Airway Obstruction In Patients Research Articles

Analysis of respiratory properties using the low-frequency piezoelectric sensor in patients undergoing intravenous sedation: a prospective observational study

BackgroundPatients who undergo general anesthesia may experience respiratory failure postoperatively because of respiratory depression or upper airway obstruction. AimWe investigated whether a piezoelectric sensor (AYA-P sensor) can be used to detect upper airway obstruction in patients undergoing intravenous sedation. MethodsThis prospective observational study included 26 patients who underwent dental treatment under sedation at a dental clinic. Participants were evaluated using a newly defined airway obstruction score (AOS). The AYA-P sensors were attached to the suprasternal notch and the midpoint between the umbilicus and xiphoid process. The patient's respiratory status was classified into four categories based on thoracic movements, capnography, and breathing sounds from recorded data (S1: no airflow, S2: hypoventilation, S3: normal breathing, and S4: artifact). The data obtained from the AYA-P sensors were processed using a 0.4-Hz low-pass filter, calculated using the moving standard deviation (MSD) method, and further processed using a 0.1-Hz low-pass filter (fMSD). Next, these data were differentiated (D-fMSD). We defined the positive predictive value (PPV) as fMSD or D-fMSD values higher than a threshold α in categories S1 and S2. PPV(αMAX) was defined as the maximum PPV, and the negative predictive value (NPV[αMAX]) was defined using the same αMAX. ResultsWe compared each of the apnea-hypopnea time ratio (AHT%) and AOS with PPV(αMAX) and NPV(αMAX). The AHT% and AOS were correlated with PPV(αMAX) and NPV(αMAX) in the neck and abdomen, respectively. These findings suggest that an AYA-P sensor attached to the neck and abdomen can detect a patient's respiratory status. ConclusionProcessed data obtained from AYA-P sensors can predict upper airway obstruction in patients, and the predicted data may be dependent on individual anatomical differences. Clinical trial registrationThis study was registrated in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) clinical trial: Unique ID: UMIN000047007.

Long-term mandibular growth in patients with airway obstruction treated with mandibular distraction

Congenital craniofacial malformations play an important role in upper airway obstruction. One of the main causes is mandibular hypoplasia which is present in the pierre robin sequence. Mandibular distraction osteogenesis (MDO) is one of the most commonly used treatments for the resolution of upper airway obstruction in patients that do not respond to a conservative treatment. We performed a long term follow up of syndromic and non-syndromic patients with pierre robin sequence where the lateral xrays were studied before surgery (T1), after MDO (T2) and long-term follow-up (T3, at least 5 years). Possible complications of the surgery were also studied through panoramic x-rays and clinical controls. The results evidenced an increase of mandibular length comparing T1-T2 and a good stability during the long-term follow-up. The Sd patients presented smaller mandible dimensions. We had not found any complications during the follow-up. The scars outcomes are modest, but none of the patients requested a surgical correction. Mandibular distraction osteogenesis is a treatment to be considered in patients with upper airway obstruction that do not respond to conservative treatments. The results of the surgery are stable and the complications in experienced hands are low.

Correlation of Impulse Oscillometry with Spirometry in Deployed Military Personnel with Airway Obstruction.

Evaluation of chronic respiratory symptoms in deployed military personnel has been conducted at Brooke Army Medical Center as part of the Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures III study. Although asthma and airway hyperreactivity have been the most common diagnoses, the clinical findings in these patients may be multifactorial. This study aims to evaluate the utility of impulse oscillometry (IOS) in diagnosing airway obstruction in patients undergoing multiple pulmonary function testing (PFT) studies. Military personnel referred for deployed-related pulmonary symptoms underwent a standardized evaluation at Brooke Army Medical Center and Walter Reed National Military Medical Center over a 5-year span. Initial studies included laboratory tests, high-resolution computed tomography imaging, cardiac evaluation with electrocardiogram, and echocardiography. PFT consisted of full PFTs, forced inspiratory/expiratory pressures, post-spirometry bronchodilator testing, IOS, exhaled nitric oxide, and methacholine challenge testing. A total of 360 patients have completed an evaluation to date. In this cohort, 108 patients (30.0%) have evidence of obstruction by spirometry, whereas 74 (20.6%) had IOS values of both an R5 > 150% and X5 < -1.5. Only 32 (8.9%) had evidence of obstruction by both spirometry and IOS, whereas 210 (57.3%) had neither. A comparison among R5 (resistance at 5 Hz), R20 (resistance at 20 Hz), and X5 (reactance at 5 Hz) was performed in those individuals with and without spirometric obstruction. R5 (% predicted) was 156.2 ± 57.4% (obstruction) vs. 129.1 ± 39.6% (no obstruction) (P < .001); R20 (% predicted) was 138.1 ± 37.7% (obstruction) vs. 125.3 ± 31.2% (no obstruction) (P = .007); and X5 (cmH2O/L/s) was -1.62 ± 1.28 (obstruction) vs. -1.25 ± 0.55 (no obstruction) (P < .001). Impulse oscillometry has been advocated as a supplemental pulmonary function test to aid in the diagnosis of airway obstruction. The use of IOS has been primarily used in pediatrics and elderly populations as a validated tool to establish a diagnosis of airway obstruction but is limited in the adult population because of a well-validated set of reference values. Prior studies in adults have most often demonstrated a correlation with an elevated R5 > 150%, elevated resonant frequency, and a negative X5 < -1.5 or a decrease of 30 to 35% in R5 post-bronchodilator. Impulse oscillometry may serve as an adjunct to diagnosis but likely cannot replace a standard spirometric evaluation. Our study highlights the future utility for diagnosing early obstructive disease in the symptomatic individual.

RETRACTED: Analysis of respiratory properties using the low-frequency piezoelectric sensor in patients undergoing intravenous sedation: A prospective observational study

BackgroundPatients who undergo general anesthesia may experience respiratory failure postoperatively because of respiratory depression or upper airway obstruction. AimWe investigated whether a piezoelectric sensor (AYA-P sensor) can be used to detect upper airway obstruction in patients undergoing intravenous sedation. MethodsThis prospective observational study included 26 patients who underwent dental treatment under sedation at a dental clinic. Participants were evaluated using a newly defined airway obstruction score (AOS). The AYA-P sensors were attached to the suprasternal notch and the midpoint between the umbilicus and xiphoid process. The patient's respiratory status was classified into four categories based on thoracic movements, capnography, and breathing sounds from recorded data (S1: no airflow, S2: hypoventilation, S3: normal breathing, and S4: artifact). The data obtained from the AYA-P sensors were processed using a 0.4-Hz low-pass filter, calculated using the moving standard deviation (MSD) method, and further processed using a 0.1-Hz low-pass filter (fMSD). Next, these data were differentiated (D-fMSD). We defined the positive predictive value (PPV) as fMSD or D-fMSD values higher than a threshold α in categories S1 and S2. PPV(αMAX) was defined as the maximum PPV, and the negative predictive value (NPV[αMAX]) was defined using the same αMAX. ResultsWe compared each of the apnea-hypopnea time ratio (AHT%) and AOS with PPV(αMAX) and NPV(αMAX). The AHT% and AOS were correlated with PPV(αMAX) and NPV(αMAX) in the neck and abdomen, respectively. These findings suggest that an AYA-P sensor attached to the neck and abdomen can detect a patient's respiratory status. ConclusionProcessed data obtained from AYA-P sensors can predict upper airway obstruction in patients, and the predicted data may be dependent on individual anatomical differences. Clinical trial registrationThis study was registrated in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) clinical trial: Unique ID: UMIN000047007.

Modified forced expiration technique using expiratory resistance in adults with cystic fibrosis.

Participation in airway clearance techniques (ACT) is important to minimise development of irreversible airway obstruction in patients with cystic fibrosis (CF). Positive expiratory pressure (PEP) and expiratory resistance devices (ERD) are often used as they can improve collateral ventilation and aid in the shearing of mucus from airways. This project looked to identify whether utilising an ERD during a forced expiration technique (FET) improves ease of expectoration, sputum amount and coughing frequency in patients with CF. Patients with CF admitted for a respiratory exacerbation completed two sessions of 10 cycles of their usual ACT with half of the FET components performed with an ERD, half with FET alone. EOE, sputum wet weight, cough frequency and patient preference were similar between groups. Improved EOE without the ERD was found in participants who usually use PEP for their ACT regime. Combining the FET with a PEP mask did not improve EOE and other outcomes in this small study. Investigating the efficacy of this technique within a larger population is warranted.

Prevalence and Identification of Nasal Airway Obstruction in Patients Presenting to Otolaryngology Clinics: Results From a Large Descriptive Practice Survey.

Objective: Determine the prevalence of nasal airway obstruction (NAO) in patients presenting to general otolaryngology clinics using the Nasal Obstruction Symptom Evaluation Scale (NOSE) score as a screening tool. Study Design: The clinic staff at 149 otolaryngology specialty clinics geographically distributed in the United States administered the NOSE Scale assessment to 3533 patients presenting to the clinics over a period of 1 week, regardless of the reason for the visit. All patients completed the NOSE Scale score, and additional data were collected, including the primary reason for the visit. Demographic and patient characteristics were summarized using frequencies and percentages for categorical variables. Results: The overall mean NOSE Scale score for the 3533 patients surveyed was 37.6 (SD 31.5). A total of 37.4% (1320/3533) of surveyed patients, regardless of visit reason, had severe/extreme NAO symptoms. Overall, the most common visit reason category was "Other" (61.2%, 2162/3533), followed by "NAO" (22.6%, 798/3533) and "Sinus" (16.2%, 573/3533). The mean NOSE scores for patients in each of the visit categories were 23.4 (SD 25.9), 64.7 (SD 23.3), and 53.3 (SD 28.1); for "Other," "NAO," and "Sinus," respectively. Among the patients coming in with "NAO" or "Sinus" as a primary complaint, 76.2% (608/798) and 57.2.% (328/573) had severe or extreme NOSE scores. A total of 17.8% (384/2162) of patients coming in for "Other" reasons had NOSE scores indicating severe/extreme NAO symptoms. Conclusions: The findings of this large, descriptive otolaryngology practice survey found a high prevalence of moderate to severe/extreme NAO among patients presenting to otolaryngology practices. Incorporating assessments, such as the NOSE Scale score and other diagnostic practices into the patient intake workflow and assessments, could help identify symptomatic NAO patients that might otherwise be overlooked.

Patient outcomes after neonatal tracheotomy: A retrospective case-control study.

Patient outcomes after neonatal tracheotomy: A retrospective case-control study.

The frequency of detection of comorbid broncho-obstructive pathology in patients with arterial hypertension admitted to a specialized cardiological hospital

Objective: To determine the frequency of detection of chronic obstructive pulmonary disease (COPD) and Asthma in patients who are admitted to specialized cardiological hospital with arterial hypertension (AH), including AH with chronic heart failure (CHF), coronary heart disease (CHD), cardiac arrhythmias. Analyze the possibility of early diagnosis and the validity of the modified questionnaire for screening risk factors and symptoms of broncho-obstructive pathology in patients with arterial hypertension.Materials and methods: The sample (n = 1000) consisting of individuals over the age of 18 who continuously arrive for inpatient treatment at the admission department of the National Medical Research Center of Cardiology with arterial hypertension, incl. AH with CHF, IHD and arrhythmias in the period from 2018 to 2019. Active identification of broncho-obstructive pathology among all persons was carried out (history taking, complaints), analysis of medical documents provided by patients (conclusions from outpatient and reference cards of the patient), screening of risk factors and symptoms of broncho-obstructive pathology (a modified questionnaire was used), external respiration function was assessed (computer spirometry), filled out the specialized respiratory questionnaires (CAT, mMRC, ACT).Results: The undiagnosed broncho-obstructive diseases was demonstrated against the background of their high occurrence in patients with hypertension, incl. CHF, coronary artery disease, NRS entering a specialized cardiological hospital. The study established the most likely predictors of airway obstruction in patients with hypertension, which signal the need to assess the function of external respiration (computed spirometry).Conclusions: The development and validation of a modified questionnaire makes it possible to identify specific symptoms and risk factors for bronchoobstructive diseases against the backdrop of their high prevalencre among patients who are admitted to cardiology hospital with arterial hypertension.

Oxytocin mediated excitation of hypoglossal motoneurons: implications for treating obstructive sleep apnea.

Clinical studies have shown that oxytocin administered intranasally (IN) decreased the incidence and duration of obstructive events in patients with obstructive sleep apnea (OSA). Although the mechanisms by which oxytocin promotes these beneficial effects are unknown, one possible target of oxytocin could be the excitation of tongue-projecting hypoglossal motoneurons in the medulla, that exert central control of upper airway patency. This study tested the hypothesis that IN oxytocin enhances tongue muscle activity via the excitation of hypoglossal motoneurons projecting to tongue protrudor muscles (PMNs). To test this hypothesis we performed in vivo and in vitro electrophysiological studies in C57BL6/J mice as well as fluorescent imaging studies in transgenic mice in which neurons that express oxytocin receptors co-express fluorescent protein. IN oxytocin significantly increased the amplitude of inspiratory-related tongue muscle activity. This effect was abolished by severing the medial branch of hypoglossal nerve that innervates PMNs of the tongue. Oxytocin receptor-positive neurons were more prevalent in the population of PMNs than in retractor-projecting hypoglossal motoneurons (RMNs). Oxytocin administration increased action potential firing in PMNs, but had no significant effect on firing activity in RMNs. In conclusion, IN oxytocin stimulates respiratory-relating tongue muscle activity likely acting on central hypoglossal motoneurons that provide tongue protrusion and upper airway opening. This mechanism may play a role in oxytocin-induced reductions in upper airway obstructions in patients with OSA.

Effect of Velopharyngeal Insufficiency on Long-Term Patient-Reported Sleep-Related Impairment in Patients With Cleft Palate

Objective: Velopharyngeal insufficiency (VPI) surgery in patients with cleft palate increases the risk for airway obstruction acutely. However, the long-term effects of VPI surgery on airway obstruction are unknown. In this work, we prospectively evaluated patient-reported sleep-related impairment scores as a screening tool for airway obstruction in patients with cleft palate (CP). Methods: Patients with CP &gt; 14 years of age from 2 institutions were prospectively administered the Patient Reported Outcomes Measurement Information Systems sleep-related impairment short form. Patient characteristics, medical, and surgical histories were reviewed. Multivariable linear regression analyses were performed to assess the contribution of independent variables to sleep-related impairment scores. Results: Forty-four patients (mean age 20.5 ± 4.7 years) were included. Twenty-three patients (52.3%) were diagnosed with VPI. Seventeen patients (38.6%) underwent VPI surgery, of whom 14 patients (82.4%) were treated with sphincter pharyngoplasties at a mean age of 7.7 ± 4.1 years. Multivariable linear regression models to control for variables that could influence sleep-related impairment such as body mass index (BMI) ≥25 were developed to evaluate the contribution of VPI and VPI treatment. The diagnosis of VPI (β = .52, P = .004), VPI surgery (β = .48, P = .008), and sphincter pharyngoplasty (β = .47, P = .011) were found to independently predict sleep-related impairment in each of the respective regression models. Conclusions: A history of VPI, any type of VPI surgery, or sphincter pharyngoplasty were separately and independently predictive of patient-reported sleep-related impairment long-term. These data suggest that longitudinal airway obstruction screening in patients with cleft palate and VPI deserves consideration.

Translation and Validation of the Thai Version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale.

The Nasal Obstruction Symptom Evaluation (NOSE) was developed to evaluate subjective outcomes of patients with deviated nasal septum and symptomatic nasal obstruction. Considering the differences in individuals' cultural, cross-cultural translation, adaptation, and validation of the instrument are necessary. The current study aimed to translate and validate the Thai version of the NOSE Questionnaire for patients with nasal septum deviation. A single-center prospective instrument validation study. Thai tertiary referral center. The study was conducted to translate and adapt the original English version of the NOSE to Thai. After translating, psychometric testing was conducted. The primary outcomes were validity (content, construct, and discriminant), reproducibility (test-retest procedure), and internal consistency (reliability). A total of 105 participants, of which 46 were patients with nasal airway obstruction and 59 were healthy asymptomatic volunteers, were enrolled in this study. The Thai-NOSE was found to be adequate for all tested psychometric properties with high internal consistency (Cronbach's α = .942), and to discriminate accurately between patients and healthy controls. The interitem and item-total correlations indicated a related construct among all items. A high level of reproducibility of the questionnaire was obtained in the test-retest procedure for each item (γ = 0.898). The initial test and retest scores indicated adequate reproducibility. The Thai-NOSE questionnaire is a reliable instrument with appropriate psychometric properties for assessing the severity and impact of nasal airway obstruction in patients with nasal septum deviation.

THIRD-TRIMESTER PREGNANCY COMPLICATED BY NON-SMALL CELL LUNG CANCER INITIALLY PRESENTING WITH CENTRAL AIRWAY OBSTRUCTION AND STENOSIS

THIRD-TRIMESTER PREGNANCY COMPLICATED BY NON-SMALL CELL LUNG CANCER INITIALLY PRESENTING WITH CENTRAL AIRWAY OBSTRUCTION AND STENOSIS

Effect of Body Mass Index on Upper Airway Obstruction as Revealed by Drug-Induced Sleep Endoscopy in Patients With Sleep-Disordered Breathing

Background and Objectives Drug-induced sleep endoscopy (DISE) usefully determines the sites of airway obstruction in patients with sleep-disordered breathing. It is widely accepted that obesity increases obstructive sleep apnea. However, no study has explored how and where obesity causes obstructions. In this study, we described the patterns of upper airway obstruction revealed by DISE in patients of various body mass indices (BMIs) with sleep-disordered breathing.Subjects and Method All subjects had sleep-disordered breathing and underwent DISE. Endoscopic findings at the retropalatal (upper lateral, upper anteroposterior [AP]) and retrolingual (lower lateral, lower AP) levels were graded; obstruction was complete (2), partial (1), or none (0). Subjects with BMI &lt;25 (&lt;25 group), 25≤BMI&lt;30 (25&lt;30 group), and ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; (&gt;30 group) were compared using a dummy variable; to this end, we employed R ver. 4.0.5.Results For the total of 153 patients reviewed, the mean age was 43.1±12.2 years and the mean BMI was 26.0±3.4 kg/m&lt;sup&gt;2&lt;/sup&gt;. At the retropalatal AP level, the DISE grade was significantly higher in the 25&lt;30 group than in the &lt;25 group (&lt;i&gt;p&lt;/i&gt;=0.029) but not in the &gt;30 group (&lt;i&gt;p&lt;/i&gt;=0.248). At the retropalatal lateral level, significant increases were evident in both of the higher BMI groups (&lt;i&gt;p&lt;/i&gt;=0.06 and &lt;i&gt;p&lt;/i&gt;=0.024, respectively). No significant relationship was found at the retrolingual level.Conclusion In terms of the retropalatal AP and lateral diameters, a higher BMI is associated with a greater incidence of more severe obstruction.

Randomised, controlled crossover trial of intermittent and continuous transcutaneous electrical stimulation of the genioglossus muscle for obstructive sleep apnoea

PurposeContinuous transcutaneous electrical stimulation (CTES) of the genioglossus muscle may benefit patients with obstructive sleep apnoea (OSA). However, the therapeutic value of intermittent transcutaneous electrical stimulation (ITES) for OSA is...

Elevated CXCL14 in Induced Sputum Was Associated with Eosinophilic Inflammation and Airway Obstruction in Patients with Asthma

Introduction: CXCL14 involved in inflammatory processes was upregulated in the asthma expression profile datasets in our pilot study. However, the expression of CXCL14 in induced sputum and its potential clinical role in asthma were poorly reported. Objective: We sought to detect CXCL14 expression in airway epithelium and induced sputum cells of asthma and explore its potential clinical implications. Methods: The expression of CXCL14 in asthma was analyzed using R software based on multiple microarray datasets, including GSE43696, GSE63142, GSE67940, and GSE76262. Subsequent verification of the CXCL14 expression pattern in induced sputum and bronchial epithelium cells was performed by qRT-PCR and ELISA. Besides, the correlations between CXCL14 and eosinophilic inflammation indicators (FeNO, EOS#, and IgE), Th2 signature genes (SERPINB2, POSTN, and CLCA1), inflammatory cytokines (IL-4, IL-5, IL-10, IL-13, IL-25, IL-33, TSLP, IL-8, IL-17A, IFN-γ, and IL-2), and airway obstruction indicators (pulmonary function and mucin secretion) were further explored. Results: The expression of CXCL14 in epithelium and sputum cells was upregulated in asthma and positively correlated with clinical eosinophilic indicators. The protein levels of CXCL14 were positively associated with Th2 signature genes (SERPINB2, POSTN, and CLCA1) and Th2 cytokines (IL-4, IL-5, IL-10, IL-13, IL-25, IL-33, and TSLP). Increased expression of CXCL14 was also observed in BEAS-2B cells stimulated by the cytokine IL-4. Furthermore, the expression of CXCL14 was positively correlated with MUC5AC secretion and negatively associated with pulmonary function. Conclusions: Upregulated CXCL14 in asthma was positively correlated with inflammatory indicators and negatively correlated with pulmonary function, which indicated that upregulated CXCL14 might act as a pathogenic gene through involvement in Th2 inflammation in asthma.

1161P Clinical outcomes of bronchoscopic cryotherapy for malignant central airway obstruction in patients with non-small cell lung cancer

The Prognosis of patients with malignant central airway obstruction (MCAO) is very poor; nonetheless, the clinical outcome of bronchoscopic cryotherapy (BC) in patients with non-small cell lung cancer (NSCLC) is not well known. This study aimed to evaluate the clinical outcomes of BC and evaluate the factors associated with complication.

Determining airflow obstruction from tracheal sound analysis: simulated tests and evaluations in patients with acromegaly.

To evaluate the ability of tracheal sound analysis (TSA) to detect airflow obstruction, particularly in patients with acromegaly. A simulated analysis compared free airflow conditions with airflow through orifice plates 6, 8, 10 and 12mm in diameter. Based on these results, TSA and spirometry examinations were performed on controls (n = 17) and patients with acromegaly (n = 17). The simulated study showed that airway obstruction and airflow values increased the values of power and a progressive displacement of the spectral distribution towards higher frequencies. In agreement with the simulation, airway obstruction in patients with acromegaly also resulted in increased values of power (p < 0.002) and displacement of the spectral distribution (p < 0.01). Significant associations were observed between the TSA parameters and the spirometry indices of obstruction (p < 0.02). In addition, the TSA parameters achieved adequate diagnostic accuracy (AUC ≥ 0.887). The present study provides evidence that TSA during resting breathing would provide adequate biomarkers of early upper airway changes in patients with acromegaly. TSA is carried out during spontaneous ventilation, requires little from the patient, and is fast and inexpensive. Taken together, these practical considerations and the results of the present study suggest that TSA may improve lung function tests for patients with acromegaly. Summary of the study, overall design flow and the main results obtained.

Effects of Inhaled Corticosteroids on Lung Function in Children With Post-infectious Bronchiolitis Obliterans in Remission.

BackgroundPost-infectious bronchiolitis obliterans (PIBO) is a rare and irreversible chronic obstructive pulmonary disease with no specific treatment, especially for patients with PIBO in remission. In this study, we evaluated the effects of continuous inhaled corticosteroids (ICSs) and intermittent ICSs on lung function in the remission of PIBO.MethodsThis was a retrospective study, and all the subjects we included were divided into continuous ICS group and intermittent ICS group according to treatment regimens. Patients in continuous ICS group received continuous ICSs (2 times a day), and patients in intermittent ICS group received intermittent ICSs (inhaled corticosteroids after acute respiratory tract infection or wheezing). Different lung function tests were performed at different ages. Tidal breathing lung function tests were performed in patients with PIBO aged ≤ 5 years, and the lung ventilation function test and the bronchial dilation test were performed in patients with PIBO aged more than 5 years. Lung function was assessed at the beginning of follow-up and at the end of follow-up (1 year of ICSs).ResultsAfter 1 year of ICSs, patients aged more than 5 years, forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1) were significantly higher than at the beginning of follow-up. After 1 year of ICSs, the difference in VT/Kg, TPTEF/TE, and VPEF/VE between the end and the beginning of follow-up in continuous ICS group shows an upward trend. But those showed a downward trend in intermittent ICS group. FVC, FEV1, and maximal mid-expiratory flow velocity 25–75% (MMEF25–75%) of continuous ICS group were significantly higher than at the beginning of follow-up. The difference in FEV1 and MMEF25–75% between the end of follow-up and the beginning of follow-up in continuous ICS group was significantly higher than that in intermittent ICS group. A total of 52.94% of patients with PIBO aged more than 5 years were positive for bronchial dilation tests.ConclusionInhaled corticosteroids can effectively improve lung function and relieve airway obstruction in patients aged more than 5 years in PIBO remission, especially continuous ICSs. Patients with PIBO may have reversible airflow limitations.

Decreasing the Incidence of Hypoxia and Airway Maneuvers During GI Procedures.

Many outpatient gastrointestinal procedures are completed with propofol anesthesia. A side effect of propofol is airway obstruction and subsequent hypoxia. This study was designed to determine whether the use of a high-flow nasal cannula is associated with a decreased incidence of hypoxia or airway obstruction in patients undergoing propofol sedation in the gastrointestinal laboratory with a STOP-BANG score ≥5. High-flow nasal cannula was administered at 70 L/min on 27 patients with a STOP-BANG score ≥5 receiving monitored anesthesia care sedation for an esophagogastroduodenoscopy, endoscopic ultrasound, or colonoscopy procedure. Patients were compared to a group from a previous project without the use of high-flow nasal cannula assessing whether hypoxia, apnea, or the need for airway maneuvers occurred. The non-high-flow nasal cannula group required an airway maneuver 53.3% (n = 8) whereas the high-flow nasal cannula group required an airway maneuver 18.5% (n = 5) (p = .021). High-flow nasal cannula was associated with a reduced need for airway maneuvers in patients with a high risk of obstructive sleep apnea undergoing propofol-assisted procedures.

Preoperative tracheotomy in the treatment of upper airway obstruction of patients with advanced stage supraglottic carcinoma

BackgroundPreoperative tracheotomy is an effective option that secures upper airway patency in laryngeal carcinoma patients suffering from upper airway obstruction, but the influence of this treatment on oncologic outcomes of laryngeal carcinoma remains controversial. The purpose of this study was to determine the impact of preoperative tracheotomy on overall survival in supraglottic carcinoma patients with tumor obstruction of the upper airway, and explore the potential causes. Materials and methodsThis retrospective study collected 243 consecutive patients with advanced stage supraglottic carcinoma from 2005 to 2010. Preoperative tracheotomy in the management of upper airway obstruction in patients with supraglottic carcinoma was analyzed. ResultsThe mean age was 60.9 years at diagnosis, with men accounting for 98.4% of all patients. Thirty nine (16.0%) patients presenting with tumor obstruction of the upper airway required preoperative tracheotomy. T4 stage patients had higher rate of tracheotomy than those of patients with T3 stage (36.8% vs 12.2%). Patients with upper airway obstruction presented with greater tumor area compared with patients without (13.7 cm2 vs 9.0 cm2). The optimal cutoff value of tumor area for tracheotomy and OS rate were both at 10 cm2. Supraglottic patients with upper airway obstruction receiving preoperative tracheotomy had poorer OS rate compared with patients without. T stage and tumor area were correlated with upper airway obstruction, and these two variables were independent predictors of OS rate in supraglottic carcinoma patients. ConclusionsAdvanced stage supraglottic carcinoma patients with upper airway obstruction undergoing preoperative tracheotomy experienced worse overall survival. Advanced T stage and greater tumor size were associated with upper airway obstruction, indicating that the negative influence of tumor obstruction on survival may be cause by these two preoperative variables. Therefore, preoperative tracheotomy acts only as an alternative procedure, and is not a prognostic agent.