Videolaryngoscopy With Noninvasive Ventilation in Subjects With Upper-Airway Obstruction.
BACKGROUND: Noninvasive ventilation (NIV) titration may be difficult when dynamic airway obstruction episodes persist, even with high expiratory positive airway pressure (EPAP). We aimed to determine the usefulness of videolaryngoscopy during NIV for identifying mechanisms and sites of obstruction a...
| Publicado en: | Respiratory Care Vol. 62; no. 2; pp. 222 - 231 |
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| Autores principales: | , , , , , , , |
| Formato: | pictorial research tables/charts tracings Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Feb2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120985875&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 120985875 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Feb2017 vid: 62 iid: 2 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 120985875 120985875 120985875 10.4187/respcare.04784 120985875 ppf: 222 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Videolaryngoscopy With Noninvasive Ventilation in Subjects With Upper-Airway Obstruction. aug: au: Sayas Catalán, Javier Jiménez Huerta, Ignacio Benavides Mañas, Pedro Lujan, Manel Lopez-Padilla, Daniel Arias Arias, Eva Hernandez Voth, Ana Rabec, Claudio affil: Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain sug: subj: Laryngoscopy Airway Obstruction Therapy Respiration, Artificial Airway Obstruction Diagnosis Human Noninvasive Procedures Positive Pressure Ventilation Oxygen Masks Palate Pathology Epiglottis Pathology Inpatients Spain Prospective Studies Research Protocols T-Tests Data Analysis Software Wilcoxon Rank Sum Test Female Middle Age Aged Male Polysomnography Middle Aged: 45-64 years Aged: 65+ years Female Male ab: BACKGROUND: Noninvasive ventilation (NIV) titration may be difficult when dynamic airway obstruction episodes persist, even with high expiratory positive airway pressure (EPAP). We aimed to determine the usefulness of videolaryngoscopy during NIV for identifying mechanisms and sites of obstruction and for providing a guide for their resolution in difficult-to-titrate subjects. METHODS: When obstructions during NIV were present in the built-in software, EPAP was raised to 12 cm H2O. If obstructions persisted, a polygraphy during NIV was performed; if the events occurred with effort, a videolaryngoscopy with nasal and oronasal masks in awake subjects was performed. RESULTS: In a population of 208 subjects in whom NIV was initiated, 13 were identified as difficult to titrate with persistent obstructions during NIV despite an EPAP of 12 cm H2O. Videolaryngoscopy during NIV was able to identify the mechanism and the site of obstruction in all cases. The obstruction under oronasal mask ventilation was due to soft-palate (velum) collapse in 4 subjects, to epiglottic backward movement in 5 other subjects, and to tongue-base obstruction reducing the retroglossal space in 3 more. Videolaryngoscopy during NIV demonstrated improvement in 9 subjects (69%) upon changing to nasal mask and suggested a possible surgical approach in 2 (15%); in one of these 2 subjects, a successful uvulopalatopharyngoplasty was performed. CONCLUSIONS: The use of videolaryngoscopy during NIV in difficult-to-titrate patients may help to identify the sites and mechanisms of obstruction and in some cases may improve quality of ventilation. pubtype: Academic Journal doctype: pictorial research tables/charts tracings Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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