Chronic inflammatory airway diseases,such as chronic bronchitis,chronic obstructive pulmonary disease,emphysema,and bronchial asthma,pose significant healthcare challenges.Interventional treatments offer promise as va...Chronic inflammatory airway diseases,such as chronic bronchitis,chronic obstructive pulmonary disease,emphysema,and bronchial asthma,pose significant healthcare challenges.Interventional treatments offer promise as valuable complements to the optimal medical therapy recommended by the Global Initiative for Chronic Obstructive Lung Disease guideline and the Global Initiative for Asthma guideline.By directly accessing the airways,these minimally invasive procedures enable precise interventions.They encompass a wide range of techniques including bronchial thermoplasty and targeted lung denervation for both chronic obstructive pulmonary disease and severe asthma,bronchoscopic lung volume reduction(including the use of endobronchial valves,coils,and bronchoscopic thermal vapor ablation),airway bypass and peripheral stent placement for emphysema,bronchial rheoplasty and spray cryotherapy for chronic bronchitis,and other emerging methods.These interventional treatments aim to improve patients’symptoms by reducing lung volume,alleviating hyperinflation,eliminating vagal innervation,disrupting hyperplastic goblet cells and thus reducing excessive mucus secretion,and weakening submucosal smooth muscles.This review highlights the potential advantages of interventional treatments for chronic inflammatory airway diseases and discusses relevant techniques tailored to specific disease subtypes.The overall aim is to assist interventional pulmonologists in selecting the most appropriate techniques for individual patients.展开更多
BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibula...BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibular retrognathism with the normal anteroposterior skeletal relationship,thereby assessing the association between cephalometric variables and airway morphology.METHODS Cone-beam computed tomography volume scans,and lateral cephalograms,3-dimensional airway volume and cross-sectional areas of 120 healthy children(54 boys and 66 girls mean age 15.19±1.28)which were done for orthodontic assessment were evaluated.The subjects were divided into 2 groups based on the angle formed between point A,Nasion and point B(ANB)values and cephalometric variables(such as anterior and posterior facial height,gonial angle etc.)airway volumes,and cross-sectional measurements were compared using independent t tests.Pearson’s correlation coefficient test was used to detect any relationship of different parts of the airway and between airway volume and 2-dimensional cephalometric variables.RESULTS Means and standard deviations for cephalometric,cross-sectional,and volumetric variables were compared.ANB,mandibular body length and facial convexity were statistically highly significant(P<0.01)whereas condylion to point A,nasal airway and total airway volume(P<0.05)were statistically significant.The nasal airway volume and the superior pharyngeal airway volume had a positive correlation(P<0.01),nasal airway was correlated to middle(P<0.05)and total airway superior had a relation with middle(P<0.05),inferior and total airway(P<0.05),middle was related to all other airways;inferior was also related to all the airways except nasal.Lateral cephalometric values were positively correlated with the airway volume with Frankfurt Mandibular Plane Angle and facial convexity showed significant correlations with total airway volume(P<0.05).Additionally,ANB angle was significantly correlated with total airway volume and superior airway(P<0展开更多
Traditionally, there are two main methods of mask placement during face mask ventilation: one handed (CE) grip and two handed grip (THT). One handed grip is limited by air leaks between mask and patients face on the s...Traditionally, there are two main methods of mask placement during face mask ventilation: one handed (CE) grip and two handed grip (THT). One handed grip is limited by air leaks between mask and patients face on the side opposite to stabilizing hand. Two handed grips provide protection against air leak but require second provider to deliver tidal volumes when using a self inflating bag or anesthesia circuit on manual ventilation. This study introduces modified CE grip which creates a firm seal at patient’s face on both sides of mask, enabling adequate tidal volume delivery with provider’s second hand. Using left hand, provider places the fifth digit along inferior border of body of left mandible. The fourth digit is placed along inferior border of body right mandible. Standing 6 inches to the left and immediately behind a supine patient on an OR table, provider rotates clockwise 45 degrees at hip, keeping elbow against their body, and lifts patient’s chin to 45 degrees. Rotational force at hip augments hand strength while tilting chin. The thumb applies pressure along left border of facemask, and the second and third digits apply pressure to right border of facemask. Methods: Patients with known predictors of difficult mask ventilation (Edentulous, bearded, Obstructive sleep apnea (OSA), mallampati 3 or 4) were in experimental group. Normal patients assigned as Controls. After induction of general anesthesia, provider ventilated patient using adult sized facemask. The anesthesia ventilator delivered standardized tidal volumes. TV, airway pressures, HR and O2 saturation were recorded after each breath. Results: All groups, except OSA, showed improvement, in tidal volumes with the novel technique compared to the traditional CE grip. Conclusion: The novel submandibular technique, an important skill, increases tidal volumes during mask ventilation for certain high risk patients.展开更多
Objective： The laryngeal mask airway （LMA） is an established way for airway control during spontaneous ventila- tion. Its ability to deliver positive pressure ventilation without leakage especially in low flow stat...Objective： The laryngeal mask airway （LMA） is an established way for airway control during spontaneous ventila- tion. Its ability to deliver positive pressure ventilation without leakage especially in low flow states is still controversy. The aim of this study is to test the possibility of using LMA in pediatric closed circuit controlled ventilation, and to find out the optimum cuff volume to perform closed system ventilation. Methods： Twenty children scheduled for elective surgeries were enrolled in a crossover study. Laryngeal mask airway was used. In stage I, the cuff was inflated with the maximum volume of air as rec- ommended by the manufacturers. Adjustment of volume of air inflated into the LMA cuff to the minimum volume to obtain the effective seal was done at stage II. The leak pressure, intracuff pressure and the leak volume were measured in both stages. Results： The cuff filling volume was significantly lower compared to the maximum cuff inflation volume in stage I. Leakage values showed significantly less values in stage II of the study with smaller cuff inflation volumes. The airway leakage pressure was significantly lower in stage fl in comparison to stage I. Cuff inflation pressure in stage I showed marked elevation which dropped significantly after adjustment of cuff volume in stage I1. Conclusion： Laryngeal mask airway is an effective tool to provide closed circuit controlled ventilation in pediatrics. Inflation of the cuff by the minimum volume of air needed to reach the just sealing pressure is suggested to minimize the leakage volume.展开更多
目的 探讨喉罩（LMA）合理的套囊充气容量.方法 择期手术30例置入4号一次性喉罩,测量套囊充气容量范围为0～30 ml（每5 ml递增）的套囊内压（ICP）和口咽漏气压（OLP）;并测量ICP为60 cm H2O时的OLP和套囊充气容量;记录ICP为60 cm H2O...目的 探讨喉罩（LMA）合理的套囊充气容量.方法 择期手术30例置入4号一次性喉罩,测量套囊充气容量范围为0～30 ml（每5 ml递增）的套囊内压（ICP）和口咽漏气压（OLP）;并测量ICP为60 cm H2O时的OLP和套囊充气容量;记录ICP为60 cm H2O时正压通气苏醒后的咽痛发生率.结果 5～15 ml的套囊充气容量可满足正压通气需要.充气超过15 ml时,ICP明显增加,而OLP改变不明显.ICP为60 cm H2O时OLP为（25.3±3.1）cm H2O、套囊充气容量为（10.7±2.2）ml,术后咽痛发生率为13.3%.结论 4号喉罩合理的套囊充气容量为5～15 ml.展开更多
基金supported by the Science and Technology Commission of Shanghai Municipality(Nos.22S31901300 and 23440790103)Shanghai Innovative Medical Device Application Demonstration Project 2023(No.23SHS02600).
文摘Chronic inflammatory airway diseases,such as chronic bronchitis,chronic obstructive pulmonary disease,emphysema,and bronchial asthma,pose significant healthcare challenges.Interventional treatments offer promise as valuable complements to the optimal medical therapy recommended by the Global Initiative for Chronic Obstructive Lung Disease guideline and the Global Initiative for Asthma guideline.By directly accessing the airways,these minimally invasive procedures enable precise interventions.They encompass a wide range of techniques including bronchial thermoplasty and targeted lung denervation for both chronic obstructive pulmonary disease and severe asthma,bronchoscopic lung volume reduction(including the use of endobronchial valves,coils,and bronchoscopic thermal vapor ablation),airway bypass and peripheral stent placement for emphysema,bronchial rheoplasty and spray cryotherapy for chronic bronchitis,and other emerging methods.These interventional treatments aim to improve patients’symptoms by reducing lung volume,alleviating hyperinflation,eliminating vagal innervation,disrupting hyperplastic goblet cells and thus reducing excessive mucus secretion,and weakening submucosal smooth muscles.This review highlights the potential advantages of interventional treatments for chronic inflammatory airway diseases and discusses relevant techniques tailored to specific disease subtypes.The overall aim is to assist interventional pulmonologists in selecting the most appropriate techniques for individual patients.
文摘BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibular retrognathism with the normal anteroposterior skeletal relationship,thereby assessing the association between cephalometric variables and airway morphology.METHODS Cone-beam computed tomography volume scans,and lateral cephalograms,3-dimensional airway volume and cross-sectional areas of 120 healthy children(54 boys and 66 girls mean age 15.19±1.28)which were done for orthodontic assessment were evaluated.The subjects were divided into 2 groups based on the angle formed between point A,Nasion and point B(ANB)values and cephalometric variables(such as anterior and posterior facial height,gonial angle etc.)airway volumes,and cross-sectional measurements were compared using independent t tests.Pearson’s correlation coefficient test was used to detect any relationship of different parts of the airway and between airway volume and 2-dimensional cephalometric variables.RESULTS Means and standard deviations for cephalometric,cross-sectional,and volumetric variables were compared.ANB,mandibular body length and facial convexity were statistically highly significant(P<0.01)whereas condylion to point A,nasal airway and total airway volume(P<0.05)were statistically significant.The nasal airway volume and the superior pharyngeal airway volume had a positive correlation(P<0.01),nasal airway was correlated to middle(P<0.05)and total airway superior had a relation with middle(P<0.05),inferior and total airway(P<0.05),middle was related to all other airways;inferior was also related to all the airways except nasal.Lateral cephalometric values were positively correlated with the airway volume with Frankfurt Mandibular Plane Angle and facial convexity showed significant correlations with total airway volume(P<0.05).Additionally,ANB angle was significantly correlated with total airway volume and superior airway(P<0
文摘Traditionally, there are two main methods of mask placement during face mask ventilation: one handed (CE) grip and two handed grip (THT). One handed grip is limited by air leaks between mask and patients face on the side opposite to stabilizing hand. Two handed grips provide protection against air leak but require second provider to deliver tidal volumes when using a self inflating bag or anesthesia circuit on manual ventilation. This study introduces modified CE grip which creates a firm seal at patient’s face on both sides of mask, enabling adequate tidal volume delivery with provider’s second hand. Using left hand, provider places the fifth digit along inferior border of body of left mandible. The fourth digit is placed along inferior border of body right mandible. Standing 6 inches to the left and immediately behind a supine patient on an OR table, provider rotates clockwise 45 degrees at hip, keeping elbow against their body, and lifts patient’s chin to 45 degrees. Rotational force at hip augments hand strength while tilting chin. The thumb applies pressure along left border of facemask, and the second and third digits apply pressure to right border of facemask. Methods: Patients with known predictors of difficult mask ventilation (Edentulous, bearded, Obstructive sleep apnea (OSA), mallampati 3 or 4) were in experimental group. Normal patients assigned as Controls. After induction of general anesthesia, provider ventilated patient using adult sized facemask. The anesthesia ventilator delivered standardized tidal volumes. TV, airway pressures, HR and O2 saturation were recorded after each breath. Results: All groups, except OSA, showed improvement, in tidal volumes with the novel technique compared to the traditional CE grip. Conclusion: The novel submandibular technique, an important skill, increases tidal volumes during mask ventilation for certain high risk patients.
文摘Objective： The laryngeal mask airway （LMA） is an established way for airway control during spontaneous ventila- tion. Its ability to deliver positive pressure ventilation without leakage especially in low flow states is still controversy. The aim of this study is to test the possibility of using LMA in pediatric closed circuit controlled ventilation, and to find out the optimum cuff volume to perform closed system ventilation. Methods： Twenty children scheduled for elective surgeries were enrolled in a crossover study. Laryngeal mask airway was used. In stage I, the cuff was inflated with the maximum volume of air as rec- ommended by the manufacturers. Adjustment of volume of air inflated into the LMA cuff to the minimum volume to obtain the effective seal was done at stage II. The leak pressure, intracuff pressure and the leak volume were measured in both stages. Results： The cuff filling volume was significantly lower compared to the maximum cuff inflation volume in stage I. Leakage values showed significantly less values in stage II of the study with smaller cuff inflation volumes. The airway leakage pressure was significantly lower in stage fl in comparison to stage I. Cuff inflation pressure in stage I showed marked elevation which dropped significantly after adjustment of cuff volume in stage I1. Conclusion： Laryngeal mask airway is an effective tool to provide closed circuit controlled ventilation in pediatrics. Inflation of the cuff by the minimum volume of air needed to reach the just sealing pressure is suggested to minimize the leakage volume.
