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tracheal occlusion

Sophia Villiere, Ko Nakase, Richard Kollmar, Hamid Arjomandi, Jason Lazar, Krishnamurthi Sundaram, Joshua B Silverman, Michael Lucchesi, David Wlody, Mark Stewart
Background: Acute laryngospasm sufficient to cause obstructive apnea is a medical emergency that can be difficult to manage within the very short time available for establishing an airway. We have presented substantial evidence that laryngospasm-based obstructive apnea is the cause of sudden death in epilepsy, and airway management is particularly challenging during seizure activity. Objective: We sought to determine if the transtracheal delivery of a bolus of oxygen or room air below the level of an obstruction to inflate the lungs could be an effective method to prolong the time available for responders seeking to establish a stable airway, and, if so, what could be learned about optimization of delivery parameters from a rat model...
August 2018: Laryngoscope Investigative Otolaryngology
Gurpreet S Dhillon, Shiraz A Maskatia, Robert W Loar, John L Colquitt, Amy R Mehollin-Ray, Rodrigo Ruano, Michael A Belfort, Oluyinka O Olutoye, Joshua A Kailin
OBJECTIVES: Fetal endoscopic tracheal occlusion (FETO) is offered to fetuses with congenital diaphragmatic hernia (CDH) and severe lung hypoplasia to promote lung growth and may secondarily affect left heart growth. The effects of FETO on left heart hypoplasia (LHH) are not described post-CDH repair. METHODS: A retrospective analysis was performed for fetuses with left-sided CDH who underwent FETO and severity-matched controls from 2007 to 2016 at our institution...
July 26, 2018: Prenatal Diagnosis
M Weis, S Hoffmann, C Henzler, C Weiss, S O Schoenberg, R Schaffelder, T Schaible, K W Neff
PURPOSE: To evaluate liver-herniation as individual parameter on outcome in children with congenital diaphragmatic hernia. MATERIALS AND METHODS: In a retrospective matched-pair analysis based on observed to expected fetal lung volume (o/e FLV), birth weight, gestational age at time-point of examination, status of tracheal occlusion therapy and side of the defect the individual impact of liver-herniation on survival, need for extracorporeal membrane oxygenation (ECMO) therapy and chronic lung disease (CLD) was investigated...
August 2018: European Journal of Radiology
Vikesh Patel, Maryanne Z A Mariyaselvam, Catherine Peutherer, Peter J Young
PURPOSE: The inadvertent, simultaneous use of heat and moisture exchangers (HMEs) and heated humidifiers (HHs) can result in waterlogging of the filter and sudden ventilation tube occlusion, with potentially fatal consequences. Following an NHS England Safety Alert, a near miss and educational reminders in our institution, we introduced new guidelines to solely use HHs in the intensive care unit and HMEs only for patient transfers. No further incidents have occurred, however this solution is potentially fallible...
October 2018: Journal of Critical Care
S Reddy, R Swamy, D V Kumar Irugu, K V V Ramji
Inflammatory myofibroblastic tumours (IMTs) are rare and clinically benign in childhood, and malignant in adults. The aetiology of IMTs is not clear, and recent studies report it as true neoplasm rather than a reactive or inflammatory lesion. IMTs can involve any part of the body, but are usually common in lungs. These are rarely seen in adults and tracheal involvement is also rare in both adults and children. We describe an 18-year-old woman who presented with respiratory difficulty to the emergency department...
April 2018: Acta Otorhinolaryngologica Italica
Yuanfei Peng, Zheng Wang, Xiaoying Wang, Feiyu Chen, Jian Zhou, Jia Fan, Yinghong Shi
BACKGROUND: Control of bleeding is extremely important for laparoscopic liver resection. We introduce a new and operationally simple laparoscopic hepatic inflow occlusion apparatus (LHIOA) and its successful application in laparoscopic surgery for patients with cirrhosis. METHODS: The self-designed LHIOA was constructed using a tracheal catheter (7.5#) and infusion set. The tracheal catheter and infusion set were trimmed to 30 and 70 cm, to serve as an occlusion tube and occlusion tape, respectively...
June 25, 2018: Surgical Endoscopy
Emrah Aydin, Rashika Joshi, Marc Oria, Brian Michael Varisco, Foong-Yen Lim, Jose Luis Peiro
BACKGROUND: Fetal tracheal occlusion (TO) is an emerging surgical therapy in congenital diaphragmatic hernia that improves the fetal lung growth. Different animal models of congenital diaphragmatic hernia and TO present advantages and disadvantages regarding ethical issues, cost, surgical difficulty, size, survival rates, and available genetic tools. We developed a minimally invasive murine transuterine TO model, which will be useful in defining how TO impacts lung molecular biology, cellular processes, and overall lung physiology...
September 2018: Journal of Surgical Research
Mary Patrice Eastwood, Jan Deprest, Francesca Maria Russo, Hongmei Wang, Drew Mulhall, Barbara Iwasiow, Thomas H Mahood, Richard Keijzer
OBJECTIVE: Profiling of miR-200b expression and its targets (transforming growth factor [TGF]-β2 and ZEB2) in the surgical rabbit congenital diaphragmatic hernia (DH) model before and after tracheal occlusion (TO). METHODS: Thirty-eight timed-pregnant rabbits had left DH creation on gestational day (GD) 23. On GD28, 17 randomly selected fetuses had TO. We harvested fetuses at GD23, GD28, or GD30. We calculated lung-to-body weight ratios, processed lungs for miR-200b in situ hybridization and real-time quantitative polymerase chain reaction, and evaluated effects on downstream targets TGF-β2 or ZEB2...
August 2018: Prenatal Diagnosis
Rodrigo Ruano, Denise B Klinkner, Karthik Balakrishnan, Victoria A Novoa Y Novoa, Norman Davies, Dean D Potter, William A Carey, Christopher E Colby, Amy B Kolbe, Katherine W Arendt, Leal Segura, Hans P Sviggum, Maureen A Lemens, Abimbola Famuyide, Andre Terzic
OBJECTIVE: To introduce the prenatal regenerative medicine service at Mayo Clinic for fetal endoscopic tracheal occlusion (FETO) care for severe congenital diaphragmatic hernia (CDH). PATIENTS AND METHODS: Two cases of prenatal management of severe CDH with FETO between January and August 2017 are reported. Per protocol, FETO was offered for life-threatening severe CDH at between 26 and 29 weeks' gestation. Regenerative outcome end point was fetal lung growth. Gestational age at procedure and maternal and perinatal outcomes were additional monitored parameters...
June 2018: Mayo Clinic Proceedings
Lennart Van der Veeken, Francesca Maria Russo, Luc De Catte, Eduard Gratacos, Alexandra Benachi, Yves Ville, Kypros Nicolaides, Christoph Berg, Glenn Gardener, Nicola Persico, Pietro Bagolan, Greg Ryan, Michael A Belfort, Jan Deprest
Background: Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and morbidity mainly due to pulmonary hypoplasia and hypertension. Temporary fetal tracheal occlusion to promote prenatal lung growth may improve survival. Entrapment of lung fluid stretches the airways, leading to lung growth. Methods: Fetal endoluminal tracheal occlusion (FETO) is performed by percutaneous sono-endoscopic insertion of a balloon developed for interventional radiology...
2018: Gynecological Surgery
Ahmed I Marwan, Uladzimir Shabeka, Julie A Reisz, Connie Zheng, Natalie J Serkova, Evgenia Dobrinskikh
INTRODUCTION: Fetal tracheal occlusion (TO) is currently an experimental approach to drive accelerated lung growth. It is stimulated by mechanotransduction that results in increased cellular proliferation and growth. However, it is currently unknown how TO affects the metabolic landscape of fetal lungs. MATERIALS AND METHODS: TO or sham was performed on fetal rabbits at 26 days followed by lung harvest on day 30. Mass spectrometry was performed to evaluate global metabolic changes...
April 18, 2018: Fetal Diagnosis and Therapy
Carlota Rodó, Tamara Illescas, Silvia Arévalo, Santiago Pérez-Hoyos, Elena Carreras
OBJECTIVE: To assess the longitudinal behavior of Quantitative Lung Index (QLI) for the follow-up of fetuses with congenital diaphragmatic hernia. STUDY DESIGN: Retrospective study of fetuses with isolated left congenital diaphragmatic hernia. The fetuses were assessed by ultrasound at different gestational ages and QLI was retrospectively calculated by means of previous lung-to-head ratio measurements. We used a random effects model (mixed model with repeated measurements) to compare the performance of the QLI in operated and non-operated fetuses throughout pregnancy...
June 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Yuval Gielchinsky, Dan V Valsky, Nili Yanai, Firas J Abdeljawad, Mazen A Muhaisen, Dan Arbell, Yehuda Ginosar, Orna Ben-Yosef, Orite Winograd, Benjamin Bar-Oz, Simcha Yagel, Smadar Eventov-Friedman
INTRODUCTION: : Minimally invasive fetal therapeutic procedures reduce the morbidity and mortality in monochorionic (MC) twins and in fetuses with congenital diaphragmatic hernia (CDH). MC pregnancies share their blood systems due to communicating vessels over their single placenta and may develop specific complications: Twin-to-Twin transfusion syndrome (TTTS), Selective intrauterine growth restriction (sIUGR), Twin Anemia-Polycythemia Sequence (TAPS), Twin Reverse Arterial Perfusion Syndrome (TRAP) or anomalies in one...
March 2018: Harefuah
Amélie Delabaere, Loïc Blanchon, Karen Coste, Gael Clairefond, Corinne Belville, Pierre Blanc, Geoffroy Marceau, Vincent Sapin, Denis Gallot
INTRODUCTION: Lung hypoplasia and pulmonary arterial hypertension in congenital diaphragmatic hernia lead to a high perinatal mortality. Although sustained fetoscopic tracheal occlusion (TO) improves lung development, a major side effect is abnormal pneumocyte differentiation. This study evaluated the potential ability of intratracheal retinoic acid (RA) administration to reduce adverse effects of sustained TO in a rabbit model of diaphragmatic hernia. METHODS: A left diaphragmatic defect was created on day 23 in time-dated pregnant rabbits...
June 2018: Prenatal Diagnosis
Saad Rehman, Harold N Lovvorn, Otis B Rickman, Christopher T Wootten, Sivakumar Chinnadurai
BACKGROUND: Mucoepidermoid carcinoma of the trachea is a rare pediatric malignancy that presents unique challenges in diagnosis, operative management, and surveillance. METHODS AND RESULTS: We present a 17-year-old girl with primary tracheal mucoepidermoid carcinoma presenting in acute respiratory distress due to near-total occlusion of the tracheal airway. An algorithmic approach to preoperative planning was developed to evaluate and remove the tumor endoscopically without compromising oxygenation...
June 2018: Head & Neck
Jorge L Morales-Estrella, Michael Machuzak, Bohdan Pichurko, Hanine Inaty, Atul C Mehta
Negative pressure pulmonary edema is a well-described complication of upper airway obstruction. However, the simultaneous occurrence of blood-stained secretions and petechial tracheobronchial hemorrhage are rarely recognized and a potential complication of transient intentional occlusion of the airways. We described a case of "hemorrhagic bronchial mucosa syndrome" and asymptomatic blood-tinged pulmonary edema after balloon bronchoplasty for a concentric tracheal stenosis using a flexible bronchoscopy...
April 2018: Journal of Bronchology & Interventional Pulmonology
Lennart van der Veeken, Francesca M Russo, Johannes van der Merwe, David Basurto, Dyuti Sharma, Tram Nguyen, Marie P Eastwood, Namesh Khoshgoo, Jaan Toelen, Karel Allegaert, Philip Dekoninck, Stuart B Hooper, Richard Keijzer, Paolo De Coppi, Jan Deprest
Congenital diaphragmatic hernia is rare birth defect, which can be easily corrected after birth. The main problem is that herniation of viscera during fetal life impairs lung development, leading to a 30% mortality and significant morbidity. In isolated cases the outcome can be accurately predicted prenatally by medical imaging. Cases with a poor prognosis can be treated before birth; clinically this is by fetoscopic endoluminal tracheal occlusion. Obstruction of the airways triggers lung growth. This procedure is currently being evaluated in a global clinical trial for left sided cases; right sided cases with poor prognosis are offered the procedure clinically...
June 2018: Minerva Pediatrica
Joseph T Church, Elena M Perkins, Megan A Coughlin, Jennifer S McLeod, Katherine Boss, J Kelley Bentley, Marc B Hershenson, Raja Rabah, Robert H Bartlett, George B Mychaliska
BACKGROUND: Extremely premature neonates suffer high morbidity and mortality. An artificial placenta (AP) using extracorporeal life support (ECLS) is a promising therapy. OBJECTIVES: We hypothesized that intratracheal perfluorocarbon (PFC) instillation during AP support would reduce lung injury and promote lung development relative to intratracheal amniotic fluid or crystalloid. METHODS: Lambs at an estimated gestational age (EGA) 116-121 days (term 145 days) were placed on venovenous ECLS with jugular drainage and umbilical vein reinfusion and intubated...
2018: Neonatology
Carla Grattarola, Federica Giorda, Barbara Iulini, Alessandra Pautasso, Marco Ballardini, Simona Zoppi, Letizia Marsili, Simone Peletto, Loretta Masoero, Katia Varello, Fulvio Garibaldi, Frine E Scaglione, Giovanni Di Guardo, Alessandro Dondo, Maria Goria, Laura Serracca, Walter Mignone, Cristina Casalone
A juvenile female striped dolphin Stenella coeruleoalba live stranded on 4 March 2016 at Alassio, western Ligurian Sea coast, Italy. The dolphin died shortly after stranding, and a complete postmortem examination was performed. Necropsy revealed severe tracheal occlusion and unilateral bronchial stenosis with luminal accumulation of abundant green-yellow mucous-gelatinous material. Histological features suggestive of tracheobronchial aspergillosis were observed. Cultures of lung tissue and tracheo-bronchial exudate isolated Aspergillus fumigatus, identified by a Microseq D2 LSUrDNA fungal sequencing kit...
January 31, 2018: Diseases of Aquatic Organisms
Aidan Kashyap, Philip DeKoninck, Kelly Crossley, Marta Thio, Graeme Polglase, Francesca Maria Russo, Jan Deprest, Stuart Hooper, Ryan Hodges
Congenital diaphragmatic hernia (CDH) is a birth defect characterized by failed closure of the diaphragm, allowing abdominal viscera to herniate into the thoracic cavity and subsequently impair pulmonary and vascular development. Despite improving standardized postnatal management, there remains a population of severe CDH for whom postnatal care falls short. In these severe cases, antenatal surgical intervention (fetoscopic endoluminal tracheal occlusion [FETO]) may improve survival; however, FETO increases the risk of preterm delivery, is not widely offered, and still fails in half of cases...
July 2018: American Journal of Perinatology
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