspiratory Flow Rate ◽  
Efficacy Measures ◽  
Study Participants

AbstractObjective:We wanted to access upper airway obstruction in patients undergoing tonsillectomy by measuring peak oral and nasal inspiratory airflow.Methods:We recruited study participants from a cohort of patients on the waiting list for tonsillectomy, with or without adenoidectomy, at University Hospital of Wales, Cardiff, UK. Fifty patients enrolled on phase I of the study and underwent pre-operative measurement of the rate of peak oral and nasal inspiratory flow; 25 of these patients returned after one month for phase II of the study and underwent post-operative measurement of the rate of both peak oral and nasal inspiratory flow.Results:Of the 25 participants who completed phase II of the study, 17 (68 per cent) showed an increase in post-operative peak oral inspiratory flow rate by an average of 45 per cent, while 18 (72 per cent) showed an increase in post-operative peak nasal inspiratory flow rate by an average of 22 per cent.Conclusion:Both peak oral and nasal inspiratory flow rate measurements may be useful measures of oral and nasal obstruction. Further larger studies are needed to develop these measurements as screening and efficacy measures for adenotonsillectomy to relieve upper airway obstruction.

scholarly journals Transtracheal flow-regulated oxygen insufflation—a simple and safe method for prolonging safe apnoea time in difficult airway management: A report of two cases

2019 ◽  
Vol 47 (6) ◽  
pp. 553-560
Author(s):  
Sivan Wexler ◽  
Stavros N Prineas ◽  
Timothy A Suharto
Keyword(s):  
Airway Management ◽  
Airway Obstruction ◽  
Difficult Airway ◽  
Oxygen Delivery ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Difficult Airway Management ◽  
Airway Patency ◽  
Safe Method ◽  
Apnoeic Oxygenation

In the absence of upper airway patency, supraglottic methods of oxygen delivery become ineffective. We present two semi-elective difficult airway cases where oxygenation via the supraglottic route was deemed impractical due to upper airway obstruction. In order to facilitate safe airway management, apnoeic oxygenation was delivered via a narrow bore transtracheal cannula using a flow-regulated oxygen insufflator. The potential for safely prolonging apnoea time with this technique in both elective and emergency settings is discussed.

ID: 127: DECREASED CPAP ADHERENCE IN NON-OBESE OSA PATIENTS WITH REVERSIBLE UPPER AIRWAY OBSTRUCTION

2016 ◽  
Vol 64 (4) ◽  
pp. 970.1-970
Author(s):  
J Doumit ◽  
P Belvitch ◽  
I Rubinstein
Keyword(s):  
Airway Obstruction ◽  
Airway Resistance ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Beta Agonist ◽  
Upper Airways ◽  
Short Acting ◽  
Cpap Adherence ◽  
Upper Airway Resistance ◽  
Airways Obstruction

RationaleUpper airway resistance is critical to the pathophysiology of obstructive sleep apnea (OSA). We have previously characterized a subset of patients with OSA who have evidence of reversible upper airways resistance as measured by spirometry. Specifically, these patients have an increased FEF50/FIF50 ratio which decreases with administration of a short acting bronchodilator. On average these patients had a lower BMI (average 27) compared to OSA patients as a whole suggesting the possibility of unique upper airway pathophysiology among this group. In the current study, we identify additional patients with OSA who have reversible upper airways obstruction on spirometry and characterize their compliance with CPAP therapy as compared to a traditional OSA population.MethodsWe retrospectively evaluated patients who had a sleep screen suggestive of OSA in the last 2 years. Patients who also had spirometry in the previous 5 years were identified for further analysis. Those patients with either normal spirometry or fixed obstructive defects who had a decrease in the FEF50/FIF50 ratio after administration of a short acting inhaled beta agonist (albuterol) were then characterized. We then measured objective CPAP adherence using data downloaded from the positive airway pressure device with adherence defined as CPAP use >4 hrs more than 70% of nights over a 30 day period.ResultsWe identified 70 patients with positive sleep screens who also had spirometry demonstrating normal of fixed lower expiratory obstruction with evidence of upper airways obstruction as demonstrated by a decreased FEF50/FIF50 ratio. Of these, 45 had a decrease in the FEF50/FIF50 ratio of more than 20% following administration of inhaled albuterol. Overall, CPAP adherence between those with reversible upper airways obstruction and those without was similar (23/45=51% vs 14/26=54%). However, subgroup analysis revealed a lower adherence rate among non-obese patients (BMI<30) with reversible airways obstruction (6/16=36%).ConclusionThe identification of a subset of patients with OSA who have evidence of decreased upper airway resistance in response to inhaled bronchodilator suggests unique pathology in this group. Decreased adherence to traditional OSA therapy with CPAP among these patients is additional evidence of differential pathophysiology requiring novel treatments. Specifically, treatment with a long acting beta agonist (LABA) prior to sleep may reduce upper airway obstruction and be better tolerated than CPAP.

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