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Lower airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Kimberley R. Kaspy, Sara M. Zak
Tracheal stenosisTracheal stenosis involves significant narrowing of the trachea. The most common cause is congenital complete tracheal rings,15,16 in which the tracheal cartilage forms a complete ring (as opposed to the typical ~300 degree C-shaped ring) as shown in Figure 5.5. Congenital tracheal stenosis can present with life-threatening respiratory failure and often requires surgical intervention.17 Complete tracheal rings can characteristically be associated with cardiovascular anomalies such as pulmonary artery sling or with trisomy 21.Acquired tracheal stenosis can occur from prolonged intubation, infection, or inflammation.17Idiopathic tracheal stenosis can occur in pediatric patients but is generally seen in adult women.17,18 This can involve small sections of the trachea or the entire trachea.
Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
A tracheostomy is a surgical procedure whereby an opening is made in the anterior trachea in order to facilitate ventilation. Emergency tracheostomy is undertaken in the context of acute airway obstruction e.g. foreign body aspiration, Ludwig angina, obstructive laryngeal cancer, or where endotracheal intubation is not possible. Indications for elective tracheostomy include ventilatory wean, as a part of head and neck cancer treatment, subglottic stenosis and chronic aspiration. Early complications include bleeding, infection and pneumothorax. Late complications include subglottic stenosis and tracheoinnominate fistula (a rare but potentially life-threatening complication that presents with significant bleeding).
Congenital Laryngeal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Partial or complete collapse of the trachea or bronchi during respiration is caused by a lack of rigidity in the developing cartilage. To some degree, this is physiological, but it can be severe and even life-threatening. It is ‘primary’ if it occurs due to segmental or complete maldevelopment of the tracheal rings, and ‘secondary’ if it occurs as a result of compression, (e.g. by a vascular ring or in association with a TOF) where it can complicate surgical repair. In severe cases, the child will have what parents and physicians often refer to as ‘dying spells’ when the airway compromise gives rise to apnoea and cyanosis, especially brought about by expiration as the smaller airways close off. Diagnosis is confirmed by endoscopy, often supplemented by contrast bronchography, especially if there is a prominent element of bronchomalacia.
Targets for obstructive sleep apnea pharmacotherapy: principles, approaches, and emerging strategies
Published in Expert Opinion on Therapeutic Targets, 2023
The upper airspace is an obligatory conduit for airflow into the lungs, but it also has the property of a collapsible tube (Figure 1). This property is essential to its non-breathing functions that require dynamic changes in airway size to move air, liquids, and solids during behaviors such as vocalization, suckling, chewing, and swallowing. To enable such motor activities, the upper airspace is surrounded by a complex anatomical arrangement of skeletal muscles and soft tissues. This structural arrangement is unlike the trachea and bronchi, for example, which are more rigid and non-collapsible as they are supported by cartilage. This property of a collapsible pharynx can compromise the essential respiratory function as a conduit for airflow. The pharynx is particularly vulnerable to closure during sleep when pharyngeal muscle tone is diminished.
Incidence, Complications, and Factors Associated with Out-of-Hospital First Attempt Intubation Failure in Adult Patients: A Secondary Analysis of the CURASMUR Trial Data
Published in Prehospital Emergency Care, 2022
Thomas Nicol, Cédric Gil-Jardiné, Patricia Jabre, Frederic Adnet, Patrick Ecollan, Bertrand Guihard, Cyril Ferdynus, Xavier Combes
Tracheal intubation is one of the most critical interventions performed by emergency physicians (1). Moreover, emergency airway management is often considered to be more difficult in the out-of-hospital setting than in hospital situations. In patients with spontaneous cardiac activity needing emergency intubation, it is well established that a rapid sequence intubation (RSI) lowers the difficult intubation rate and increase the first attempt intubation success rate (2–4). Most studies that assessed first attempt intubation failure rate in out-of-hospital emergency setting have included both patients in cardiac arrest and with spontaneous cardiac activity during their airway control process (5, 6). In these studies, 35% and 50% of patients were respectively in cardiac arrest at the moment of intubation and thus, it was not possible to assess only those patients intubated using RSI (5, 6). If first attempt intubation failure rate in emergency context has been already reported in several studies, assessment of its associated factors for patients intubated under a RSI technique have rarely been evaluated in a large cohort of patients managed in an out-of-hospital setting (7–9). The aim of this further analysis of the CURASMUR data was to assess the first intubation attempt failure rate and to assess its associated factors and related complications in a large population of adult patients intubated for life-threatening distress using RSI as a systematic procedure.
Investigation of airflow at different activity conditions in a realistic model of human upper respiratory tract
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Reza Tabe, Roohollah Rafee, Mohammad Sadegh Valipour, Goodarz Ahmadi
Velocity vectors within the trachea at sections R11 to R15 are presented in Figure 7. Here, the in-plane velocity vectors are shown for inhalation airflow rates of 30, 45, and 60 L/min. It is seen that the airflow pattern in the trachea is influenced by the upstream laryngeal jet. The velocity vectors shown in sections R11 to R15 demonstrate that the airflow pattern experiences significant variation as it crosses the trachea. The velocity vectors in the trachea are similar for three breathing rates studied and exhibit certain vortical structures. For 30 and 45 L/min, the formation of two vortices at R11 and R12 show the appearance of flow recirculation, due to the sudden opening of the passage. When the inspiratory flow rate reaches to 60 L/min, a small vortex near to the right wall, and a larger vortex close to the left wall are observed. At R13, near the right wall, a single vortex is formed, with a counter-clockwise rotation. Interestingly, compared to the 30, and 45 L/min breathing cases, the vortex is weaker for the 60 L/min breathing rate and tends to decay faster. Similar behavior was reported by Kleinstreuer and Zhang (2003) and Corcoran and Chigier (2000). When the airflow moves down the trachea, the secondary flow pattern decreases and becomes quite weak at R14 and R15 sections.