Academic literature on the topic 'Oro-nasal pressure'

Introduction: Deep sedation or general anesthesia is usually required for Magnetic Resonance Imaging when patients cannot remain motionless in the suite. Various anesthetic devices have been used to maintain the airway and ventilate the lungs during this period but some of them produce artifacts that pose difficulties in the interpretation of images. The aim of this study was to identify the devices that produced artifacts during Magnetic Resonance Imaging.Methods: Twelve anesthetic devices were considered: oro-pharyngeal airway, naso-pharygeal airway, face mask with reservoir bag, nasal cannula, endotracheal tube, disposable Ambu Laryngeal Mask Airway, Laryngeal Mask Airway Unique, Disposable Laryngeal Tube Sonda, i-gel, Ambubag, Bain Circuit, Jackson Rees Circuit.Magnetic Resonance Imaging was performed with each device placed on the top of a phantom simulator respectively to resemble the position in vivo.Results: The artifacts with Disposable Laryngeal Tube Sonda, Laryngeal Mask Airway Unique and endotracheal tube were related to ferromagnetic material in the pilot valve were similar. No artifacts were found with oro-pharyngeal airway, naso-pharygeal airway, nasal cannula, endo-tracheal tube with pilot valve detached, face masks with reservoir bag (metal removed), Ambu bag (without Adjustable Pressure Limiting valve), i-gel , disposable Ambu Laryngeal Mask Airway, Bain Circuit and Jackson Rees Circuit.Conclusions: Anesthetic devices not containing any ferromagnetic material are recommended for use during MRI scanning to reduce artifacts.

Background: Deep sedation or general anesthesia is usually required for Magnetic Resonance Imaging when patients cannot remain motionless in the suite. Various anesthetic devices have been used to maintain the airway and ventilate the lungs during this period. Some of them produce artifacts that pose difficulties in the interpretation of images. The aim of this study was to identify the devices that produced artifacts during Magnetic Resonance Imaging.Methods: Twelve anesthetic devices were considered: oro-pharyngeal airway, nasopharygeal airway, face mask with reservoir bag, nasal cannula, endotracheal tube, disposable Ambu Laryngeal Mask Airway, Laryngeal Mask Airway Unique, Disposable Laryngeal Tube Sonda, i-gel, Ambu bag, Bain Circuit, Jackson Rees Circuit. Magnetic Resonance Imaging was performed with each device placed on the top of a phantom simulator respectively to resemble the position in vivo.Results: The artifacts with Disposable Laryngeal Tube Sonda, Laryngeal Mask Airway Unique and endotracheal tube were related to ferromagnetic material in the pilot valve and were similar. No artifacts were found with oro-pharyngeal airway, nasopharygeal airway, nasal cannula, endo-tracheal tube with pilot valve detached, face masks with reservoir bag (metal removed), Ambu bag (without Adjustable Pressure Limiting valve), i-gel , disposable Ambu Laryngeal Mask Airway, Bain Circuit and Jackson Rees Circuit.Conclusion: Anesthetic devices that produce Magnetic Resonance Imaging artifacts are disposable Laryngeal Tube Sonda, Laryngeal Mask Airway Unique and Endotracheal Tube.Journal of Society of Anesthesiologists of Nepal 2015; 2(1): 13-16

Background and aimLittle is known about the current use of long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases, including chest wall disorders and neuromuscular disorders (NMD). This study aimed to capture the pattern of LTHNIV in patients with restrictive thoracic diseases via a web-based international survey.MethodsThe survey involved European Respiratory Society (ERS) Assembly 2.02 (NIV-dedicated group), from October to December 2019.Results166 (22.2%) out of 748 members from 41 countries responded; 80% were physicians, of whom 43% worked in a respiratory intermediate intensive care unit. The ratio of NMD to chest wall disorders was 5:1, with amyotrophic lateral sclerosis the most frequent indication within NMD (78%). The main reason to initiate LTHNIV was diurnal hypercapnia (71%). Quality of life/sleep was the most important goal to achieve. In 25% of cases, clinicians based their choice of the ventilator on patients’ feedback. Among NIV modes, spontaneous-timed pressure support ventilation (ST-PSV) was the most frequently prescribed for day- and night-time. Mouthpieces were the preferred daytime NIV interface, whereas oro-nasal masks the first choice overnight. Heated humidification was frequently added to LTHNIV (72%). Single-limb circuits with intentional leaks (79%) were the most frequently prescribed. Follow-up was most often provided in an outpatient setting.ConclusionsThis ERS survey illustrates physicians’ practices of LTHNIV in patients with restrictive thoracic diseases. NMD and, specifically, amyotrophic lateral sclerosis were the main indications for LTHNIV. NIV was started mostly because of diurnal hypoventilation with a primary goal of patient-centred benefits. Bi-level ST-PSV and oro-nasal masks were more likely to be chosen for providing NIV. LTHNIV efficacy was assessed mainly in an outpatient setting.

Abstract Introduction Swallowing involves a complex motor pattern and coordination with breathing and other oro-motor behaviors. Sleep has major depressive effect on many of the motor neuronal pools that facilitate swallowing, particularly upper airway muscles. This study examines the state-depedence of the swallow motor program and coordination with breathing. Methods Adult subjects recruited from community undertook an overnight sleep laboratory study. Subjects were instrumented to monitor sleep (EEG), breathing (nasal mask, pneumotach), swallowing / airway valving events (epiglottic pressure, submental EMG) and pharyngeal muscle activity (peroral genioglosuss EMG electrodes).We report preliminary findings (N=5; 2 female; age: 23-57 yrs) from an ongoing study. Data reported mean ± SD. Results Nocturnal swallowing occurred intermittently thoughout the night, the majority triggered during an arousal from sleep (43-98% of all nocturnal swallows). Pharyngeal swallowing pressure was 147±44 cmH2O during quiet wake, 137±25 cmH2O during arousal from sleep, and 78 ± 23 cmH2O in stable sleep (p=0.02, RM-ANOVA). Swallows generated a brief, near-maximal burst of genioglossus EMG activity during quiet wake (90 ± 2 %, N=2) and during arousal from sleep (107 ± 24 %). In stable sleep, swallow EMG activity was 34 ± 1 %. Swallows during wakefulness occurred during expiration, the vast majority bracketed by expiration (Ex/Ex). Swallows in sleep, or during arousal from sleep, occurred in all phases of the respiratory cycle. Conclusions Swallows elicited during arousal from sleep generate ballistic EMG and pharyngeal pressures equivalent to wake state. In contrast, swallowing in stable sleep produces a markedly attenuated EMG and pharyngeal pressure.

Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19 is substantially different from ARDS caused by other diseases and its treatment is dissimilar and challenging. As many studies showed conflicting results regarding the use of Non-invasive ventilation in COVID-19-associated ARDS, no unquestionable indications by operational guidelines were reported. The aim of this study was to estimate the use and success rate of Helmet (h) Continuous Positive Airway Pressure (CPAP) in COVID-19-associated ARDS in medical regular wards patients and describe the predictive risk factors for its use and failure. In our monocentric retrospective observational study, we included patients admitted for COVID-19 in medical regular wards. hCPAP was delivered when supplemental conventional or high-flow nasal oxygen failed to achieve respiratory targets. The primary outcomes were hCPAP use and failure rate (including the need to use Bilevel (BL) PAP or oro-tracheal intubation (OTI) and death during ventilation). The secondary outcome was the rate of in-hospital death and OTI. We computed a score derived from the factors independently associated with hCPAP failure. Out of 701 patients admitted with COVID-19 symptoms, 295 were diagnosed with ARDS caused by COVID-19 and treated with hCPAP. Factors associated with the need for hCPAP use were the PaO2/FiO2 ratio < 270, IL-6 serum levels over 46 pg/mL, AST > 33 U/L, and LDH > 570 U/L; age > 78 years and neuropsychiatric conditions were associated with lower use of hCPAP. Failure of hCPAP occurred in 125 patients and was associated with male sex, polypharmacotherapy (at least three medications), platelet count < 180 × 109/L, and PaO2/FiO2 ratio < 240. The computed hCPAP-f Score, ranging from 0 to 11.5 points, had an AUC of 0.74 in predicting hCPAP failure (significantly superior to Call Score), and 0.73 for the secondary outcome (non-inferior to IL-6 serum levels). In conclusion, hCPAP was widely used in patients with COVID-19 symptoms admitted to medical regular wards and developing ARDS, with a low OTI rate. A score computed combining male sex, multi-pharmacotherapy, low platelet count, and low PaO2/FiO2 was able to predict hCPAP failure in hospitalized patients with ARDS caused by COVID-19.

In 1863, the term “odontoma” was introduced by Paul Broca which he described as a tumor formed by overgrowth of transitory or complete dental tissue. The World Health Organization classified them under mixed benign odontogenic tumors because of their origin from epithelial and mesenchymal cells, exhibiting different structures of dental tissue (enamel, dentin, cementum and pulp).1 There are two distinct types: compound and complex. Compound odontoma is composed of all odontogenic tissue in an orderly fashion resulting in many teeth-like structures but with no morphological resemblance to normal teeth, whereas a complex odontoma appears as an irregular mass with no similarity even to rudimentary teeth.2,3,4 The pathogenesis of odontomas has not been completely established, although the most accepted etiology is related to trauma, infection, growth pressure, and genetic mutations in one or more genes that cause disturbances in the mechanism controlling tooth development.1,5 Patients with compound odontoma are often asymptomatic. It is usually detected on routine radiography upon examination of an unerrupted tooth.6 Odontomas can occur anywhere in the jaws and are usually found associated with or within the alveolar process.7 However, the presence of an odontoma in the maxillary sinus is very rare. We present a female patient with a compound odontoma in the maxillary sinus, initially managed as nasal vestibulitis with maxillary sinusitis. CASE REPORT A 63-year-old woman from Cavite City, Philippines consulted in our institution due to perception of foul odor. Six weeks prior to admission, she experienced right alar pain, facial fullness and swelling with associated undocumented fever. She consulted an ENT specialist and was diagnosed with nasal vestibulitis with maxillary sinusitis. She was given cefixime 200mg, one tablet twice a day and Metronidazole 500mg, one tablet every six hours for seven days. Five weeks prior to admission, despite resolution of the nasal and maxillary swelling and pain, she started to perceive a foul odor. There was no associated nasal congestion and nasal discharge, fever, no nasal itchiness nor frequent sneezing. Her physician requested an orthopantomogram hat revealed a suspicious mass and haziness in the right maxillary sinus and an impacted tooth in the left maxillary sinus. (Figure 1) She was advised surgery but opted for a second opinion. 2 weeks prior to admission, still with perception of foul odor, she consulted another ENT specialist and was given co-amoxiclav 625mg, one tablet every eight hours. A CT scan of the paranasal sinuses revealed mucoperiosteal thickening and calcific density within the opacified right maxillary sinus. (Figure 2 A, B) The patient was advised surgery. The patient had pulmonary tuberculosis in 1983 but was treated for six months. She does not recall having any un-erupted teeth and claimed that her previous dental extractions were unremarkable. She had a family history of bronchial asthma and colon cancer. She did not drink alcoholic beverages but she previously smoked for 1 pack-year. Anterior rhinoscopy revealed scant clear mucoid discharge in both nasal cavities, noncongested and nonhyperemic turbinates, and no intranasal mass. She was edentulous, with no facial mass or swelling. The rest of the examination was unremarkable. With an assessment of a right maxillary mass (odontogenic tumor versus foreign body) with right maxillary sinusitis, and an impacted tooth in the left maxilla she underwent a Caldwell-Luc procedure. Antrotomy was performed through the canine fossa via a gingivolabial incision overlying the anterior maxillary wall. Thick clear mucous was seen oozing out and eventually drained and suctioned out. (Figure 3) A 2 cm x 2 cm x 2.1 cm ovoid, whitish to tan colored hard mass partially covered by black fragments was carefully extracted. (Figure 4) Irrigation of the maxillary sinus was performed using normal saline solution and the natural maxillary ostium was widened. The incision was closed with interrupted mattress sutures using chromic 3.0 and the mass was submitted for histopathological analysis. Microscopic sections revealed misshapen teeth or denticles with a coordinated pattern of calcification such as enamel, dentin and cementum. (Figure 5 A - C) The final histopathologic report was a compound odontoma of the right maxillary sinus. The postoperative follow-up was satisfactory. Our patient developed no oro-antral fistula and showed no signs of maxillary sinusitis and the perception of foul odor resolved. DISCUSSION Odontoma is a generally asymptomatic, slowly progressing tumor that may pass unnoticed. It is usually detected by routine radiograph. This may be associated with un-erupted tooth, mainly the mandibular third molar, followed by the upper canine and upper central incisor. The prevalence of odontoma associated with impacted canine is 1.5 %.8 The maxillary sinus is a frequent site for pathologies of odontogenic origin because of its close anatomical relationship with teeth and periodontal tissues. This makes a frequent but not a common site for inflammatory diseases as well as neoplastic lesions.6 The patient initially presented with right alar pain and right facial swelling. She did not recall having an un-erupted tooth and claimed that her previous dental extractions were unremarkable. After treatment, the pain and swelling resolved but she started to perceive a malodorous smell. Commonly, clinicians arrive at the diagnosis of sinusitis when failure of its resolution despite antibiotic treatment prompts warning bells that warrant further radiographic investigation. The radiographic appearance of odontoma is almost always diagnostic3 as in the presented case. Panoramic and periapical images usually show well-defined borders of a similar density to calcified dental tissue, having a ground-glass appearance, and a radiopaque mass occupying the affected maxillary sinus.9 This was evident in the patient's panoramic radiograph. Additional radiographic evaluation with computed tomography was necessary to determine the extension and features of the lesion because periapical and panoramic images do not provide complete visualization of the maxillofacial complex. CT scans serve as a guide not only for evaluation of the lesion itself, but also for localization of associated pathology and proper treatment planning.10 In this case, the computed tomography scan of the paranasal sinuses revealed mucoperiosteal thickening and calcific density within the opacified right maxillary sinus, suggesting odontogenic origin with concomitant maxillary sinusitis. Due to its asymptomatic course, it can be surmised that the patient might have had the asymptomatic compound odontoma for a long time. The mass in her maxillary sinus was seen freely floating in her CT scan. It may be hypothesized that obstruction by the odontoma could have altered the ventilation and drainage of the maxillary sinus, causing the symptoms of the patient. Cabov, et al. reported that odontomas in the maxillary sinus may also cause pain, facial asymmetry and chronic congestion of the sinus.11 Management for this case was surgical removal of the mass with drainage of trapped mucus as well as medical treatment of the maxillary sinus infection. The Caldwell-Luc procedure was the favored approach to this case because it offered easy access to the mass that could not be extracted trans-nasally because of its size and solid nature. Restoring the drainage of the maxillary sinus was also essential and this was done by widening the natural maxillary sinus ostium. The histological characteristics of the mass extracted from the patient consisted of denticles with a coordinated pattern of calcification such as enamel, dentin and cementum, compatible with a compound odontoma. The rarity of odontomas makes them easy to miss should a radiographic examination not have been done. Despite their being usually asymptomatic, our patient had chronic perception of foul odor that was bothersome and frustrating. A clinician relying on medical history and physical examination alone could not have arrived at the correct diagnosis. In this case, it was shown that radiographic imaging was very crucial in catching a hidden and rare tumor.

AbstractStudy ObjectivesMandibular advancement splint (MAS) therapy is a well-tolerated alternative to continuous positive airway pressure for obstructive sleep apnea (OSA). Other therapies, including nasal expiratory positive airway pressure (EPAP) valves, can also reduce OSA severity. However, >50% of patients have an incomplete or no therapeutic response with either therapy alone and thus remain at risk of adverse health outcomes. Combining these therapies may yield greater efficacy to provide a therapeutic solution for many incomplete/nonresponders to MAS therapy. Thus, this study evaluated the efficacy of combination therapy with MAS plus EPAP in incomplete/nonresponders to MAS alone.MethodsTwenty-two people with OSA (apnea–hypopnea index [AHI] = 22 [13, 42] events/hr), who were incomplete/nonresponders (residual AHI > 5 events/hr) on an initial split-night polysomnography with a novel MAS device containing an oral airway, completed an additional split-night polysomnography with MAS + oral EPAP valve and MAS + oral and nasal EPAP valves (order randomized).ResultsCompared with MAS alone, MAS + oral EPAP significantly reduced the median total AHI, with further reductions with the MAS + oral/nasal EPAP combination (15 [10, 34] vs. 10 [7, 21] vs. 7 [3, 13] events/hr, p < 0.01). Larger reductions occurred in supine nonrapid eye movement AHI with MAS + oral/nasal EPAP combination therapy (ΔAHI = 23 events/hr, p < 0.01). OSA resolved (AHI < 5 events/hr) with MAS + oral/nasal EPAP in nine individuals and 13 had ≥50% reduction in AHI from no MAS. However, sleep efficiency was lower with MAS + oral/nasal EPAP versus MAS alone or MAS + oral EPAP (78 ± 19 vs. 87 ± 10 and 88 ± 10% respectively, p < 0.05).ConclusionsCombination therapy with a novel MAS device and simple oral or oro-nasal EPAP valves reduces OSA severity to therapeutic levels for a substantial proportion of incomplete/nonresponders to MAS therapy alone.Clinical TrialsName: Targeted combination therapy: Physiological mechanistic studies to inform treatment for obstructive sleep apnea (OSA)URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372279 Registration: ACTRN12617000492358 (Part C)

Abstract Background Obstructive sleep apnea (OSA) is due to the obstruction of the upper airway during sleep. This condition is often associated with multiple symptoms and co-morbidities. There are many treatment options mentioned in the literature to manage OSA, among which interventional option of continuous positive airflow (CPAP) and non-interventional option, i.e., mandibular advancement device (MAD), which is an oral appliance (OA), are the most preferred ones. This study aims to evaluate the efficacy of customized maxillary oral appliances with mandibular advancement devices in moderate OSA patients. Methods A prospective interventional study with a randomized controlled trial will be carried out involving 40 participants (sample size), with an apnea-hypopnea index (AHI) > 15–30, recorded on polysomnography (PSG). Study participants will be randomly divided into the following treatment groups: control group or group subjected to mandibular advancement device (MAD, n=20) and second group subjected to customized maxillary oral appliance (CMOA, n=20). Baseline assessment of apnea/hypopnea index (AHI), oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be done. Then both study group participants will receive their respective appliances. And after one month and three months of delivery of the appliance, all the parameters, i.e., AHI, oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be re-evaluated and compared with the baseline measurements. Descriptive and analytical statistics will be done. SPSS (Statistical Package for Social Sciences) Version 20.1 will be used as statistical software. The statistical significance between the two groups after one month and three months will be evaluated at p< 0.05. Discussion We expect, customized maxillary oral appliance to be more efficient in managing moderate OSA, in comparison with MAD. If the hypothesis of the present study is confirmed, then this customized maxillary appliance will be quoted as a “gold standard” for managing moderate OSA. Trial registration CTRI/2020/07/026936 Registered 31 July 2020.

We investigated the effects of heliox administration (80% Helium in O2) on tidal inspiratory flow limitation (tIFL) occurring in supine anesthetized spontaneously breathing rabbits, regarded as an animal model of obstructive apnea-hypopnea syndrome. 22 rabbits were instrumented to record oro-nasal mask flow, airway opening, tracheal and esophageal pressures and diaphragm and genioglossus electromyographic activities while breathing either room air or heliox, and, in 12 rabbits, also during the application of continuous positive airway pressure (CPAP; 6 cmH2O). For the group, heliox increased peak inspiratory flow, ventilation (18±11%), peak inspiratory tracheal and dynamic transpulmonary pressures, but in no animal eliminated tIFL, as instead CPAP did in all. Muscle activities were unaffected by heliox. In the presence of IFL the increase in flow with heliox (ΔV̇IFL) varied markedly among rabbits (2 to 49%), allowing the distinction between responders and non-responders. None of the baseline variables discriminated responders and non-responders. However, fitting the Rohrer equation (R=K1+K2V̇) to the tracheal pressure-flow relationship over the first 0.1s of inspiration while breathing air allowed such discrimination on the basis of larger K2 in responders (0.005±.002 vs 0.002±.001 cmH2O·s2·ml-2; p<0.001), suggesting a corresponding difference in the relative contribution of laminar and turbulent flow. The differences in ΔV̇IFL between responders and non-responders were simulated by modeling the collapsible segment of the upper airways as a non-linear resistor and varying its pressure-volume curve, length and diameter, thus showing the importance of mechanical and geometrical factors in determining the response to heliox in the presence of tIFL.