Airway Patency Research Articles

Three-dimensional comparison between the effects of mandibular advancement device and maxillomandibular advancement surgery on upper airway

BackgroundThe efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA.MethodsThe sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation.ResultsBoth groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and − 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region.ConclusionsThe MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.

Microinjection Molded Biopolymeric Airway Stent with Antibacterial and Anti-hyperplastic Properties.

Central airway stenosis is a condition that the diameter of trachea or main bronchus shrinkage caused by external compression or internal tissue hyperplasia, which can cause difficulty breathing, asphyxia, and even death. Airway stenting is an easy way to restore the patency of central airway, but airway stents commonly used in clinical practice can lead to complications such as mucus plugging, bacterial infection and granulation tissue hyperplasia. Moreover, the non-degradable characteristic makes it require a second operation to remove, which have the potential to cause tissue damage. In this study, a biodegradable airway stent fabricated by microinjection molding using the bioelastomer of poly (L-lactide-co-ε-caprolactone) (PLCL) as the matrix material. The airway stent has excellent mechanical properties and an appropriate degradation rate. The hydrophilic surface of the airway stent can inhibit mucus plugging. The loading of silver nanoparticles (AgNPs) and cisplatin endows the stent with antibacterial and anti-hyperplastic functions. In vitro and in vivo experiments demonstrate that this study provides an antibacterial and anti-hyperplastic biodegradable airway stent with elastic properties to avoid secondary removal operation and reduce complications associated with mucus plugging, bacterial infection and granulation tissue hyperplasia. This article is protected by copyright. All rights reserved.

Candidate genes for obstructive sleep apnea in non-syndromic children with craniofacial dysmorphisms - a narrative review.

Pediatric obstructive sleep apnea (POSA) is a complex disease with multifactorial etiopathogenesis. The presence of craniofacial dysmorphisms influencing the patency of the upper airway is considered a risk factor for POSA development. The craniofacial features associated with sleep-related breathing disorders (SRBD) - craniosynostosis, retrognathia and micrognathia, midface and maxillary hypoplasia - have high heritability and, in a less severe form, could be also found in non-syndromic children suffering from POSA. As genetic factors play a role in both POSA and craniofacial dysmorphisms, we hypothesize that some genes associated with specific craniofacial features that are involved in the development of the orofacial area may be also considered candidate genes for POSA. The genetic background of POSA in children is less explored than in adults; so far, only one genome-wide association study for POSA has been conducted; however, children with craniofacial disorders were excluded from that study. In this narrative review, we discuss syndromes that are commonly associated with severe craniofacial dysmorphisms and a high prevalence of sleep-related breathing disorders (SRBD), including POSA. We also summarized information about their genetic background and based on this, proposed 30 candidate genes for POSA affecting craniofacial development that may play a role in children with syndromes, and identified seven of these genes that were previously associated with craniofacial features risky for POSA development in non-syndromic children. The evidence-based approach supports the proposition that variants of these candidate genes could lead to POSA phenotype even in these children, and, thus, should be considered in future research in the general pediatric population.

Effectiveness of video assisted teaching on knowledge and practice regarding suctioning of children on mechanical ventilator among nurses working in paediatric department

Background: Airway secretion clearance is a normal process that is essential for preventing respiratory infections, atelectasis, pulmonary haemorrhage and maintaining airway patency. In order to ensure this, effective and safe suction is necessary. Thus, endotracheal suctioning removes secretions which gets accumulated in the endotracheal tube through using negative suction pressure. The study aimed to assess the effectiveness of video assisted teaching on knowledge and practice regarding suctioning of children on mechanical ventilator among nurses working in pediatric department. Methods: Data were collected with the help of demographic-profile, Self-Structured knowledge questionnaire and Rating scale tool from 38 samples using Purposive sampling technique who met the inclusion criteria. The pretest data collected before intervention and post-test data collected after one week of video assisted teaching. Results: The result revealed that post intervention knowledge score was found to be more (20.44±2.68) than pre intervention knowledge score (14.31±2.77), t=9.19. Post intervention attitude score was found to be more (26.86±3.30) than pre intervention attitude score (18.52±3.68), t=8.17 at 0.05 level of significance. Conclusions: These findings revealed that the video assisted teaching programme on knowledge and practice was effective.

Cryoextraction via flexible bronchoscopy in children with tracheobronchial obstruction.

Cryoextraction via flexible bronchoscopy (FB) can be used to alleviate airway obstruction due to blood clots, casts, mucus, and foreign bodies. There is limited literature regarding the utility of cryoextraction to restore airway patency in critically ill children, especially on extracorporeal membrane oxygenation (ECMO). The aims of this study were to describe the clinical course and outcomes of children who underwent cryoextraction via FB. A singlecenter retrospective review of children who underwent cryoextraction via FB between 2017 and 2021 was conducted. The analyzed data included diagnoses, indications for cryoextraction, respiratory support modalities, FB and chest imaging results, and outcomes. Eleven patients aged 3-17 years underwent a total of 33 cryoextraction sessions via FB. Patients required ECMO (n = 9) or conventional mechanical ventilation (CMV) for pneumonia, pulmonary hemorrhage, pulmonary embolism, asthma exacerbation, and cardiorespiratory failure following cardiac surgery. One patient underwent elective FB and cryoextraction for plastic bronchitis. Indications for cryoextraction included airway obstruction due to tracheobronchial thrombi (n = 8), mucus plugs (n = 1), or plastic bronchitis (n = 2). Cryoextraction via FB was performed on patients on ECMO (n = 9) and CMV (n = 2) with 6 patients requiring ≥3 cryoextraction sessions for airway obstruction. There were no complications related to cryoextraction. Patient outcomes included partial (n = 5) or complete (n = 6) restoration of airway patency with ECMO decannulation (n = 5) and death (n = 4) due to critical illness. Cryoextraction via FB is an effective intervention that can be utilized in critically ill children with refractory tracheobronchial obstruction to restore airway patency and to facilitate liberation from ECMO.

Beyond the Blockage: Unveiling Diagnosis and Management of Choanal Atresia-A Case Series.

Choanal atresia is a rare congenital disorder characterised by anatomical closure of the posterior choana in the nasal cavity due to failed recanalization during foetal development. The main aim of our study is to focus on our experience with choanal atresia and its management. In this study, we are discussing the prospective study of 12 cases of choanal atresia that came to a tertiary hospital from July 2017 to July 2022. All 12 choanal atresia cases underwent thorough evaluation, including history, blood investigations, nasal endoscopy, and CT scanning. Intra-nasal endoscopic choanoplasty with stenting was performed on all patients, followed by a 2-year follow-up, except for one case that missed follow-up after 6months. All 12 cases were female, with their ages varying from newborn to 4months old. In our study, 75% were unilateral and 25% were bilateral cases from newborn to 4months old. The right was more prevalent in unilateral choanal atresia. The mixed type was the most commonly observed. The most common symptom was difficulty breathing and a running nose. All cases achieved an adequate patent airway. No intraoperative complications were noted in any case. All cases of choanal atresia can be diagnosed by a cold spatula test, failure to pass an intra-nasal catheter, and a CT scan is confirmatory. Surgical correction with endoscopic intranasal choanoplasty and stenting has less morbidity, a high success rate, and a lower recurrence rate.

Loss of larger hypoglossal motor neurons in aged Fischer 344 rats

The intrinsic (longitudinal, transversalis and verticalis) and extrinsic (genioglossus, styloglossus, hyoglossus and geniohyoid) tongue muscles are innervated by hypoglossal motor neurons (MNs). Tongue muscle activations occur during many behaviors: maintaining upper airway patency, chewing, swallowing, vocalization, vomiting, coughing, sneezing and grooming/sexual activities. In the tongues of the elderly, reduced oral motor function and strength contribute to increased risk of obstructive sleep apnoea. Tongue muscle atrophy and weakness is also described in rats, yet hypoglossal MN numbers are unknown. In young (6-months, n = 10) and old (24-months, n = 8) female and male Fischer 344 (F344) rats, stereological assessment of hypoglossal MN numbers and surface areas were performed on 16 µm Nissl-stained brainstem cryosections. We observed a robust loss of ∼15 % of hypoglossal MNs and a modest ∼8 % reduction in their surface areas with age. In the larger size tertile of, age-associated loss of hypoglossal MNs approached ∼30 % These findings uncover a potential neurogenic locus of pathology for age-associated tongue dysfunctions.

Edukasi Pemberian Terapi Uap Sederhana untuk Bersihan Jalan Napas Tidak Efektif pada ISPA

Acute respiratory infection (ARI) is one of the public health problems that is important to pay attention to. ARI is an infection that occurs in the respiratory tract, both upper and lower respiratory tract. This infection can cause symptoms of cough, runny nose, and fever. The problem that often arises in this ARI is ineffective airway clearance due to hypersecretion in the respiratory tract. Interventions are carried out to maintain a patent airway so that you can breathe spontaneously without difficulty, pain is reduced and oxygen needs are met. One of the efforts to overcome airway clearance is not effective because of nasal congestion can be done with simple steam therapy with eucalyptus oil. This community service aims to train the community's independence in dealing with health problems experienced, especially related to ARI with simple steam therapy with eucalyptus oil. This activity was carried out on December 19, 2021 in Sesela village, West Lombok district with 43 participants. The method of implementation is through lectures, discussions and demonstrations. The results of the evaluation of this activity showed that participants were able to understand and understand the meaning, signs and symptoms, causes and management of ARI and understand and know how to do simple steam therapy with eucalyptus oil.

Assessing the concern for airway complications introduced by Wendler's glottoplasty.

Wendler's glottoplasty (WG) is a pitch-elevating surgery performed by laryngologists providing gender-affirming care. The surgery creates an anterior glottic web that could theoretically cause airway concerns, either perioperatively or at the time of future procedures; such concerns are not well-described in the literature. We seek to assess surgeon opinions on airway concerns regarding WG. A survey of laryngologists assessing opinions on airway considerations in glottoplasty. A total of 19 physicians responded, representing approximately 193 surgeries. 52.6% performed glottoplasty and the remainder responded based on experience with anterior glottic webs. Two perioperative airway complications were reported, both mild stridor that did not prevent same-day discharge. No long-term sequela was reported. All surveyed laryngologists endorsed an altered general anesthetic approach for future procedures, with 73.7% advocating for use of a smaller endotracheal tube. 72.2% did not have "major concerns" about future intubations, and only 5.3% thought the immediate risk of airway compromise was a "real concern." 91.9% counsel their patients routinely but briefly on airway concerns. Open-ended comments conveyed themes of concern for post-operative disruption of the web more than of airway compromise. Because glottoplasty is performed in the anterior glottis and does not significantly impact airway patency, the risk of serious airway complications appears to be minimal. Laryngologists believe future intubations require a modified approach with a smaller tube, partly due to concern for glottic web trauma. Based on this pilot study, the topic deserves greater work to standardize care and anesthetic alterations for patients with WG. 5.

ABSES SUBMANDIBULA

The purpose of this literature review is as an additional reference in diagnosing and managing submandibular abscess. The writing of this article was obtained from various sources in the form of books, scientific journals and guidelines for related institutions. Source searches were carried out on various online portals such as Medscape, NCBI Google Scholar and other health websites. Submandibular abscess is an inflammation accompanied by accumulation of pus in the potential space between deep neck fascia which is an anatomically very complex space. Nearly all odontogenic infections that cause abscesses are caused by a mixture of aerobic and anaerobic microbes. Necrosis of the dental pulp as a result of deep caries provides an entry channel for bacteria into the periapical tissues. After periapical inoculation of bacteria, infection develops which will spread in all directions, but more in areas of lowest resistance. The main priority for deep neck abscesses is to maintain airway patency, followed by intravenous antibiotics and then surgical drainage.

Proposal of a Full Digital Workflow for a Bite Fork to Assess Mandibular Advancement during Drug-Induced Sleep Endoscopy (DISE) for Obstructive Sleep Apnea

(1) Background. Drug-induced sleep endoscopy (DISE) is currently regarded as the gold standard diagnostic procedure to assess the site(s) of upper airway collapse in subjects affected by Obstructive Sleep Apnea Syndrome (OSAS). During DISE, a jaw thrust maneuver is performed to advance the mandible and to predict the effectiveness of outcomes of treatment with mandibular advancement devices (MADs). However, the maneuver is not predictable and could be influenced by specific patients’ anatomical/functional conditions. The aim of this work is to propose a full-digital workflow for customizing an individual mandibular advancement fork, usable by otorhinolaryngologists during DISE. (2) Materials. Two patients with a diagnosis of mild-to-moderate OSAS (AHI ≥ 5 to ≤30/h of sleep) underwent orthodontic examination to verify the usability of the MAD. Intra-oral scans and registration were performed, including bite registration with 65% of mandibular advancement. The latter measurement was used as a reference to design a 3D-printed fork for DISE, as well as for the future MAD. Both patients underwent DISE in the operating room in the presence of an anesthesiologist, otolaryngologist, orthodontic specialist and neurophysiopathology technician. (3) Results. In the intraoperative polysomnography recording, during sleep, the presence of obstructive apnea was confirmed based on respiratory parameters (PNG1, PNG2, PNG3) with associated desaturation and increased muscle activities on PNG4 (mylohyoid muscle), EMG1 (right masseter muscle) and EMG2 (left masseter muscle). With the advancement fork in place, the immediate improvement effect on all respiratory parameters with normal saturation values and the complete suppression of masseter muscles were observed. Accordingly, both patients were considered potential good-responders to the MAD treatment. (4) Conclusions. The preliminary data shown are encouraging and would suggest that the fork represents a stable reference for the otorhinolaryngologist to evaluate the airway patency within the physiological range of movement. The efficiency of the work-flow from data registration to the DISE procedure and laboratory process represent two significant advantages that justify the integration of a digital system in the management of patients affected by OSAS.

0040 Leptin Signaling in the Dorsomedial Hypothalamus Couples Metabolism and Breathing in Obesity

Abstract Introduction Individuals with obesity hypoventilation syndrome (OHS) are unable to increase ventilation to match increased CO2 production (VCO2). Obstructive sleep apnea (OSA), defined by the closure of the upper airway during sleep, is present in 90% of OHS patients. Leptin, an adipocyte-produced hormone, acts in leptin receptor (LEPRb) positive neurons and was implicated in the pathophysiology of OSA and OHS. Diet-induced obese (DIO) C57BL/6J mice shows features of OHS and OSA. Leptin-mediated neural pathways may link metabolism and breathing in obesity. We hypothesized that LEPRb-positive neurons in the dorsomedial hypothalamus (DMH) are necessary and sufficient to match control of breathing to VCO2 and that the stimulation of these neurons relieves OHS in DIO mice. Methods We expressed designer receptors exclusively activated by designer drugs (DREADDs) in DMH of DIO Leprb-Cre mice and measured breathing during sleep, the hypercapnic ventilatory response (HCVR), VCO2, and O2 consumption (VO2). Results Activation of LEPRb-positive DMH neurons increased inspiratory flow and minute ventilation during REM sleep, without affecting sleep architecture. The effect was pronounced during inspiratory flow limitation, suggeting that upper airway obstruction during REM sleep was relieved. Activation of these neurons increased the HCVR and this response was blunted by a serotonin receptor antagonist, methysergide. Activation of these neurons augmented VCO2, VO2, and VE/VCO2, suggesting that breathing was stimulated out of proportion to increases in metabolism. In vitro experiments revealed that LEPRb-positive DMH neurons project to 5-HT neurons in the dorsal raphe (DR) and that optogenetic stimulation of these neurons evoked excitatory postsynaptic currents in 5-HT neurons of the DR. Administration of retrograde Cre-dependent AAV harboring caspase to the DR in Leprb-Cre mice deleted LEPRb-positive DMH neurons and abolished respiratory and metabolic effects of chemogenetic stimulation. Apoptosis of LEPRb-positive DMH neurons projecting to the DR also prevented the increase in ventilation during REM sleep induced by intranasal leptin. Conclusion Leptin increases the HCVR, improves upper airway patency during sleep, and increases VCO2 acting on LEPRb-positive DMH neurons projecting to the DR. We conclude that LEPRb-positive DMH neurons projecting to the DR couple metabolism and breathing in obesity. Support (if any) NIH (R01 HL128970, R01 HL133100, and R01 HL138932), AHA (#915167).

POSITION OF HEADS OF THE TEMPOROMANDABULARY JOINT AND LINEAR DIMENSIONS OF UPPER RESPIRATORY TRACT IN PATIENTS WITH SKELETAL SAGITAL BITE ANOMALIES

Maxillofacial anomalies not only affect aesthetics but also contribute to temporomandibular joint disease. The position of the temporomandibular joint and occlusal factors can influence the airway patency therefore medical interventions should aim at restoring normal breathing, treating TMJ and muscles, and then correcting the occlusion. The aim of this study is to investigate the relationship between the position of the lower jaw, position of TMJ heads, and changes in upper respiratory tract in patients with Class I and II skeletal sagittal bite anomalies according to Angle's classification.&#x0D; Cone-beam computer tomograms of 64 patients were analyzed. The patients were divided into two groups based on the ANB angle. The position of the temporomandibular joint heads was determined using N. Gelb's method in the mid-sagittal plane, while the linear parameters of the upper respiratory tract were assessed using the McNamara method. Regardless of the bite pathology, only 12.5% of patients (n=8) exhibited the correct symmetrical position of the TMJ heads on both sides according to the Gelb grid. In the 1st group, the average width of the upper and lower parts of the pharynx measured by the McNamara method was 17.41±0.44mm and 10.1±0.73mm, respectively. In the 2nd group, the average width of the upper part was 15.82±0.61mm, and the lower part measured 10.25±0.51mm. Among orthodontic patients with Class I and II bite anomalies, only a small percentage (12.5%) was found to have the correct and symmetrical position of the temporomandibular joint. The reduction in the width of the lower respiratory tract in these patients may be associated with posterior displacement of the temporomandibular joint heads.

Sleep bruxism in children, from evidence to the clinic. A systematic review.

The present paper aims to systematically review the literature published from 2015 to 2023 on bruxism in children with the aim to compilate the best available evidence. A systematic search in the National Library of Medicine's PubMed, Medline (EBSCO), SCOPUS, and Google Scholar databases was performed to identify all studies on humans assessing genetic, biopsychosocial, and sleep factors assessed with any different approach for sleep bruxism (SB) in children and its interventions. The selected articles were assessed independently by the two authors according to a structured reading of the article's format (PICO). The quality of the articles was evaluated using Quality Assessments Tool for Experimental Bruxism Studies (Qu-ATEBS) and the JBI critical appraisal tools. A total of 16 articles were included for discussion in the review and grouped into questionnaire/parental-report (n = 7), SB assessment through parental report of SB and clinical examination (n = 4), and instrumental assessment (n = 5) studies. The total quality scores evaluated with STROBE and Qu-ATEBS were high for all included papers. However, in general, there was no control of bias strategies and there was no control group in the intervention studies. Investigations based on self-report, clinical, and instrumental bruxism assessment showed a positive association with genetics, quality of life aspects (school and emotional functions and overuse of screen-time), mother anxiety and family conformation, diet, alteration in sleep behaviors and architecture, and sleep breathing disorders. Additionally, the literature presents options to increase airway patency and, thus, reduce the occurrence of SB. Tooth wear was not found to be a major sign of SB in children. However, methods of SB assessment are heterogeneous and hamper a reliable comparison of the results.

Incidence of Airway Complications in ICU.

To show the incidence of airway complications in ICU. Endotracheal intubation is an essential skill performed by multiple medical specialists to secure a patient's airway as well as provide oxygenation and ventilation through the oral route or nose. The goal of endotracheal intubation in the emergency setting is to secure the patient's airway and obtain first-pass success. There are many indications for endotracheal intubation, including poor respiratory drive, questionable airway patency, hypoxia, and Hypercapnia. These indications are assessed by evaluating the patient's mental status, conditions that may compromise the airway, level of consciousness, respiratory rate, respiratory acidosis, and level of oxygenation. In the setting of trauma, a Glasgow Coma Scale of 8 or less is generally an indication for intubation. There are many different complications of intubation as hoarseness of voice, dental injuries, arytenoid dislocation, laryngeal stenosis, tracheal stenosis and tracheomalacia. . 150 patients who were sat in the ICU that developed certain complications. 86 patients (57.3%) were sitting in the ICU develoed certain complications. Liver diseases were the main cause of ICU admission 34 (22.7%) patients then shock 32 (21.3%) patients. Blockage of endotracheal tube was the main ICU complications 18 (12%) patients then sinusitis 16 (10.7%) patients. Endotracheal intubation is a lifesaving procedure and its complications are significant problems in ICUs. A successful procedure of intubation avoids complications. Skilled endotracheal intubation in the ICU decreases the complications.

Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies.

Bronchial anomalies are rare but challenging conditions to treat in children, encompassing a variety of structural abnormalities that could compromise airway patency. This includes complete rings, absent cartilage, traumatic avulsions, bronchoesophageal fistulas, and cartilaginous sleeves. The objective of this study is to describe the characteristics and outcomes of a series of pediatric cases of bronchial anomalies that were treated by slide tracheobronchoplasty. This is a single-institution retrospective case series of pediatric patients with bronchial anomalies who underwent surgical treatment between February 2004 and April 2020. Data extracted from electronic medical records included patient demographics, comorbidities, and surgical outcomes. There were a total of 29 patients included in the study, of which 14 had complete bronchial rings, 8 had absent bronchial rings, 4 had traumatic bronchial avulsions, 2 had bronchoesophageal fistulas, and one had a cartilaginous sleeve. Median follow-up time was 13 months (with a range of 0.5-213 months). The overall mortality rate was 17.2% (5 patients), all of whom had complete bronchial rings. Patients with complete bronchial rings also had a higher rate of not only cardiac (85.7%) and pulmonary comorbidities (85.7%) but also secondary airway lesions (78.6%). This is the largest series to date describing surgical treatment for bronchial anomalies. Complete bronchial rings were the most common anomaly treated, followed by absent rings and trauma. Surgical treatment can be successful but mortality rates are higher in patients with complete bronchial rings, possibly due to higher rates of pulmonary and cardiac comorbidities. 4 Laryngoscope, 133:3334-3340, 2023.

The effects of benralizumab on airway geometry and dynamics in severe eosinophilic asthma: a single-arm study design exploring a functional respiratory imaging approach

BackgroundSevere eosinophilic asthma (SEA) is characterised by elevated blood/sputum eosinophil counts and airway inflammation, which can lead to mucus plug-mediated airway obstruction, increased exacerbation frequency, declines in lung function, and death. Benralizumab targets the alpha-subunit of the interleukin-5 receptor found on eosinophils, leading to rapid and near complete eosinophil depletion. This is expected to result in reduced eosinophilic inflammation, reduced mucus plugging and improved airway patency and airflow distribution.MethodsBURAN is an interventional, single-arm, open-label, uncontrolled, prospective, multicentre study during which participants will receive three 30 mg subcutaneous doses of benralizumab at 4-week intervals. This study will use functional respiratory imaging (FRI), a novel, quantitative method of assessing patients’ lung structure and function based on detailed, three-dimensional models of the airways, with direct comparison of images taken at Weeks 0 and 13. Patients aged ≥ 18 years with established SEA who may be receiving oral corticosteroids and/or other asthma controller medications, who are inadequately controlled on inhaled corticosteroid-long-acting β2-agonist therapies and who have had ≥ 2 asthma exacerbations in the previous 12 months will be included. The objectives of BURAN are to describe changes in airway geometry and dynamics, measured by specific image-based airway volume and other FRI endpoints, following benralizumab therapy. Outcomes will be evaluated using descriptive statistics. Changes in FRI parameters, mucus plugging scores and central/peripheral ratio will be quantified as mean percent change from baseline (Week 0) to Week 13 (± 5 days) and statistical significance will be evaluated using paired t-tests. Relationships between FRI parameters/mucus plugging scores and conventional lung function measurements at baseline will be assessed with linear regression analyses for associations between outcomes, scatterplots to visualise the relationship, and correlation coefficients (Spearman’s rank and Pearson’s) to quantify the strength of these associations.ConclusionsThe BURAN study will represent one of the first applications of FRI—a novel, non-invasive, highly sensitive method of assessing lung structure, function and health—in the field of biologic respiratory therapies. Findings from this study will increase understanding of cellular-level eosinophil depletion mechanisms and improvements in lung function and asthma control following benralizumab treatment.Trial registration EudraCT: 2022-000152-11 and NCT05552508

Retrospective Investigation of Difficult Airway Cases Encountered in Bursa Uludag˘ University Medical Faculty Operating Room.

Ensuring airway patency and proper management of ventilation by anticipating difficulties that can occur in airway control are vital in preventing anaesthesia-related complications. We aimed to determine the role of preoperative assessment findings in difficult airway management. In this study, critical incident records of difficult airway patients between 2010 and 2020 in the operating room of Bursa Uludag˘ University Medical Faculty were retrospectively analysed. A total of 613 patients, whose records were fully accessible, were grouped as paediatric (under 18 years old) and adult (18 years and over). The success rate for maintaining an airway in all patients was 98.7%. Pathological situations which cause difficult airways were head and neck region malignancies in adult patients and congenital syndromes in paediatric patients. Anatomical reasons that cause difficult airway were anterior larynx (31.1%) and short muscular neck (29.7%) in adult patients and small chin (38.0%) in paediatric patients. A significant statistical relationship was found between difficult mask ventilation and increased body mass index, male gender, modified Mallampati class 3-4, and thyromental distance <6 cm (P = .001, P < .001, P < .001, and P < .001, respectively). The correlation of Cormack-Lehane grading with modified Mallampati classification, upper lip bite test, and mouth opening distance was statistically significant (P < .001, P < .001, and P < .001, respectively). In male patients with increased body mass index, modified Mallampati test class of 3-4 and thyromental distance of < 6 cm should suggest the possibility of difficult mask ventilation. In modified Mallampati classification and upper lip bite tests, the possibility of difficult laryngoscopy should be considered as class increases and mouth opening distance becomes shorter. Preoperative assessment, including a good history taken from the patient and a complete physical examination, is crucial to provide solutions for difficult airway management.

Mechanics and Dynamics of the Pharynx

Maintaining airway patency during anaesthesia is the primary responsibility of the anaesthesiologist. Apart from anaesthetic agents, there are many factors which influence the pharyngeal patency. Understanding the pharyngeal collapsibility and behaviour of the upper airway during sleep would help in increasing the safety of patients under anaesthesia. The mechanism of pharyngeal collapse, the role of pharyngeal dilators, negative intra-thoracic pressure and multiple other factors involved to maintain pharyngeal patency are described in the article. Clinical and radiological tools to predict upper airway collapsibility have also been explained with supportive evidence. This article should be considered a resource for concepts of pharyngeal dynamics and mechanics to improve airway patency and to predict pharyngeal collapsibility and thereby safety during anaesthesia.

The application of simultaneous mainstem bronchus dilation with pulmonary artery stenting in the context of hypoplastic left heart syndrome

Hypoplastic left heart syndrome (HLHS) is a congenital diagnosis that necessitates immediate intervention at the beginning of life to ensure survival past infancy and to optimize left-side cardiac function. Often, these required procedures can lead to deleterious side effects and resultant complications. In this case report, we present a 15-month-old patient with HLHS who underwent multiple procedures, including two aortic arch surgeries. After the interventions, the patient experienced left main pulmonary bronchus compression along with pulmonary artery stenosis. In this case, we outline an approach to performing vascular dilation without compromise of airway patency.