The predictive value of upper airway assessment during routine flexible bronchoscopy for the diagnosis of OSAS

Ineffective efforts (IEs) are among the most common types of patient–ventilator asynchrony. The objective of this study is to validate IE detection during expiration using pressure and flow signals, with respiratory effort detection by esophageal pressure (Pes) measurement as the reference, in patients with neuromuscular diseases (NMDs). We included 10 patients diagnosed with chronic respiratory failure related to NMD. Twenty-eight 5-minute recordings of daytime ventilation were studied for IE detection. Standard formulas were used to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IE detection using pressure and flow signals compared to Pes measurement. Mean sensitivity and specificity of flow and pressure signal-based IE detection versus Pes measurement were 97.5% ± 5.3% and 91.4% ± 13.7%, respectively. NPV was 98.1% ± 8.2% and PPV was 67.6% ± 33.8%. Spearman’s rank correlation coefficient indicated a moderately significant correlation between frequencies of IEs and controlled cycles ( ρ = 0.50 and p = 0.01). Among respiratory cycles, 311 (11.2%) were false-positive IEs overall. Separating false-positive IEs according to their mechanisms, we observed premature cycling in 1.2% of cycles, delayed ventilator triggering in 0.1%, cardiac contraction in 9.2%, and upper airway instability during expiration in 0.3%. Using flow and pressure signals to detect IEs is a simple and rapid method that produces adequate data to support clinical decisions.

Download Full-text

A Case of Tracheal Hamartoma Resected with Loop Electrocautery

Case Reports in Pulmonology ◽

10.1155/2013/568590 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Marios Panagiotou ◽

Alexandros Kalkanis ◽

Napoleon Karagiannidis ◽

Vlasis Polychronopoulos

Keyword(s):

Airway Obstruction ◽

Upper Airway ◽

Flexible Bronchoscopy ◽

Upper Airway Obstruction ◽

Interventional Bronchoscopy ◽

Tracheal Tumor ◽

Upper Third ◽

Tracheal Tumors

The authors report on the case of a 67-year-old man with longstanding breathlessness, which was eventually attributed to a fixed mass in the upper third of the trachea causing upper airway obstruction. The lesion was amenable to loop electrocautery resection via flexible bronchoscopy that led to prompt resolution of patient symptoms. Biopsy was consistent with tracheal hamartoma, an exceedingly rare benign tracheal tumor. All the cases of tracheal hamartomas in the literature to date, the application of electrocautery and other methods of interventional bronchoscopy for resection of selected tracheal tumors are discussed.

Download Full-text

Predictive value of upper lip bite test and ratio of height to thyromental distance compared to other multivariate airway assessment tests for difficult laryngoscopy in apparently normal patients

Journal of Anaesthesiology Clinical Pharmacology ◽

10.4103/0970-9185.111700 ◽

2013 ◽

Vol 29 (2) ◽

pp. 191 ◽

Cited By ~ 15

Author(s):

PratibhaJain Shah ◽

KamtaPrasad Dubey ◽

JaiPrakash Yadav

Keyword(s):

Predictive Value ◽

Difficult Laryngoscopy ◽

Upper Lip ◽

Airway Assessment ◽

Assessment Tests

Download Full-text

Comparison of Upper Lip Bite Test with Modified Mallampati Test and Thyromental Distance for Prediction of Difficult Intubation

Nepal Journal of Medical Sciences ◽

10.3126/njms.v5i1.36792 ◽

2020 ◽

Vol 5 (1) ◽

pp. 2-9

Author(s):

Sabin Koirala ◽

Bigen Man Shakya ◽

Moda Nath Marhatta

Keyword(s):

Difficult Intubation ◽

Predictive Value ◽

Elective Surgery ◽

Cross Sectional Study ◽

Upper Lip ◽

Cross Sectional ◽

Airway Assessment ◽

Total Percentage ◽

Bedside Test ◽

Sensitivity Specificity

Introduction: The prediction of difficult intubation using simple bedside test is of great importance to prevent mismanagement of airway. This study was conducted to compare Upper Lip Bite Test (ULBT) with Modified Mallampati Test (MMT) and Thyromental Distance (TMD) for the prediction of difficult intubation. Method: This was descriptive cross-sectional study conducted in 121 patients of American Society of Anaesthesiologists Physical Status (ASA PS) I and II patients scheduled for elective surgery requiring general anaesthesia with endotracheal tube. The airway assessment of the patients was done one day prior to the surgery using Upper Lip Bite Test (ULBT), Modified Mallampati Test (MMT) and measurement of Thyromental Distance (TMD) . On the day of surgery during laryngoscopy, Cormack-Lehane (CL) grading was recorded. The CL grading of III and IV was labeled as difficult intubation. The Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR) of ULBT, MMT and TMD were calculated and compared. Results: The total percentage of difficult intubation, defined by Cormack-Lehane (CL) III and IV was 16.52 %. The sensitivity, specificity, PPV, NPV and accuracy of Upper Lip Bite Test (ULBT) was 50%, 100%, 100%, 91% and 91.74% respectively. ULBT had a significantly higher sensitivity, specificity and PPV when compared to MMT or TMD or MMT and TMD when combined together. Conclusions: Upper Lip Bite Test (ULBT) is better predictor of difficult intubation and it should be used along with other test during airway assessment.

Download Full-text

Validity of upper airway assessment in children:A clinical, cephalometric, and MRI study

The Angle Orthodontist ◽

10.2319/063010-362.1 ◽

2011 ◽

Vol 81 (3) ◽

pp. 433-439 ◽

Cited By ~ 40

Author(s):

Kirsi Pirilä-Parkkinen ◽

Heikki Löppönen ◽

Peter Nieminen ◽

Uolevi Tolonen ◽

Eija Pääkkö ◽

...

Keyword(s):

Upper Airway ◽

Airway Assessment ◽

Mri Study

Download Full-text

Sustained pharyngeal inflation on upper airway effects in children—Flexible bronchoscopy measurement

Pediatric Pulmonology ◽

10.1002/ppul.25608 ◽

2021 ◽

Author(s):

Wen‐Jue Soong ◽

Chieh‐Ho Chen ◽

Chien‐Heng Lin ◽

Chia‐Fang Yang ◽

Yu‐Sheng Lee ◽

...

Keyword(s):

Upper Airway ◽

Flexible Bronchoscopy

Download Full-text

Three-dimensional upper-airway assessment in patients with bronchial asthma

The Angle Orthodontist ◽

10.2319/030113-176.1 ◽

2013 ◽

pp. 130829070355001

Author(s):

Alexandre Marcos Bandeira ◽

Paula Vanessa Pedron Oltramari-Navarro ◽

Ricardo de Lima Navarro ◽

Ana Cláudia de Castro Ferreira Conti ◽

Marcio Rodrigues de Almeida ◽

...

Keyword(s):

Bronchial Asthma ◽

Three Dimensional ◽

Upper Airway ◽

Airway Assessment

Download Full-text

Bronchoscopic evaluation of children less than 5 years old with stridor

10.22541/au.162093870.07441398/v1 ◽

2021 ◽

Author(s):

Kaustubh Mohite ◽

Mahesh Mohite

Keyword(s):

Clinical Characteristics ◽

Upper Airway ◽

Flexible Bronchoscopy ◽

Age Group ◽

Pediatric Age ◽

Flexible Bronchoscope ◽

Pediatric Age Group ◽

Single Center Study ◽

Turbulent Airflow ◽

Study Setting

Background: Stridor is a harsh, vibratory sound with variable pitch which is caused by partial obstruction of airway that results in turbulent airflow. It is mainly due to anatomic deformities in the infantile age group. However, various acquired conditions affecting upper airway may also cause stridor. Here, we evaluated 87 cases of stridor using Flexible bronchoscope in order to determine the cause of stridor. Objective: To determine the clinical characteristics, Flexible bronchoscopy findings and clinical correlation in children admitted in our hospital with complains of stridor. Design: Retrospective observational study. Setting: Single center study conducted in Amrut medical foundation. 87 children aged less than 5 years with a clinical complains of stridor were included in the study and Flexible bronchoscopy was performed. The findings were analyzed and results were reported. Results: A total of 87 children with stridor were enrolled in the study and Flexible Bronchoscopy was performed in them. Of these, 68 children had an abnormal bronchoscopy finding. Laryngomalacia was the commonest cause of stridor observed followed by subglottic stenosis and tracheomalacia. Cough was the commonest presenting symptom associated with stridor and tachypnea was the commonest clinical sign observed in these children. Conclusion: Flexible bronchoscopy plays an important role in diagnosing the exact cause of stridor in pediatric age group. Key words: Stridor, Flexible Bronchoscopy, Laryngomalacia.

Download Full-text