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Simulated airway

Dr Gian Domenico Giusti, Dr Cecilia Rogari, Dr Alessio Gili, Dr Fulvio Nisi
BACKGROUND: Endotracheal intubation (ETI) for mechanical ventilation has a central role in the Intensive Care Unit (ICU). ETI is one of the main risk factors for the development of ventilator-associated pneumonia (VAP) as its presence reduces the natural defences of the upper airway and allows the micro-suction of secretions in the airways. In order to minimise such complications, it is fundamental to maintain a suitable pressure inside the tube cuff. AIM AND SCOPE: The main objective of the present study is to evaluate the effectiveness and reliability of palpation method, performed with the operators fingers, for detecting the tube cuff pressure...
October 18, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Michael C Sklar, Karen Burns, Nuttapol Rittayamai, Ashley Lanys, Michela Rauseo, Lu Chen, Martin Dres, Guang-Qiang Chen, Ewan C Goligher, Neill Kj Adhikari, Laurent Brochard, Jan O Friedrich
Introduction Spontaneous breathing trials (SBTs) are designed to simulate conditions following extubation and it is essential to understand the physiological impact of different methods. We conducted a systematic review and pooled measures reflecting patient respiratory effort among studies comparing SBT methods in a meta-analysis. Methods We searched Medline, EMBASE, and Web of Science from inception to January 2016 to identify randomized and non-randomized clinical trials reporting physiological measurements of respiratory effort (pressure-time product, PTP) or work of breathing during at least 2 SBT techniques...
October 21, 2016: American Journal of Respiratory and Critical Care Medicine
Jacob Herrmann, Merryn H Tawhai, David W Kaczka
Regional ventilation in the injured lung is heterogeneous and frequency-dependent, making it difficult to predict how an oscillatory flow waveform at a specified frequency will be distributed throughout the periphery. To predict the impact of mechanical heterogeneity on regional ventilation distribution and gas transport, we developed a computational model of distributed gas flow and CO2 elimination during oscillatory ventilation from 0.1 to 30 Hz. The model consists of a three dimensional airway network of a canine lung, with heterogeneous parenchymal tissues to mimic effects of gravity and injury...
October 7, 2016: Journal of Applied Physiology
Hsueh-Yu Li, Yu-Lun Lo, Chao-Jan Wang, Li-Jen Hsin, Wan-Ni Lin, Tuan-Jen Fang, Li-Ang Lee
Surgical success for obstructive sleep apnea (OSA) depends on identifying sites of obstruction in the upper airway. In this study, we investigated sites of obstruction by evaluating dynamic changes in the upper airway using drug-induced sleep computed tomography (DI-SCT) in patients with OSA. Thirty-five adult patients with OSA were prospectively enrolled. Sleep was induced with propofol under light sedation (bispectral index 70-75), and low-dose 320-detector row CT was performed for 10 seconds over a span of 2-3 respiratory cycles with supporting a continuous positive airway pressure model...
October 20, 2016: Scientific Reports
Young Yong Kim, Gu Hyun Kang, Won Hee Kim, Hyun Young Choi, Yong Soo Jang, Young Jae Lee, Jae Guk Kim, Hyeongtae Kim, Gyoung Yong Kim
OBJECTIVE: This study aimed to compare intubation performance between blind intubation through supraglottic airway devices and direct laryngoscopy by novices under manikin simulation. We hypothesized that the intubation time by novices using supraglottic airway devices was superior to that with the Macintosh laryngoscope (MCL). METHODS: A prospective, randomized crossover study was conducted with 95 participants, to evaluate i-gel, air-Q, LMA Fastrach, and MCL devices...
June 2016: Clin Exp Emerg Med
Yong Tack Kong, Hyun Jung Lee, Ji Ung Na, Dong Hyuk Shin, Sang Kuk Han, Jeong Hun Lee, Pil Cho Choi
OBJECTIVE: To compare the effectiveness of the GlideRite stylet with the conventional malleable stylet (CMS) in endotracheal intubation (ETI) by the Macintosh laryngoscope. METHODS: This study is a randomized, crossover, simulation study. Participants performed ETI using both the GlideRite stylet and the CMS in a normal airway model and a tongue edema model (simulated difficult airway resulting in lower percentage of glottic opening [POGO]). RESULTS: In both the normal and tongue edema models, all 36 participants successfully performed ETI with the two stylets on the first attempt...
March 2016: Clin Exp Emerg Med
Jung-In Ko, Sang Ook Ha, Min Seok Koo, Miyoung Kwon, Jieun Kim, Jin Jeon, So Hee Park, Sangwoo Shim, Youjin Chang, Taejin Park
OBJECTIVE: Airway management in patients with suspected cervical spine injury is classified as a "difficult airway." The best device for managing difficult airways is not known. Therefore, we conducted an intubation study simulating patients with cervical spine injury using three devices: a conventional Macintosh laryngoscope, a video laryngoscope (GlideScope), and a fiberoptic bronchoscope (MAF-TM). Success rates, intubation time, and complication rates were compared. METHODS: Nine physician experts in airway management participated in this study...
December 2015: Clin Exp Emerg Med
Jonathan Kei, Donald P Mebust
BACKGROUND: It has been suggested that an adult 8.0 endotracheal tube (ETT) connected to a neonatal meconium aspirator would improve suctioning during emergent endotracheal intubation compared to the Yankauer suction instrument, the standard tool used by emergency physicians. OBJECTIVES: This study was designed to compare the effectiveness of a Yankauer vs. an ETT-meconium aspirator set-up in suctioning liquids of different viscosities. METHODS: The Yankauer and ETT-meconium aspirator device underwent a head-to-head timed comparison, suctioning 250 mL of three different fluids, varying in viscosity...
October 14, 2016: Journal of Emergency Medicine
Per Bäckman, Ulrika Tehler, Bo Olsson
BACKGROUND: Exposure following oral inhalation depends on the deposition pattern of the inhaled aerosol, the extent and rate of oral and pulmonary absorption, as well as systemic distribution and clearance. For lipophilic inhaled compounds with low water solubility and high permeability, the extent and rate of pulmonary absorption can be assumed dependent on deposition pattern as well as dissolution rate. MATERIALS AND METHODS: A mechanistic model of airway deposition, mucociliary clearance, dissolution, absorption, and dissipation was applied to simulate systemic exposure of the novel selective glucocorticoid receptor modulator, AZD5423, when dosed to healthy volunteers using two different nebulizers and two different dry powder inhalers in combination with two different primary particle size distributions...
October 14, 2016: Journal of Aerosol Medicine and Pulmonary Drug Delivery
T Beament, S J Mercer
'Speaking up' or the ability to effectively challenge erroneous decisions is essential to preventing harm. This mixed-methods study in two parts explores the concept of 'barriers to challenging seniors' for anaesthetic trainees, and proposes a conceptual framework. Using a fully immersive simulation scenario with unanticipated airway difficulty, we investigated how junior anaesthetists (one to two years of training) challenged a scripted error. We also conducted focus groups with senior trainees (three to seven years of training) and undertook a 'thematic network analysis' of responses...
November 2016: Anaesthesia
Ramon Farré, Daniel Navajas, Josep M Montserrat
Current devices for providing noninvasive respiratory support contain sensors and built-in intelligence for automatically modifying ventilation according to the patient's needs. These devices, including automatic continuous positive airway pressure devices and noninvasive ventilators, are technologically complex and offer a considerable number of different modes of ventilation and setting options, the details of which are sometimes difficult to capture by the user. Therefore, better predicting and interpreting the actual performance of these ventilation devices in clinical application requires understanding their functioning principles and assessing their performance under well controlled bench test conditions with simulated patients...
January 2016: ERJ Open Research
Xingli Liu, Weiwei Yan, Yang Liu, Yat Sze Choy, Yikun Wei
The flow characteristics in the realistic human upper airway (HUA) with obstruction that resulted from pharyngeal collapse were numerically investigated. The 3D anatomically accurate HUA model was reconstructed from CT-scan images of a Chinese male patient (38 years, BMI 25.7). The computational fluid dynamics (CFD) with the large eddy simulation (LES) method was applied to simulate the airflow dynamics within the HUA model in both inspiration and expiration processes. The laser Doppler anemometry (LDA) technique was simultaneously adopted to measure the airflow fields in the HUA model for the purpose of testifying the reliability of LES approach...
2016: Computational and Mathematical Methods in Medicine
Alireza Nejati, Natalia Kabaliuk, Mark C Jermy, John E Cater
BACKGROUND: Understanding airflow through human airways is of importance in drug delivery and development of assisted breathing methods. In this work, we focus on development of a new method to obtain an averaged upper airway geometry from computed tomography (CT) scans of many individuals. This geometry can be used for air flow simulation. We examine the geometry resulting from a data set consisting of 26 airway scans. The methods used to achieve this include nasal cavity segmentation and a deformable template matching procedure...
October 1, 2016: BMC Medical Imaging
Ravishekar Ravi Kannan, Z J Chen, Narender Singh, Andrzej Przekwas, Renishkumar Delvadia, Geng Tian, Ross Walenga
The models used for modeling the airflow in the human airways are either 0D compartmental or full 3D Computational Fluid Dynamics (CFD) models. In the former, airways are treated as compartments and the computations are performed with several assumptions, thereby generating a low fidelity solution. The CFD method displays extremely high fidelity since the solution is obtained by solving the conservation equations in a physiologically consistent geometry. However, CFD models (i) require millions of degrees of freedom (DOF) to accurately describe the geometry and to reduce the discretization errors, (ii) have convergence problems and (iii) require several days to simulate a few breathing cycles...
October 5, 2016: International Journal for Numerical Methods in Biomedical Engineering
Myungju Shin, Sun Joon Bai, Ki-Young Lee, Ein Oh, Hyun Joo Kim
We hypothesized that the McGRATH MAC would decrease the time of intubation compared to C-MAC for novices. Thirty-nine medical students who had used the Macintosh blade to intubate a manikin fewer than 3 times were recruited. The participants performed sequential intubations on the manikin in two simulated settings that included a normal airway and a difficult airway (tongue edema). The intubation time, success rate of intubation, Cormack-Lehane grade at laryngoscopy, and difficulty using the device were recorded...
2016: BioMed Research International
Miaorong Yu, Jiuling Wang, Yiwei Yang, Chunliu Zhu, Qian Su, Shiyan Guo, Jiashu Sun, Yong Gan, Xinghua Shi, Huajian Gao
Mucus is a viscoelastic gel layer that typically protects exposed surfaces of the gastrointestinal (GI) tract, lung airways, and other mucosal tissues. Particles targeted to these tissues can be efficiently trapped and removed by mucus, thereby limiting the effectiveness of such drug delivery systems. In this study, we experimentally and theoretically demonstrated that cylindrical nanoparticles (NPs), such as mesoporous silica nanorods and calcium phosphate nanorods, have superior transport and trafficking capability in mucus compared with spheres of the same chemistry...
October 4, 2016: Nano Letters
Shao-Hui Lin, Wei Cui, Gui-Ling Wang, Shuai Meng, Ying-Chun Liu, Hong-Wei Jin, Liang-Ren Zhang, Ying Xie
Albumin-based nanoparticles (NPs) are a promising technology for developing drug-carrier systems, with improved deposition and retention profiles in lungs. Improved understanding of these drug-carrier interactions could lead to better drug-delivery systems. The present study combines computational and experimental methods to gain insights into the mechanism of binding of albuterol sulfate (AS) to bovine serum albumin (BSA) on the molecular level. Molecular dynamics simulation and surface plasmon resonance spectroscopy were used to determine that there are two binding sites on BSA for AS: the first of which is a high-affinity site corresponding to AS1 and the second of which appears to represent the integrated functions of several low-affinity sites corresponding to AS2, AS3, and AS8...
2016: Drug Design, Development and Therapy
Andreas Moritz, Sebastian Heinrich, Andrea Irouschek, Torsten Birkholz, Johannes Prottengeier, Joachim Schmidt
BACKGROUND: Single-use plastic blades (SUPB) and single-use metal blades (SUMB) for direct laryngoscopy and tracheal intubation have not yet been compared with reusable metal blades (RUMB) in difficult airway scenarios. OBJECTIVE: The purpose of our manikin study was to compare the effectiveness of these different laryngoscope blades in a difficult airway scenario, as well as in a difficult airway scenario with simulated severe inhalation injury. METHODS: Thirty anesthetists performed tracheal intubation (TI) with each of the three laryngoscope blades in the two scenario manikins...
September 29, 2016: Journal of Emergency Medicine
Jeffrey Siegler, Melissa Kroll, Susan Wojcik, Hawnwan Philip Moy
INTRODUCTION: In the prehospital setting, Emergency Medical Services (EMS) professionals rely on providing positive pressure ventilation with a bag-valve-mask (BVM). Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. Our primary objective was to determine if a group of EMS professionals could provide ventilations with a smaller BVM that would be sufficient to ventilate patients. Secondary objectives included 1) if the pediatric bag provided volumes similar to lung-protective ventilation in the hospital setting and 2) compare volumes provided to the patient depending on the type of airway (mask, King tube, and intubation)...
October 3, 2016: Prehospital Emergency Care
Rebecca A M Blom, Silvia T Erni, Kristína Krempaská, Olivier Schaerer, R Maarten van Dijk, Mario Amacker, Christian Moser, Sean R R Hall, Christophe von Garnier, Fabian Blank
The respiratory tract with its ease of access, vast surface area and dense network of antigen-presenting cells (APCs) represents an ideal target for immune-modulation. Bio-mimetic nanocarriers such as virosomes may provide immunomodulatory properties to treat diseases such as allergic asthma. In our study we employed a triple co-culture model of epithelial cells, macrophages and dendritic cells to simulate the human airway barrier. The epithelial cell line 16HBE was grown on inserts and supplemented with human blood monocyte-derived macrophages (MDMs) and dendritic cells (MDDCs) for exposure to influenza virosomes and liposomes...
2016: PloS One
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