Endobronchial Ultrasound Bronchoscope Insertion Through a Flexible Tracheostomy Tube: A Novel Approach to Perform EBUS in Patients With Closed Upper Airway

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 799A
Author(s):  
Bilal Jalil ◽  
Fuzail Ahmad Abdur Rahman ◽  
Ali Saeed
Keyword(s):  
Tracheostomy Tube ◽  
Upper Airway ◽  
Endobronchial Ultrasound ◽  
Novel Approach

17 Decannulation Following Tracheostomy in Children: A Systematic Review

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e11-e12
Author(s):  
Rahul Verma ◽  
Cora Mocanu ◽  
Jenny Shi ◽  
Michael Miller ◽  
Jackie Chiang ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Airway Obstruction ◽  
Clinical Outcomes ◽  
Tracheostomy Tube ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Evidence Based ◽  
Anatomic Site ◽  
Large Variability ◽  
Evidence Based Guidelines

Abstract Primary Subject area Respirology Background Despite the large morbidity and potential mortality associated with tracheostomy tube decannulation failure, there are currently no consensus guidelines on pediatric tracheostomy decannulation. This has led to wide practice variation that is largely based on expert option. This is the largest review of pediatric decannulation protocols. Objectives To systematically review the literature on existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes. Design/Methods Five online databases were searched for relevant studies from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Independent reviewers extracted data, including patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted, including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location and length of observation period, and clinical outcomes were also collected. Quality assessment of included studies was performed using the Newcastle-Ottawa Scale (NOS) tool. Descriptive statistical analyses were performed. Results Twenty-three studies with 1328 children were included (Figure 1). Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (37%), upper airway obstruction not at a well-defined site (13%), and need for long-term ventilation (50%). Bronchoscopy was routinely used in 96% of protocols. Tracheostomy tube modifications in the protocols included capping (83%), downsizing (57%), and fenestrations (9%). Measurements of gas exchange in the protocols included polysomnography (72%), oximetry (61%), blood gases (17%), and capnography with end-tidal CO2 (17%). After tracheostomy decannulation, children in 92% of protocols were transitioned to room air, and 38% of protocols used non-invasive ventilation. Most children (76%) were observed in hospital for 48 hours or less. Of all decannulation attempts, 79% were successful. Overall risk of bias in included studies was low. Conclusion The absence of clear evidence-based guidelines in pediatric tracheostomy decannulation has led to large variability in clinical practice. Most protocols include bronchoscopy, tube modifications, gas exchange measurements, and brief hospital admission. Polysomnography plays an integral role in assessing the majority of children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.

An Animal Model for Airway Sensory Deprivation Producing Obstructive Apnea with Postmortem Findings of Sudden Infant Death Syndrome

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 796-801
Author(s):  
Yousef K. Abu-Osba ◽  
Oommen P. Mathew ◽  
Bradley T. Thach
Keyword(s):  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Tracheostomy Tube ◽  
Upper Airway ◽  
Sudden Infant Death ◽  
Topical Anesthesia ◽  
Sudden Infant ◽  
Airway Patency ◽  
Pharyngeal Airway ◽  
Pressure Changes

A series of experiments was performed in rabbits to investigate the effects of airway sensory stimuli on upper airway patency. Pharyngeal airway closure was observed in rabbits breathing through a tracheostomy tube; pharyngeal patency was rapidly restored either by closing the tracheostomy tube, which forced the animals to resume nasal breathing, or by creating cyclical pressure changes in the nose and pharynx to stimulate respiratory tidal airflow. This airway opening effect of pressure fluctuations was eliminated by topical anesthesia of the airway mucosa, an observation suggesting that sensory stimulation from pressure change is needed for airway patency. The observation that dead animals have a patent pharyngeal airway that is resistant to collapse from negative intraluminal pressure, whereas animals breathing via a tracheostomy have a readily collapsible airway that is closed at zero transmural pressure, suggests that airway-constricting muscles close the airway when the animals breathe via the tracheostomy. Loss of electromyographic activity from airway-dilating muscles (genioglossus) was observed during tracheostomal breathing and was restored by cyclical pressure changes applied to the upper airway lumen, an observation further supporting the concept that airway reflexes responding to pressure regulate the activity of airway-dilating and airway-constricting muscles. Topical anesthesia of the upper airway mucous membrane, which eliminated these responses to pressure, was associated with an obstructed pharynegal airway and death from apparent asphyxia in either pentobarbital-anesthetized adult animals or young animals without general anesthetic. Death resulting from airway obstruction in this manner was associated with postmortem findings of sudden infant death syndrome (pulmonary edema and pleural petechiae) in the majority of animals.

Upper Airway Obstruction Due to Primary Laryngeal Blastomycosis in a Dog

2020 ◽  
Vol 56 (3) ◽  
pp. 181
Author(s):  
Laura R. Van Vertloo ◽  
Melissa R. Gettinger ◽  
Jaron H. Naiman ◽  
Joseph S. Haynes
Keyword(s):  
Airway Obstruction ◽  
Tracheostomy Tube ◽  
Upper Airway ◽  
Complete Recovery ◽  
Term Treatment ◽  
Upper Airway Obstruction ◽  
Inspiratory Stridor ◽  
Long Term Treatment ◽  
Laryngeal Disease ◽  
The Masses

ABSTRACT A 9 yr old female spayed Labrador retriever presented for progressive dyspnea. Inspiratory stridor and inspiratory and expiratory dyspnea were present, consistent with an upper airway obstruction. A laryngeal exam revealed severe thickening of the arytenoid cartilages and masses associated with the arytenoids. A tracheostomy tube was placed, and the masses were biopsied. Histopathology showed pyogranulomatous inflammation secondary to Blastomyces dermatitidis. The dog was initially treated with amphotericin B and terbinafine in the hospital until the airway obstruction resolved and the tracheostomy tube could be removed. The dog experienced complete recovery after long-term treatment with itraconazole and terbinafine. This is the first report of laryngeal obstruction secondary to primary laryngeal blastomycosis in a dog. Blastomycosis should be considered for cases of obstructive laryngeal disease, and a good outcome can be achieved with antifungal treatment.

scholarly journals Recurrent Rhinosporidiosis: Coblation Assisted Surgical Resection—A Novel Approach in Management

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Iram Khan ◽  
Shweta Gogia ◽  
Alok Agarwal ◽  
Ajay Swaroop
Keyword(s):  
Chronic Granulomatous Disease ◽  
Surgical Resection ◽  
Upper Airway ◽  
Surgical Excision ◽  
Interesting Case ◽  
Granulomatous Disease ◽  
Male Resident ◽  
Surgical Tool ◽  
Novel Approach ◽  
History Of

Recurrent rhinosporidiosis is a chronic granulomatous disease with a known tendency to reoccur. Coblation EVAC 70 is a novel surgical tool which seems to provide excellent option in management of this notorious disease. We present an interesting case and the innovative approach in its management, using Coblation system.Introduction. Rhinosporidiosis seeberi causes a chronic granulomatous disease of upper airway, usually involving the nose and nasopharynx, and has a notorious tendency to reoccur. The current line of management is surgical excision of the lesion along with cauterization of the base, which does not prevent reoccurrence of the disease.Case Presentation. A 65-year-old male resident of rural India reported a history of breathing difficulty and change in voice. Patient is a Hindu priest by profession, who according to their rituals has to take bath in local pond or river.Conclusion. Rhinosporidiosis is a difficult to treat pathology due to its tendency to reoccur. Till date the management of the disease is far from satisfactory. Coblation system which has already found its roots in otorhinolaryngology can be used as a novel tool in surgical resection of recurrent rhinosporidiosis and has added advantage of low temperature dissection along with clear surgical field due to constant suctioning.

scholarly journals Endobronchial ultrasound‐guided transbronchial cryo‐nodal biopsy: a novel approach for mediastinal lymph node sampling

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Hari Kishan Gonuguntla ◽  
Milap Shah ◽  
Nitesh Gupta ◽  
Sumita Agrawal ◽  
Venerino Poletti ◽  
...  
Keyword(s):  
Lymph Node ◽  
Mediastinal Lymph Node ◽  
Endobronchial Ultrasound ◽  
Ultrasound Guided ◽  
Lymph Node Sampling ◽  
Novel Approach ◽  
Mediastinal Lymph Node Sampling

scholarly journals A Novel Approach for Investigating Upper Airway Hyperresponsiveness Using Micro-CT in Eosinophilic Upper Airway Inflammation such as Allergic Rhinitis Model

Biomolecules ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. 252
Author(s):  
Dan Van Bui ◽  
Akira Kanda ◽  
Yoshiki Kobayashi ◽  
Yoshiko Sakata ◽  
Yumiko Kono ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Nasal Cavity ◽  
Airway Inflammation ◽  
Nasal Mucosa ◽  
Airway Hyperresponsiveness ◽  
Upper Airway ◽  
Assessment System ◽  
Micro Ct ◽  
Novel Approach ◽  
Cavity Structure

Airway hyperresponsiveness (AHR) has been proposed as a feature of pathogenesis of eosinophilic upper airway inflammation such as allergic rhinitis (AR). The measurement system for upper AHR (UAHR) in rodents is poorly developed, although measurements of nasal resistance have been reported. Here we assessed UAHR by direct measurement of swelling of the nasal mucosa induced by intranasal methacholine (MCh) using micro-computed tomography (micro-CT). Micro-CT analysis was performed in both naïve and ovalbumin-induced AR mice following intranasal administration of MCh. The nasal cavity was segmented into two-dimensional horizontal and axial planes, and the data for nasal mucosa were acquired for the region of interest threshold. Then, a ratio between the nasal mucosa area and nasal cavity area was calculated as nasal mucosa index. Using our novel method, nasal cavity structure was clearly identified on micro-CT, and dose-dependent increased swelling of the nasal mucosa was observed upon MCh treatment. Moreover, the nasal mucosa index was significantly increased in AR mice compared to controls following MCh treatment, while ovalbumin administration did not affect swelling of the nasal mucosa in either group. This UAHR following MCh treatment was completely reversed by pretreatment with glucocorticoids. This novel approach using micro-CT for investigating UAHR reflects a precise assessment system for swelling of the nasal mucosa following MCh treatment; it not only sheds light on the mechanism of AR but also contributes to the development of new therapeutic drugs in AR patients.

Laryngopharyngeal mucosal fold causing upper airway obstruction in a dog

2019 ◽  
Vol 7 (2) ◽  
pp. e000823
Author(s):  
Miles John Penfold ◽  
Johannes van der Zee ◽  
Marthinus Jacobus Hartman
Keyword(s):  
Airway Obstruction ◽  
Diode Laser ◽  
Tracheostomy Tube ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Uneventful Recovery ◽  
Laryngeal Oedema ◽  
First Report ◽  
Mucosal Fold

A 2.4-kg, six-year-old, sterilised, male Pomeranian presented with dyspnoea that had begun two years prior and slowly progressed. Pharyngoscopy identified a redundant laryngopharyngeal mucosal fold that was being aspirated cranially into the laryngeal opening causing upper airway obstruction. A diode laser was used to resect the fold. Postoperative laryngeal oedema necessitated the use of a tracheostomy tube for just over two days. Otherwise, the dog made an uneventful recovery. To the authors’ knowledge, this is the first report of a redundant laryngopharyngeal mucosal fold resulting in upper airway obstruction in a dog.

scholarly journals Balloon dilatation of tracheostomal stenosis with cuffed tracheostomy tube. A novel approach to tracheostomal dilatation

2011 ◽  
Vol 121 (3) ◽  
pp. 583-584 ◽  
Author(s):  
Samuel A. C. MacKeith ◽  
Miran Pankhania ◽  
Roland Hettige ◽  
Paul Gurr
Keyword(s):  
Tracheostomy Tube ◽  
Balloon Dilatation ◽  
Novel Approach
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