Search Results (18)

Background: Ultrasound-guided identification of the cricothyroid membrane is more accurate than traditional palpation techniques. Additionally, real-time ultrasound-guided puncture is more precise than ultrasound alone. However, no dedicated device currently exists for ultrasound-guided needle cricothyroidotomy. In this study, we aimed to develop and evaluate a novel ultrasound-guided cricothyroidotomy device. Methods: A randomized, prospective, crossover simulation study was conducted using a porcine larynx model. Sixteen anesthesiologists and six anesthesia residents participated after receiving video-based and hands-on training. Each participant performed cricothyroidotomy using three methods: ultrasound-guided needle cricothyroidotomy using the novel device (US-G), needle cricothyroidotomy using a commercial cricothyroidotomy kit (QuickTrach^®), and scalpel incisional cricothyroidotomy after conventional palpation identifying the cricothyroid membrane (Pal-SI). The primary outcome was the puncture success rate. Secondary outcomes included procedure time and tracheal wall injury rates. Results: Cricothyroidotomy of the porcine larynx had a success rate of 100% for US-G and Pal-C and 95% for Pal-SI. The US-G procedure time was significantly longer (median: 80 s) than for Pal-C (22 s) or Pal-SI (51 s). No significant differences in the tracheal wall injury rates were noted across methods, and no severe injuries were reported in the US-G group. Conclusions: US-G demonstrated a high success rate and good safety profile. Although the procedure time was longer than other methods, its precision may still be beneficial in cases involving anticipated difficult airways. Further clinical validation is warranted. Full article

Introduction: Hypoglossal nerve stimulation (HNS) “Inspire_© therapy” has garnered popularity among obstructive sleep apnea (OSA) patients seeking an alternative to continuous positive airway pressure (CPAP) therapy. The growth in HNS has been particularly high in older adults living with OSA. Consistent and proper use of HNS in the geriatric population faces unique age-associated barriers: a high rate of multiple chronic conditions (MCC) and polypharmacy (being on five or more drugs). Early recognition and patient-centered management of these barriers will allow older patients to obtain maximum benefits from HNS. HNS has distinct advantages in the geriatric population because it overcomes many concerns related to CPAP therapy adherence, such as mechanical limitations due to manual dexterity, maxillofacial anatomy, dental issues such as usage of dentures, allergy/otolaryngology-related disorders, and pre-existing post-traumatic stress disorder-related claustrophobia. This paper describes how we worked with older patients with OSA and their care partners to overcome these barriers so patients can continue to derive cardiovascular, neurologic, and quality of life benefits resulting from optimal OSA management. These benefits are especially important in the older population because of higher rates of comorbidities (dementia, coronary artery disease, and atrial fibrillation) exacerbated by sub-optimally treated OSA. In this article, we describe our clinical experience with elderly patients on Inspire_© therapy, with a focus on the everyday difficulties faced by these patients and the measures implemented to address and mitigate these barriers. Methods: A retrospective chart review was conducted to identify patients aged 65 and above who underwent hypoglossal nerve stimulator insertion. Experiences of older patients during and after the insertion procedure were documented and compared to a younger population of patients on HNS therapy. We specifically collected information on difficulties encountered during activation or follow-up visits and compared them between the different age groups. Using this information, we identified areas to improve treatment adherence from the patients’ perspectives. Results: We identified 43 geriatric (65 to 86 years old) patients who received the Inspire implant at a tertiary academic medical center and compared them to a younger population of 23 patients. Most common challenges noted—with a potential to impact adherence—included orofacial and lingual neuropraxia (ischemic or demyelination-induced neuropathy) at activation, cognitive dysfunction (memory problems), preexisting anxiety, and insomnia. Other difficulties that are less commonly reported but equally important to consistent and proper use of HNS included headaches, concerns of device malfunction, change in comfort levels after cardiac procedures, and general intolerance of the device. The older patient population had a statistically significant higher incidence of cognitive difficulties (30.2% vs. 4.4%) and a smaller social support system (62.8% vs. 91.3%) affecting device usage compared to the younger population. There were no statistically significant differences in the rates of other more commonly reported adverse effects such as headaches, dry mouth, and anxiety between the two age groups. Conclusion: Despite several challenges faced by geriatric patients, Inspire_© hypoglossal nerve stimulation remains a viable, alternative treatment option for OSA with improved tolerance and adherence compared to CPAP. After identifying less commonly reported barriers such as cognitive decline, sensory deficits, and decreased social support systems, minor adjustments and appropriate education on use allows older patients to correctly use and benefit from Inspire_© device therapy, with subsequent improvement in sleep and overall quality of life. Full article

Background: The accurate measurement of the distances within the airways during bronchoscopy is necessary for diagnostic purposes; however, a reliable and simple device does not exist. Methods: The LJ system, consisting of a probe, a box with a display, an encoder, and a microcontroller, has been developed, and its prototype has been tested in vitro and validated in clinical practice in suitable procedures of interventional bronchoscopy. Results: In vitro, the device measurements showed a good correlation with the control performed with a digital caliper. Subsequently, ten patients were included in a pilot study evaluating this novel prototype of a measurement device. The device was used on four patients with tracheal stenosis indicated for Y-stent placement, four patients indicated for open surgery, and two cases of tracheoesophageal fistula. The measurements have been validated using computed tomography imaging or by direct inspection and measurement during open surgical procedures. Conclusions: The first experience and pilot study evaluating this novel instrument for distance measurements during interventional bronchology procedures showed that the LJ device can provide precise readings of the distance from the vocal cords, the lengths of tracheal stenoses, or the size of tumorous and other lesions. Its use might be widened to other endoscopic indications. Full article

Background/Objectives: Pneumothorax is a common complication of neonatal respiratory distress syndrome, which is decreased by surfactant therapy. Rescue administration of surfactant in neonates with severe RDS complicated by pneumothorax requires management of the pneumothorax to optimize surfactant distribution while avoiding positive pressure ventilation to minimize iatrogenic exacerbation of the air leak. Methods: We retrospectively reviewed our center’s experience with neonates who had clinically significant pneumothorax complicating RDS, in whom we used a novel technique to administer surfactant through a laryngeal mask/supraglottic airway device without applying positive pressure ventilation. Results: In 13 of the 20 neonates in our cohort, subsequent invasive ventilation and chest tube insertion were avoided. There were no major complications or unfavorable outcomes. We describe our experience with this method and suggest an approach to individualize the management of neonates with pneumothorax preceding surfactant therapy. Conclusions: In our setting, laryngeal mask airway devices are now the preferred method to deliver surfactant in neonates with RDS and pre-existing pneumothorax. We believe this approach is readily applicable in most neonatal care settings. Full article

Obstructive Sleep Apnea (OSA) is a prevalent chronic sleep-related breathing disorder characterized by partial or complete airway obstruction. The expensive, time-consuming, and labor-intensive nature of the gold-standard approach, polysomnography (PSG), and the lack of regular monitoring of patients’ daily lives with existing solutions motivates the development of clinical support for enhanced prognosis. In this study, we utilize image representations of sleep stages and contextual patient-specific data, including medical history and stage durations, to investigate the use of wearable devices for OSA screening and comorbid conditions. For this purpose, we leverage the publicly available Wisconsin Sleep Cohort (WSC) dataset. Given that wearable devices are adept at detecting sleep stages (often using proprietary algorithms), and medical history data can be efficiently captured through simple binary (yes/no) responses, we seek to explore neural network models with this. Without needing access to the raw physiological signals and using epoch-wise sleep scores and demographic data, we attempt to validate the effectiveness of screening capabilities and assess the interplay between sleep stages, OSA, insomnia, and depression. Our findings reveal that sleep stage representations combined with demographic data enhance the precision of OSA screening, achieving F1 scores of up to 69.40. This approach holds potential for broader applications in population health management as a plausible alternative to traditional diagnostic approaches. However, we find that purely modality-agnostic sleep stages for a single night and routine lifestyle information by themselves may be insufficient for clinical utility, and further work accommodating individual variability and longitudinal data is needed for real-world applicability. Full article

Background: The swapping of a supraglottic airway device or a tracheal tube in anaesthetised adult patients is a challenging procedure because potential complications through hypoxemia and loss of airway may occur, with life-threatening implications. This study aims to evaluate which airway technique offers the highest success rate concerning a secure airway in established supraglottic airway and tracheal tube airway exchange scenarios. Methods: After ethical approval, anaesthesiologists were randomised 1:1 into simulated scenarios: an LTS group (malpositioned laryngeal tube) and a Cuff group (relevant cuff leakage of a placed tracheal tube). After that, both groups completed a common scenario consisting of a partially obstructed tracheal tube lumen in a fixed prone position with a Mayfield clamp. The primary endpoint was a successful tracheal airway exchange within ten minutes after the start of the scenario and before severe hypoxemia (SpO₂ < 80%) arose. Secondary endpoints were the evaluation of factors influencing success after 10 min. Results: In total, 60 anaesthesiologists (LTS group n = 30; Cuff group n = 30) with a median experience of 7 years (IQR 4-11) were observed. Within 10 min, a malpositioned laryngeal tube was successfully exchanged by 27/30 (90%) participants, compared to the exchange of a tracheal tube with a relevant cuff leakage by 29/30 (97%; p > 0.05). An airway exchange in an obstructed tube scenario occurred in 22/59 (37%). Loss of airway maintenance showed an obvious association with failure in the common scenario (p = 0.02). Conclusion: The results of this simulation-based study reflect that the exchange of an existing but insufficient airway device in clinical practice is a high-risk procedure. Especially in a fixed prone position, the deliberate evaluation of the existing airway patency and well-conceived airway management in the case of the accidental loss of the airway or obstructed airway access are crucial. Full article

Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over “de-skilling” at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research. Full article

Background: The Internet of Medical Things, often known as IoMT, is a revolutionary method of connecting medical equipment and the software that operates on it to the computer networks that are used in healthcare 5.0. The rapid development of smart medical devices on IoMT platforms has led to the adoption of major technologies in the modernization of healthcare procedures, the administration of diseases, and the improvement in patient treatment standards. The IoMT offers a variety of cloud-based applications, including data exchange, data screening, patient surveillance, information collection and analysis, and hygienic hospital attention. Wireless sensor networks (WSNs) are responsible for both the gathering and delivery of data. Method: The safety of patients and their right to privacy are the top priorities in the healthcare sector. Anyone may see and modify the patient’s health information because the data from these smart gadgets are sent wirelessly through the airways. Hence, we developed a unique elliptic curve cryptography-based energy-efficient routing protocol (ECC-EERP) to provide a high level of security and energy efficient system for healthcare 5.0. Data can be encrypted using the key-based method ECC-EERP. It employs pairs of public and private keys to decrypt and encrypts web traffic and reducse the amount of energy needed by a WSN in aggregate. Result and Discussion: The efficiency of the suggested method was evaluated in comparison with that of a variety of existing methods. The suggested method was evaluated with the use of many parameters such as security, encryption throughput, energy efficiency, network lifetime, communication overload, computation time, and implementation cost. The results showed that the proposed technique provides enhanced security and energy efficiency. Full article

Background: In obstructive sleep apnoea (OSA), treatment with mandibular advancement devices (MADs) reduces patients’ Apnoea–Hypopnoea index (AHI) scores and improves their sleepiness and quality of life. MADs are non-invasive alternatives for patients who cannot tolerate traditional continuous positive airway pressure (CPAP) therapy. The variability of responses to these devices makes it necessary to search for predictors of success. The aim of our study was to evaluate the presence of mandibular torus as a predictor of MAD efficacy in OSA and to identify other potential cephalometric factors that could influence the response to treatment. Methods: This was a retrospective cohort study. The study included 103 patients diagnosed of OSA who met the criteria for initiation of treatment with MAD. Structural variables were collected (cephalometric and the presence or absence of mandibular torus). Statistical analysis was performed to evaluate the existence of predictive factors for the efficacy of MADs. Results: A total of 103 patients who were consecutively referred for treatment with MAD were included (89.3% men); the mean age of the participants was 46.3 years, and the mean AHI before MAD was 31.4 (SD 16.2) and post- MAD 11.3 (SD 9.2). Thirty-three percent of patients had mandibular torus. Torus was associated with a better response (odds ratio (OR) = 2.854 (p = 0.035)) after adjustment for sex, age, body mass index (BMI; kg/m²), the angle formed by the occlusal plane to the sella–nasion plane (OCC plane to SN), overinjection, and smoking. No cephalometric predictors of efficacy were found that were predictive of MAD treatment success. Conclusions: The presence of a mandibular torus practically triples the probability of MAD success. This is the simplest examination with the greatest benefits in terms of the efficacy of MAD treatment for OSA. Full article

Continuous positive airway pressure (CPAP) telemonitoring (TMg) has become widely implemented in routine clinical care. Objective measures of CPAP compliance, residual respiratory events, and leaks can be easily monitored, but limitations exist. This review aims to assess the role of TMg in CPAP-treated obstructive sleep apnea (OSA) patients. We report recent data related to the accuracy of parameters measured by CPAP and try to determine the role of TMg in CPAP treatment follow-up, from the perspective of both healthcare professionals and patients. Measurement and accuracy of CPAP-recorded data, clinical management of these data, and impacts of TMg on therapy are reviewed in light of the current literature. Moreover, the crucial questions of who and how to monitor are discussed. TMg is a useful tool to support, fine-tune, adapt, and control both CPAP efficacy and compliance in newly-diagnosed OSA patients. However, clinicians should be aware of the limits of the accuracy of CPAP devices to measure residual respiratory events and leaks and issues such as privacy and cost-effectiveness are still a matter of concern. The best methods to focus our efforts on the patients who need TMg support should be properly defined in future long-term studies. Full article

Airway clearance refers to the clearing of any airway blockage caused due to foreign objects such as mud, gravel, and biomaterials such as blood, vomit, or teeth fragments using the technology of choice, portable suction devices. Currently available devices are either too heavy and bulky to be carried, or insufficiently powered to be useful despite being in accordance with the ISO 10079-1 standards. When applied to portable suction, the design and testing standards lack clinical relevancy, which is evidenced by how available portable suction devices are sparingly used in pre-hospital situations. Lack of clinical relevancy despite being in accordance with design/manufacturing standards arise due to little if any collaboration between those developing clinical standards and the bodies that maintain design and manufacturing standards. An updated set of standards is required that accurately reflects evidence-based requirements and specifications, which should promote valid, rational, and relevant engineering designs and manufacturing standards in consideration of the unique scenarios facing prehospital casualty care. This paper aims to critically review the existing standards for portable suction devices and propose modifications based on the evidence and requirements, especially for civilian prehospital and combat casualty care situations. Full article

Background: Choking is a prevalent source of injury and mortality worldwide. Traditional choking interventions, including abdominal thrusts and back blows, have remained the standard of care for decades despite limited published data. Suction-based airway clearance devices (ACDs) are becoming increasingly popular and there is an urgent need to evaluate their role in choking intervention. The aim of this study was to describe the effectiveness (i.e., resolution of choking symptoms) and safety (i.e., adverse events) of identified airway clearance devices interventions to date. Methods: This retrospective descriptive analysis included any individual who self-identified to manufacturers as having used an ACD as a choking intervention prior to 1 July 2021. Records were included if they contained three clinical variables (patient’s age, type of foreign body, and resolution of choking symptoms). Researchers performed data extraction using a standardized form which included patient, situational, and outcome variables. Results: The analysis included 124 non-invasive (LifeVac©) and 61 minimally invasive (Dechoker©) ACD interventions. Median patient age was 40 (LifeVac©, 2–80) and 73 (Dechoker©, 5–84) with extremes of age being most common [<5 years: LifeVac© 37.1%, Dechoker© 23.0%; 80+ years: 27.4%, 37.7%]. Food was the most frequent foreign body (LifeVac© 84.7%, Dechoker© 91.8%). Abdominal thrusts (LifeVac© 37.9%, Dechoker© 31.1%) and back blows (LifeVac© 39.5%, Dechoker© 41.0%) were often co-interventions. Resolution of choking symptoms occurred following use of the ACD in 123 (LifeVac©) and 60 (Dechoker©) cases. Three adverse events (1.6%) were reported: disconnection of bellows/mask during intervention (LifeVac©), a lip laceration (Dechoker©), and an avulsed tooth (Dechoker©). Conclusion: Initial available data has shown ACDs to be promising in the treatment of choking. However, limitations in data collection methods and quality exist. The second phase of this evaluation will be an industry independent, prospective assessment in order to improve data quality, and inform future choking intervention algorithms. Full article

Accurate knowledge of the delivery of locally acting drug products, such as metered-dose inhaler (MDI) formulations, to large and small airways is essential to develop reliable in vitro/in vivo correlations (IVIVCs). However, challenges exist in modeling MDI delivery, due to the highly transient multiscale spray formation, the large variability in actuation–inhalation coordination, and the complex lung networks. The objective of this study was to develop/validate a computational MDI-releasing-delivery model and to evaluate the device actuation effects on the dose distribution with the newly developed model. An integrated MDI–mouth–lung (G9) geometry was developed. An albuterol MDI with the chlorofluorocarbon propellant was simulated with polydisperse aerosol size distribution measured by laser light scatter and aerosol discharge velocity derived from measurements taken while using a phase Doppler anemometry. The highly transient, multiscale airflow and droplet dynamics were simulated by using large eddy simulation (LES) and Lagrangian tracking with sufficiently fine computation mesh. A high-speed camera imaging of the MDI plume formation was conducted and compared with LES predictions. The aerosol discharge velocity at the MDI orifice was reversely determined to be 40 m/s based on the phase Doppler anemometry (PDA) measurements at two different locations from the mouthpiece. The LES-predicted instantaneous vortex structures and corresponding spray clouds resembled each other. There are three phases of the MDI plume evolution (discharging, dispersion, and dispensing), each with distinct features regardless of the actuation time. Good agreement was achieved between the predicted and measured doses in both the device, mouth–throat, and lung. Concerning the device–patient coordination, delayed MDI actuation increased drug deposition in the mouth and reduced drug delivery to the lung. Firing MDI before inhalation was found to increase drug loss in the device; however, it also reduced mouth–throat loss and increased lung doses in both the central and peripheral regions. Full article

A low-cost video laryngoscope (VDL) called Hybrid 1.0 was developed using smart devices for visualization. To test its performance, we compared it with a high-end VDL device, using both in vitro and in vivo studies. During the in vitro study, medical students without experience in airway intubation were randomly asked to intubate a mannequin with different degrees of difficulty (Cormack–Lehane scales) by using either the Hybrid 1.0 VDL (GI) or a conventional laryngoscope (GII). During the in vivo study, N = 60 endotracheal intubations were performed by resident and base physicians, divided into two groups; the first group intubated with the Hybrid 1.0 VDL (GI) while the second group used a VDL C-Mac shovel (GII). As performance indexes, both studies reported the number of successful intubations (correct capnography signal) and intubation time. For the in vitro testing, no statistically significant differences were found regarding the number of successful intubations, while statistically significant differences were found regarding the intubation times. During the in vivo tests, procedures were performed by residents and by base physicians, and no statistically significant differences were found. The provided results point out that the VDL proposed can be clinically useful and offers technical characteristics similar to other VDLs that currently exist on the market. Full article

The rapid adoption of Internet of Things (IoT) has encouraged the integration of new connected devices such as Unmanned Aerial Vehicles (UAVs) to the ubiquitous network. UAVs promise a pragmatic solution to the limitations of existing terrestrial IoT infrastructure as well as bring new means of delivering IoT services through a wide range of applications. Owning to their potential, UAVs are expected to soon dominate the low-altitude airspace over populated cities. This introduces new research challenges such as the safe management of UAVs operation under high traffic demands. This paper proposes a novel way of structuring the uncontrolled, low-altitude airspace, with the aim of addressing the complex problem of UAV traffic management at an abstract level. The work, hence, introduces a model of the airspace as a weighted multilayer network of nodes and airways and presents a set of experimental simulation results using three UAV traffic management heuristics. Full article