scholarly journals Continuous positive airway pressure titration in infants with severe upper airway obstruction or bronchopulmonary dysplasia

Critical Care ◽  
2013 ◽  
Vol 17 (4) ◽  
pp. R167 ◽  
Author(s):  
Sonia Khirani ◽  
Adriana Ramirez ◽  
Sabrina Aloui ◽  
Nicolas Leboulanger ◽  
Arnaud Picard ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Obstruction ◽  
Bronchopulmonary Dysplasia ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction

Tracheomalacia in an Infant with Multiplex Congenita (Larsen's) Syndrome

1981 ◽  
Vol 90 (4) ◽  
pp. 303-306 ◽  
Author(s):  
Kenneth M. Grundfast ◽  
Robert Kanter ◽  
Anwar Mumtaz ◽  
Murray Pollack
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Tracheal Lumen ◽  
Thoracic Cage ◽  
Adequate Ventilation

An infant born with multiplex congenita (Larsen's) syndrome developed respiratory distress 30 days following tracheostomy for relief of upper airway obstruction. The infant had structural and functional abnormalities of the thoracic cage. Tracheobronchoscopy revealed excessive compliance of the trachea with a tendency for collapse of the tracheal rings and obliteration of the tracheal lumen. Continuous positive airway pressure in the range of 20–25 cm H2O was used to maintain patency of the tracheal lumen and assure adequate ventilation. Hemodynamic and pulmonary barometric complications often observed when high levels of positive airway pressure are utilized in infants were not observed.

scholarly journals Severe upper airway obstruction in a preterm infant with nasal continuous positive airway pressure

2009 ◽  
Vol 2009 (mar02 1) ◽  
pp. bcr0920080889-bcr0920080889
Author(s):  
N. Nakwan ◽  
P. Pornladnum ◽  
J. Chokechuleekorn ◽  
P. Dissaneevate
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Obstruction ◽  
Preterm Infant ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction

Bench Model To Simulate Upper Airway Obstruction for Analyzing Automatic Continuous Positive Airway Pressure Devices

CHEST Journal ◽  
2006 ◽  
Vol 130 (2) ◽  
pp. 350-361 ◽  
Author(s):  
Jordi Rigau ◽  
Josep M. Montserrat ◽  
Holger Wöhrle ◽  
Diana Plattner ◽  
Matthias Schwaibold ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Bench Model

P372 Upper airway obstruction may affect nasal continuous positive airway pressure level

2006 ◽  
Vol 7 ◽  
pp. S75
Author(s):  
Kwon Hyo Bok ◽  
Hyo Yeol Kim ◽  
Jin-Young Min ◽  
Seung Kyu Chung ◽  
Hun-Jong Dhong ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Pressure Level ◽  
Upper Airway Obstruction

scholarly journals 1244 A Curious Case of ASV Failure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A474-A474
Author(s):  
Nishant Chaudhary ◽  
Mirna Ayache ◽  
John Carter
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Neck Extension ◽  
Sleep Study ◽  
Obstructive Sleep

Abstract Introduction Positive airway pressure-induced upper airway obstruction has been reported with the treatment of obstructive sleep apnea (OSA) using continuous positive airway pressure (CPAP) along with an oronasal interface. Here we describe a case of persistent treatment emergent central sleep apnea (TECSA) inadequately treated with adaptive servo ventilation (ASV), with an airflow pattern suggestive of ASV-induced upper airway obstruction. Report of Case A 32-year-old male, with severe OSA (apnea hypopnea index: 52.4) and no other significant past medical history, was treated with CPAP and required higher pressures during titration sleep studies to alleviate obstructive events, despite a Mallampati Class II airway and a normal body mass index. Drug-Induced Sleep Endoscopy (DISE) showed a complete velopharynx and oropharynx anterior posterior (AP) collapse, long soft palate, which improved with neck extension. CPAP therapy, however, did not result in any symptomatic benefit and compliance reports revealed high residual AHI and persistent TECSA. He underwent an ASV titration sleep study up to a final setting of expiratory positive airway pressure 9 cm H2O, pressure support 6-15 cm H2O (auto-rate), with a full-face mask due to high oral leak associated with the nasal interface. The ASV device detected central apneas and provided mandatory breaths, but did not capture the thorax or abdomen, despite normal mask pressure tracings. Several such apneas occurred, with significant oxyhemoglobin desaturation. Conclusion We postulate that the ASV failure to correct central sleep apnea as evidenced by the absence of thoracoabdominal inspiratory effort, occurred due to ASV-induced upper airway obstruction. Further treatment options for this ASV phenomenon are to pursue an ASV-assisted DISE and determine the effectiveness of adjunctive therapy including neck extension, nasal mask with a mouth closing device and a mandibular assist device.

scholarly journals Surgical Versus Nonsurgical Interventions to Relieve upper Airway Obstruction in Children with Pierre Robin Sequence

2015 ◽  
Vol 22 (3) ◽  
pp. 171-175 ◽  
Author(s):  
Karen Kam ◽  
Meghan McKay ◽  
Joanna MacLean ◽  
Manisha B Witmans ◽  
Sheldon Spier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Pierre Robin Sequence ◽  
Pierre Robin

BACKGROUND: Newborns with Pierre Robin sequence (PRS) often experience chronic intermittent hypoxemia/hypoventilation associated with airway obstruction. The heterogeneity of the severity of upper airway obstruction makes management a challenge; the optimal intervention in individual cases is not clear.OBJECTIVE: To investigate the prevalence of surgical/nonsurgical interventions for PRS at two children’s hospitals. Patient characteristics and outcomes were examined.METHODS: The present retrospective chart review identified 139 patients with PRS born between 2000 and 2010. Demographic information, mode of airway management, associated anomalies and syndromes, polysomnography results, length of intensive care unit and hospital stay, complications and deaths were extracted.RESULTS: Interventions included prone positioning (alone [61%]), tongue-lip adhesion (45%), nasopharyngeal intubation (28%), continuous positive airway pressure (20%), tracheostomy (19%) and mandibular distraction osteogenesis (5%). Tracheostomies were more prevalent in syndromic patients (P=0.03). Patients who underwent tracheostomy had a lower birth weight (P=0.03) compared with newborns with other interventions. Patients who underwent surgical interventions had longer intensive care unit stays (P<0.001). No intervention was associated with a statistically significant likelihood of requiring a subsequent intervention. Thirty percent of patients underwent polysomnography, with a higher proportion of these using continuous positive airway pressure (n=15) (P<0.01).CONCLUSIONS: In the present descriptive study, patients with syndromic PRS or low birth weight underwent early intervention, which included a tracheostomy. Objective measures of airway obstruction were underutilized. Decision making regarding evaluation and management of upper airway obstruction in this population remains clinician and resource dependent. Reporting data obtained from a large cohort of PRS patients is important to compare experiences and motivate future studies investigating this complex condition.

scholarly journals Continuous positive airway pressure treatment does not normalize the prolonged reflex inhibition to inspiratory loading in obstructive sleep apnea

2016 ◽  
Vol 121 (4) ◽  
pp. 910-916
Author(s):  
Nicholas P. S. Murray ◽  
David K. McKenzie ◽  
Simon C. Gandevia ◽  
Jane E. Butler
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Cpap Therapy ◽  
Airway Occlusion ◽  
Obstructive Sleep

In obstructive sleep apnea (OSA), the short-latency inhibitory reflex (IR) of inspiratory muscles to airway occlusion is prolonged in proportion to the severity of the OSA. The mechanism underlying the prolongation may relate to chronic inspiratory muscle loading due to upper airway obstruction or sensory changes due to chronic OSA-mediated inflammation. Continuous positive airway pressure (CPAP) therapy prevents upper airway obstruction and reverses inflammation. We therefore tested whether CPAP therapy normalized the IR abnormality in OSA. The IR responses of scalene muscles to brief airway occlusion were measured in 37 adult participants with untreated, mostly severe, OSA, of whom 13 were restudied after the initiation of CPAP therapy (usage >4 h/night). Participants received CPAP treatment as standard clinical care, and the mean CPAP usage between initial and subsequent studies was 6.5 h/night (range 4.1-8.8 h/night) for a mean of 19 mo (range 4–41 mo). The duration of the IR in scalene muscles in response to brief (250 ms) inspiratory loading was confirmed to be prolonged in the participants with OSA. The IR was assessed before and after CPAP therapy. CPAP treatment did not normalize the prolonged duration of the IR to airway occlusion (60 ± 21 ms pretreatment vs. 59 ± 18 ms posttreatment, means ± SD) observed in participants with severe OSA. This suggests that the prolongation of IR reflects alterations in the reflex pathway that may be irreversible, or a specific disease trait.

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