airway patency
Recently Published Documents


TOTAL DOCUMENTS

438
(FIVE YEARS 126)

H-INDEX

42
(FIVE YEARS 2)

2022 ◽  
Vol 8 ◽  
Author(s):  
Miuni Athauda Arachchige ◽  
Joerg Steier

Obstructive Sleep Apnoea (OSA) is common and characterised by repeated apnoeas and hypopnoeas while asleep due to collapse of the upper airway. OSA can have a significant impact on physical and mental health and, when left untreated, is associated with increased risk of developing cardiovascular ill health. Besides cardiorespiratory implications excessive daytime sleepiness, morning headaches, limited memory function and lack of concentration are some further symptoms caused by OSA. Continuous Positive Airway Pressure (CPAP) therapy is the evidence-based treatment to maintain upper airway patency in patients with moderate to severe OSA. Proper adherence to CPAP therapy successfully abolishes nocturnal apnoeas and hypopnoeas, and diminishes consequences of uncontrolled OSA, such as treatment resistant hypertension. However, long term adherence to CPAP remains an unresolved limitation of this method. Although alternatives to CPAP therapy may be less efficacious, there is a variety of non-CPAP treatments that includes conventional lifestyle advice, postural advice, the use of mandibular advancement devices (MADs), surgical treatment options, such as uvulopalatopharyngoplasty, tonsillectomy, or maxillomandibular advancement, and the use of electrical stimulation of the upper airway dilator muscles. Hypoglossal Nerve Stimulation is available as an invasive (HNS) and a transcutaneous (TESLA) approach. For the management of “difficult-to-treat” patients with OSA, particularly in those in whom first line therapy proved to be unsuccessful, a multidisciplinary team approach may be helpful to incorporate the available options of non-CPAP therapy and provide appropriate choices. Symptom control, patient-related outcome measures and long-term cardiovascular health should be prioritised when choosing long-term therapies to treat OSA. The inclusion of patients in the choice of successful management options of their condition will facilitate better long-term adherence. Advancing clinical trials in the field will further help to resolve the relative lack of evidence for effective non-CPAP methods.


2022 ◽  
Vol 7 (1) ◽  
pp. e000859
Author(s):  
Seif Tarek El-Swaify ◽  
Mazen A Refaat ◽  
Sara H Ali ◽  
Abdelrahman E Mostafa Abdelrazek ◽  
Pavly Wagih Beshay ◽  
...  

Traumatic brain injury (TBI) accounts for around 30% of all trauma-related deaths. Over the past 40 years, TBI has remained a major cause of mortality after trauma. The primary injury caused by the injurious mechanical force leads to irreversible damage to brain tissue. The potentially preventable secondary injury can be accentuated by addressing systemic insults. Early recognition and prompt intervention are integral to achieve better outcomes. Consequently, surgeons still need to be aware of the basic yet integral emergency management strategies for severe TBI (sTBI). In this narrative review, we outlined some of the controversies in the early care of sTBI that have not been settled by the publication of the Brain Trauma Foundation’s 4th edition guidelines in 2017. The topics covered included the following: mode of prehospital transport, maintaining airway patency while securing the cervical spine, achieving adequate ventilation, and optimizing circulatory physiology. We discuss fluid resuscitation and blood product transfusion as components of improving circulatory mechanics and oxygen delivery to injured brain tissue. An outline of evidence-based antiplatelet and anticoagulant reversal strategies is discussed in the review. In addition, the current evidence as well as the evidence gaps for using tranexamic acid in sTBI are briefly reviewed. A brief note on the controversial emergency surgical interventions for sTBI is included. Clinicians should be aware of the latest evidence for sTBI. Periods between different editions of guidelines can have an abundance of new literature that can influence patient care. The recent advances included in this review should be considered both for formulating future guidelines for the management of sTBI and for designing future clinical studies in domains with clinical equipoise.


2021 ◽  
pp. 155335062110599
Author(s):  
Ayhan Şahin ◽  
Onur Baran ◽  
Ahmet Gültekin ◽  
Gülcan Gücer Şahin ◽  
Tolga Ersözlü ◽  
...  

Introduction The cervical plexus block (CPB) has been used for a long time for both analgesia and anesthesia in carotid endarterectomy and thyroid operations. To be unfamiliar with the technique and its perceived difficulty, potential risks, and possible adverse effects such as intravascular injection has limited broader use before the practical use of ultrasound. We hypothesize that the cervical plexus block can provide adequate anesthesia in tracheostomy cases and provide excellent anesthesia comfort when combined with a translaryngeal block. Methods This double-blinded, randomized 29 patients undergoing primary tracheostomy operation to receive either CPB (Group S) or CPB with translaryngeal block (Group ST). The primary outcome was cumulated analgesic consumption during the first 24 postoperative hours. Secondary outcomes were as follows: pain related to incision, patient tolerance as assessed by tracheostomy cannula comfort score, cough and gag, pain at rest, nausea and vomiting, and time to first analgesic demand. Results The patient tolerance for tracheostomy was higher in Group ST than Group S. The median tracheostomy cannula comfort score was 4.0 in Group S. In contrast, the median score was significantly lower in group ST (P<.001). The cough and gag reflex scores were significantly lower in Group ST than Group S (1.0 vs 4.0, P<.001). Conclusion This trial supported the hypothesis that the CPB combined with the translaryngeal block yields excellent anesthesia for tracheostomies. The technique we briefly described, in a way, is the equivalent of awake fiberoptic intubation to awake tracheostomy with minimal sedation adjusted according to airway patency.


2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Cynthia Medina ◽  
Hiroshi Ueda ◽  
Koji Iwai ◽  
Ryo Kunimatsu ◽  
Kotaro Tanimoto

2021 ◽  
pp. 67-72
Author(s):  
S.A. Gumenyuk ◽  
◽  
V.I. Potapov ◽  
A.Yu. Sysoev ◽  
◽  
...  

The aim of the study is to identify and to analyze the features of respiratory support in patients with severe acute respiratory failure when performing air ambulance evacuation by light class helicopters by specialists of aeromedical teams. Materials and methods. We used materials containing data on the frequency and peculiarities of ventilator usage and tracheal intubation during emergency medical care for patients with acute respiratory failure over the last 5 years (2016-2020). During this period emergency medical care was provided to 53579 patients, 298 of whom were in extremely severe and serious condition requiring ventilator usage and tracheal intubation. The following methods were used in the study: historical, statistical, analytical. Results of the study and their analysis. Trauma prevailed among nosological forms in patients with acute respiratory failure. Artificial lung ventilation with tracheal intubation should be started before the patient is transported to the helicopter cabin. During air ambulance evacuation of patients with acute respiratory failure by helicopter of light class, doctors should take differentiated approach to the choice of type and mode of respiratory support and of method of airway patency assurance.


2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Alessandro Nota ◽  
Shideh Ehsani ◽  
Laura Pittari ◽  
Giorgio Gastaldi ◽  
Simona Tecco

Abstract Background The median solitary maxillary central incisor syndrome (SMMCI) is a rare malformative syndrome consisting of multiple defects, mainly found on the body midline. It can be correlated to the etiopathological and phenotypic pattern of panhypopituitarism. This case-report describes the rare case of a patient suffering from SMMCI and panhypopituitarism, showing an unusual craniofacial morphology. Case presentation From the cephalometric analysis, a skeletal class III was identified (despite the other cases described in literature described as skeletal class II), derived from hypomaxillia and mandibular protrusion. A convex lip profile, with tendency to mandibular hyper-divergency, airway patency, anterior and posterior cross-bite were observed. At the clinical examination, a maxillary cant was evident on the frontal plane that appeared asymmetric, with the prevalence of the third lower part of the face. There were some dysmorphic signs such as: small nose, rectilinear eyelid line and reduced interocular distance. Conclusions The present clinical case shows how, despite the literature, SMMCI can be associated with a III skeletal class, with maxillary hypoplasia and mandibular protrusion. The interdisciplinary collaboration between dentist and pediatrician is therefore important for the early interception of the malocclusions associated with these syndromes.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Shiv Bhandari ◽  
Jason Coult ◽  
Natalie Bulger ◽  
Catherine Counts ◽  
Heemun Kwok ◽  
...  

Introduction: In 40-70% of out-of-hospital cardiac arrest (OHCA) cases, chest compressions (CCs) during CPR induce measurable oscillations in capnography (E T CO 2 ). Recent studies suggest the magnitude and frequency of oscillations are due to intrathoracic airflow dependent on airway patency. These oscillations can be quantified by the Airway Opening Index (AOI), ranging from 0-100%. We sought to develop, automate, and evaluate multiple methods of computing AOI throughout CPR. Methods: We conducted a retrospective study of all OHCA cases in Seattle, WA during 2019. E T CO 2 and impedance waveforms from LifePak 15 defibrillators were annotated for the presence of intubation and CPR, and imported into MATLAB for analysis. Four proposed methods for computing AOI were developed (Fig. 1) using peak E T CO 2 in conjunction with ΔE T CO 2 (oscillations in E T CO 2 from CCs). We examined the feasibility of automating ΔE T CO 2 and AOI calculation during CCs throughout OHCA resuscitation and evaluated differences in mean AOI using each method. Statistical significance was assessed with ANOVA (alpha = 0.05). Results: AOI was measurable in 312 of 465 cases. Mean [95% confidence interval] AOI across all cases was 34.3% [32.0-36.5%] for method 1, 27.6% [25.5-29.7%] for method 2, 22.7% [21.1-24.3%] for method 3, and 28.8% [26.6-31.0%] for method 4. Mean AOI was significantly different across the four methods (p<0.001), with the greatest difference between method 1 and 3 (11.6%, p<0.001), but no significant difference between methods 2 and 4 (p=0.44). Mean ΔE T CO 2 was 7.76 [7.08-8.44] mmHg. Conclusion: We implemented four proposed methods of automatically calculating AOI during OHCA. Each method produced a different average AOI. Consistent, automated methods to measure AOI provide the foundation to evaluate if, and how, AOI may change with treatment or predict outcomes. These four approaches require additional investigation to understand which may be best suited to improve OHCA care.


2021 ◽  
Author(s):  
Qi Ren ◽  
Fang Chen ◽  
Huijuan Zhang ◽  
Juanhua Tu ◽  
Xiaowei Xu ◽  
...  

Abstract Background The New Nurses who lack the ability to recognize and manage anaphylactic shock can endanger the patients. In this study, we explored the effect of a simulated scenario designed to improve nurses’ understanding of their roles and responsibilities during the rescue of a patient with anaphylactic shock. Methods The program of a simulation-based training was designed to teach learners to recognize the signs and symptoms of anaphylactic shock, place the patient in the correct position, stop ongoing intravenous infusion of the antibiotic which trigger the anaphylactic shock, restart an intravenous infusion on a new infusion apparatus, give 100% oxygen via a nasal cannula or mask, preserve airway patency, call the rapid response team (RRT), and correctly administer the medications prescribed by the clinician. Instructors evaluated each learner’s skills and behaviors by using a clinical competency questionnaire. All learners then completed the Chinese version of the Simulation Design Scale (SDS) and participated in semi-structured interviews with their instructors after the training. Results All learners showed significant improvements in the 6 competencies assessed by the clinical competency questionnaire after the simulation-based training (all P<0.001). Scores on the SDS revealed that the learners were highly satisfied with all aspects of the simulation-based training (the 20 satisfaction rates were all above 90.00%). During the semi-structured interviews, new graduated nurses reported that simulation-based training in the management of anaphylactic shock was extremely important and would guide them in clinical practice. Conclusions The simulation-based training in anaphylactic shock is a potentially viable and effective method to teach new registered nurses to manage clinical incidents.


Pharmaceutics ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 1851
Author(s):  
Sabna Kotta ◽  
Hibah Mubarak Aldawsari ◽  
Shaimaa M. Badr-Eldin ◽  
Lenah S. Binmahfouz ◽  
Rana Bakur Bakhaidar ◽  
...  

Excessive architectural re-modeling of tissues in pulmonary fibrosis due to proliferation of myofibroblasts and deposition of extracellular matrix adversely affects the elasticity of the alveoli and lung function. Progressively destructive chronic inflammatory disease, therefore, necessitates safe and effective non-invasive airway delivery that can reach deep alveoli, restore the surfactant function and reduce oxidative stress. We designed an endogenous surfactant-based liposomal delivery system of naringin to be delivered as an aerosol that supports pulmonary mechanics for the management of pulmonary fibrosis. Phosphatidylcholine-based liposomes showed 91.5 ± 2.4% encapsulation of naringin, with a mean size of 171.4 ± 5.8 nm and zeta potential of −15.5 ± 1.3 mV. Liposomes with the unilamellar structure were found to be spherical and homogeneous in shape using electron microscope imaging. The formulation showed surface tension of 32.6 ± 0.96 mN/m and was able to maintain airway patency of 97 ± 2.5% for a 120 s test period ensuring the effective opening of lung capillaries and deep lung delivery. In vitro lung deposition utilizing Twin Stage Impinger showed 79 ± 1.5% deposition in lower airways, and Anderson Cascade Impactor deposition revealed a mass median aerodynamic diameter of 2.35 ± 1.02 μm for the aerosolized formulation. In vivo efficacy of the developed formulation was analyzed in bleomycin-induced lung fibrosis model in rats after administration by the inhalation route. Lactate dehydrogenase activity, total protein content, and inflammatory cell infiltration in broncho-alveolar lavage fluid were substantially reduced by liposomal naringin. Oxidative stress was minimized as observed from levels of antioxidant enzymes. Masson’s Trichrome staining of lung tissue revealed significant amelioration of histological changes and lesser deposition of collagen. Overall results indicated the therapeutic potential of the developed non-invasive aerosol formulation for the effective management of pulmonary fibrosis.


2021 ◽  
Author(s):  
Philip M. Hartigan ◽  
Sergey Karamnov ◽  
Ritu R. Gill ◽  
Ju-Mei Ng ◽  
Stephanie Yacoubian ◽  
...  

Background Central airway occlusion is a feared complication of general anesthesia in patients with mediastinal masses. Maintenance of spontaneous ventilation and avoiding neuromuscular blockade are recommended to reduce this risk. Physiologic arguments supporting these recommendations are controversial and direct evidence is lacking. The authors hypothesized that, in adult patients with moderate to severe mediastinal mass–mediated tracheobronchial compression, anesthetic interventions including positive pressure ventilation and neuromuscular blockade could be instituted without compromising central airway patency. Methods Seventeen adult patients with large mediastinal masses requiring general anesthesia underwent awake intubation followed by continuous video bronchoscopy recordings of the compromised portion of the airway during staged induction. Assessments of changes in anterior–posterior airway diameter relative to baseline (awake, spontaneous ventilation) were performed using the following patency scores: unchanged = 0; 25 to 50% larger = +1; more than 50% larger = +2; 25 to 50% smaller = −1; more than 50% smaller = −2. Assessments were made by seven experienced bronchoscopists in side-by-side blinded and scrambled comparisons between (1) baseline awake, spontaneous breathing; (2) anesthetized with spontaneous ventilation; (3) anesthetized with positive pressure ventilation; and (4) anesthetized with positive pressure ventilation and neuromuscular blockade. Tidal volumes, respiratory rate, and inspiratory/expiratory ratio were similar between phases. Results No significant change from baseline was observed in the mean airway patency scores after the induction of general anesthesia (0 [95% CI, 0 to 0]; P = 0.953). The mean airway patency score increased with the addition of positive pressure ventilation (0 [95% CI, 0 to 1]; P = 0.024) and neuromuscular blockade (1 [95% CI, 0 to 1]; P &lt; 0.001). No patient suffered airway collapse or difficult ventilation during any anesthetic phase. Conclusions These observations suggest a need to reassess prevailing assumptions regarding positive pressure ventilation and/or paralysis and mediastinal mass–mediated airway collapse, but do not prove that conventional (nonstaged) inductions are safe for such patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New


Sign in / Sign up

Export Citation Format

Share Document