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Pathogenesis of Sleep-Disordered Breathing in Adults
Published in Susmita Chowdhuri, M Safwan Badr, James A Rowley, Control of Breathing during Sleep, 2022
Thomas M Tolbert, Indu Ayappa, David M Rapoport
The upper airway is a conductive passage for the flow of air from the ambient atmosphere to the trachea. In normal subjects, nasal breathing predominates during sleep, with inspiratory airflow beginning at the nares, passing through the nasal passages, the nasopharynx, velopharynx, oropharynx, and hypopharynx before finally reaching the trachea (16, 17).
Tracheostomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Kate Stephenson, Michelle Wyatt
Tracheostomy is one of the oldest documented surgical procedures and was initially used to relieve upper airway obstruction, principally associated with acute airway infections such as diphtheria and croup. Advances in vaccination and pediatric intensive care practices including endotracheal intubation have reduced this need. The majority of pediatric tracheostomies are now performed for long-term airway or respiratory support.
The immune and lymphatic systems, infection and sepsis
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Michelle Treacy, Caroline Smales, Helen Dutton
Airway patency can be compromised due to rapidly swelling deep tissues of the mucus membranes and lips known as angioedema. Swelling of the tongue associated with oropharyngeal and laryngeal oedema may also threaten the airway. The patient’s ability to swallow their own saliva should be assessed, and the development of a hoarse voice indicates partial airway obstruction. High-pitched inspiratory noise or stridor is caused by upper airway obstruction and should be immediately recognised and dealt with by summoning urgent help via the peri-arrest or cardiac arrest call systems. Under the direction of the medical team, intramuscular adrenaline and other pharmacology agents should be urgently administered. Worsening signs of airway obstruction include: Swelling of tongue and lips.Hoarseness.Oropharyngeal swelling.
Nanocrystals based pulmonary inhalation delivery system: advance and challenge
Published in Drug Delivery, 2022
Pengfei Yue, Weicheng Zhou, Guiting Huang, Fangfang Lei, Yingchong Chen, Zhilin Ma, Liru Chen, Ming Yang
The lungs are the organs that contact with the exchange of air between the organism and the outside world. They are divided into two main regions: the conducting airway region and the respiratory region. The airway is a continuous branch from the bronchi to the lungs and consists mainly of bronchi, bronchioles, and terminal bronchioles. As the bronchi continue to branch, the diameter of the tubes becomes smaller, the tube wall becomes thinner, and the structure of the tube wall changes gradually. The annular smooth muscles of the bronchi contract or relax under splanchnic nerves innervation and it is responsible for the regulation of airflow passage into the alveoli. This is the site where the lung tissue completes gas exchange consisting of respiratory bronchioles, alveolar ducts, lung sacs, and alveoli. The respiratory bronchiole is the transitional pipes between the pulmonary airway and the respiratory site. Each respiratory bronchiole branch is divided into 2–3 alveolar ducts. The alveolar sacs are the common opening of several alveoli and are connected to the alveolar ducts. The gut is the main site for the digestion and absorption of nutrients.
A computational model of upper airway respiratory function with muscular coupling
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Olusegun J. Ilegbusi, Don Nadun S. Kuruppumullage, Matthew Schiefer, Kingman P. Strohl
Figure 7 shows the predicted velocity distribution within the airway lumen for the three cases considered. Figure 7(a) presents the velocity distribution within the airway in the standing position. Air enters the airway from the nasal cavity and flows down through the airway lumen to the larynx. As expected, the highest velocity magnitude occurs near the axis of the airway lumen and the smallest velocities occur near the walls of the airway due to frictional effects are highest. There is no significant airflow into the oral cavity in both the standing posture (Figure 7(a)) and the case when dilator muscle is activated (Figure 7(c)). The result is consistent with the fact that a typical human being inhales air through the nose during breathing if no obstruction occurs. Some localized swirls are observed mostly near the irregular morphological regions of the airway. The airflow, however, is found to be significantly disturbed in the supine position due to the partial airway collapse. Specifically, the velocity within the lumen increases significantly in the epiglottic region to compensate for the narrowing walls. Figure 7(c) shows a notable recovery of the air flow velocity in the airway lumen with activation of the dilator muscle. Dilator muscle activation causes the airway to expand and allows air to flow with minimal obstruction. In our model, we allowed the oral cavity to have a small opening which in turn allows air to flow freely through the oral cavity.
Stents for small airways: current practice
Published in Expert Review of Respiratory Medicine, 2020
Paul Zarogoulidis, Konstantinos Sapalidis, Christoforos Kosmidis, Kosmas Tsakiridis, Haidong Huang, Chong Bai, Wolfgang Hohenforst-Schmidt, Stavros Tryfon, Anastasios Vagionas, Konstantinos Drevelegas, Eleni-Isidora Perdikouri, Lutz Freitag
Airway obstruction can be induced either by cancer or benign causes. Benign bronchus stenosis is being caused by: tuberculosis, sarcoidosis, vasculitis, and chronic inflammation due to smoking in chronic obstructive pulmonary disease patients or lung transplantation [1]. Tracheomalacia can be caused by infection, and stent placement could be used if surgery is not possible. Moreover, due to malignancies (lung cancer or metastatic cancer in the bronchus), after treatment with radiotherapy or surgical intervention such as sleeve resection can lead to atelectasis and impairment of lung function [2]. The ideal airway stent should: (a) be easy to place and remove, (b) be large enough to maintain position, (c) be flexible enough to mimic airway physiology but have sufficient radial force to resist airway compression, (d) yet not too large and as congruent as possible to avoid granulation tissue reactions, and (e) not impair mucociliary clearance. The time to insert the stent is also very important; in benign inflammatory diseases we should wait until the inflammation stops, unless it is absolutely necessary for the respiration of the patient. In any case, the main purpose of stent placement is the improvement of quality of life.