Search Results (48)

Bronchopulmonary dysplasia (BPD) remains a major complication of extreme prematurity, driven in part by persistent inflammation. Interleukin (IL)-1–mediated signaling plays a central role in sustaining lung injury, making IL-1 blockade a potential therapeutic target. Evidence on the use of anakinra, a recombinant IL-1 receptor antagonist, in neonatal BPD is still limited. We report the case of a female preterm infant (28⁺² weeks’ gestation, birth weight 800 g, −1.41 zs) affected by BPD requiring prolonged respiratory support. Due to persistent respiratory failure despite standard therapies, off-label treatment with subcutaneous anakinra (5 mg/kg twice daily) was initiated at 150 days of life. Clinical respiratory parameters and exploratory salivary inflammatory biomarkers (IL-6 and soluble urokinase plasminogen activator receptor, suPAR) were longitudinally monitored. Following anakinra initiation, the patient showed a gradual improvement in respiratory parameters, with reduction in oxygen requirement, mean airway pressure, and improved gas exchange. Respiratory support was gradually de-escalated from nasal intermittent positive pressure ventilation to continuous positive airway pressure and subsequently to high-flow nasal cannula. Salivary suPAR levels demonstrated a decreasing trend, while IL-6 showed transient fluctuations, partly associated with intercurrent infections. Treatment was generally well tolerated during the observation period. The infant was discharged on minimal respiratory support, with continued improvement during follow-up. This case suggests a possible role of IL-1 blockade in the modulation of persistent inflammation in BPD with a refractory clinical course, although the observed clinical course may also reflect the natural evolution of the disease. Longitudinal salivary biomarkers may represent a feasible, exploratory, non-invasive approach to describe inflammatory dynamics over time. Larger prospective studies are needed to evaluate the efficacy, safety, and optimal treatment protocols of anakinra. Full article

Background: Non-invasive respiratory supports (High-Flow Nasal Oxygen, HFNO; Continuous Positive Airway Pressure, CPAP; Non-Invasive Ventilation, NIV) are frequently used in Acute Hypoxemic Respiratory Failure (AHRF). However, the experience of assisted breathing may profoundly affect patients’ psychological balance, particularly during acute critical illness and subsequent rehabilitation. Aims and objectives: This longitudinal study investigated the psychological burden associated with non-invasive respiratory support use in patients with COVID-19-related AHRF, exploring changes in psychological functioning from acute hospitalization (RICU/ICU) (T0) to follow-up, conducted at a mean of 6.0 ± 3.1 months after respiratory rehabilitation (T1). Methods: Fifty-two patients (mean age = 66.9 ± 9.17 years) were assessed at T0 and T1. Standardized measures evaluated anxiety, psychological distress, post-traumatic stress symptoms, depression, and resilience, in relation to perceived illness severity and subjective experience of non-invasive respiratory support. Results: During acute care, patients reported high levels of fear and anxiety related to illness severity and uncertainty. The experience of non-invasive respiratory support, often perceived as a marker of critical condition, was associated with increased fear and anxiety (t(14) = 2.79, p = 0.014) compared to the recovery phase, leading to feelings of loss of control and diminished psychological well-being (t(17) = 2.35, p = 0.031). However, resilience significantly improved over time (t(16) = −4.78, p < 0.001). Conclusions: Non-invasive respiratory support may represent a psychologically demanding experience, often perceived as challenging to patients’ sense of safety and control. Encouragingly, psychological adaptation and resilience can improve during rehabilitation. Integrating structured psychological support within respiratory rehabilitation pathways may promote recovery and restore psychological balance in patients requiring assisted ventilation. Full article

Objectives: This study investigated whether visual field abnormalities are present in eyes with suspected nasal optic disc hypoplasia (NOH) by using fundus photography and optical coherence tomography (OCT). Methods: NOH was diagnosed using the following criteria: (1) small optic disc, (2) nasal optic disc pallor or optic disc margin irregularity, (3) wedge-shaped temporal visual field defects extending from Mariotte’s blind spot, and (4) reduced nasal circumpapillary retinal nerve fiber layer (cpRNFL) thickness. Eyes fulfilling criteria 1, 2, and 4 without visual field abnormalities were classified as pseudo-NOH (pNOH), whereas eyes without visual field or cpRNFL abnormalities were considered normal. Nasal cpRNFL thickness was measured using OCT, radial peripapillary capillary (RPC) density was assessed using OCT angiography (OCTA), visual field testing was performed, and optic disc blood flow velocity was evaluated using the mean blur rate (MBR) and laser speckle flowgraphy (LSFG). Results: Seven eyes with NOH, 13 eyes with pNOH, and 24 normal right eyes were included. Nasal cpRNFL thickness and MBR were significantly reduced in both the NOH and pNOH groups compared with the normal group, with no significant difference between the NOH and pNOH groups. Nasal RPC density was significantly lower in the NOH group than in both the pNOH and normal groups, and no significant difference was observed between the pNOH and normal groups. Conclusions: Even when NOH was suspected from fundus, LSFG, and OCT C-scan findings, visual field abnormalities were not consistently present. Differences in RPC density measured using OCTA may have contributed to this variability. This study examined whether suspected nasal optic disc hypoplasia (NOH) is always associated with visual field defects. Using fundus imaging, OCT, OCT angiography, and laser speckle flowgraphy, we compared eyes with NOH, pseudo-NOH, and normal eyes. Although structural changes such as reduced nasal nerve fiber layer thickness and decreased blood flow were observed in both NOH and pseudo-NOH, visual field abnormalities were not consistently present. Notably, reduced radial peripapillary capillary density was specific to NOH, suggesting that vascular differences may explain variability in visual function. These findings highlight the importance of multimodal imaging in NOH evaluation. Full article

Background: Nasal valve dysfunction (NVD) is a common yet underrecognized cause of nasal airway obstruction, with a significant impact on quality of life. Despite its clinical relevance, no universally accepted diagnostic standard exists, and optimal management remains debated. Multiple diagnostic tools and surgical or minimally invasive treatments have been proposed. This systematic review and meta-analysis aimed to evaluate current evidence regarding diagnostic approaches and treatment outcomes in NVD. Methods: A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library was performed for studies published between January 1990 and January 2026, in accordance with PRISMA 2020 guidelines. Randomized controlled trials, non-randomized comparative studies, cohort studies, and case series (≥10 patients) assessing diagnostic methods or therapeutic interventions for NVD were included. Diagnostic data were synthesized narratively. The primary surgical outcome was change in the Nasal Obstruction Symptom Evaluation (NOSE) score. Risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2 tools. Results: Seventy-two primary clinical studies were included (15 diagnostic, 57 treatment-focused). Objective airflow measurements, particularly rhinomanometry and peak nasal inspiratory flow, showed greater reliability than isolated clinical maneuvers. Imaging modalities provided anatomical detail but correlated inconsistently with symptoms. Meta-analysis of 12 studies (n = 1210 patients) suggests that both traditional surgical and minimally invasive interventions can substantially improve nasal breathing, with mean NOSE score reductions of 40–55 points, though heterogeneity precludes direct comparison of their relative effectiveness. Conclusions: Diagnosis of NVD requires a multimodal approach combining clinical assessment, validated symptom scores, and selective objective testing. Surgical and minimally invasive treatments provide substantial symptom improvement when appropriately indicated. Evidence is constrained by the predominance of observational data, emphasizing the need for standardized diagnostics and robust comparative trials. Full article

This qualitative study examined how a 21-day integrated program fosters interoceptive awareness and mind–body integration among urban adults in mainland China (n = 11). The intervention combined daily nasal breathing regulation, spontaneous mandala making, and descriptive journaling, complemented by weekly group sharing. Using a cultural–psychological lens, we investigated how an inward–turning tradition in Chinese culture shapes embodied experience and meaning–making. Applying Interpretative Phenomenological Analysis to diaries, drawings, and focus-group data, we identified three interrelated processes: (1) the refinement of bodily attention; (2) a shift from deliberate control to natural immersion; and (3) the symbolization of feeling through artistic expression and social resonance. Findings indicate that systematic engagement in the “breath–mandala” intervention heightened sensitivity to chest-centered embodied sensations and promoted the integration of bodily experience into personal narratives; a non-goal-directed, relaxed practice style facilitated the transition from control to absorption, activating self-regulatory mechanisms; and non-evaluative awareness deepened flow while supporting cognitive reorganization and reflective capacity. The study delineates a core pathway by which breath-triggered interoceptive work operates within mind–body interventions, offering a theoretical basis and practical direction for tailored regulation programs across diverse populations. Full article

Background/Objectives: Flexible bronchoscopy (FB) enables airway exploration and diagnosis of various respiratory pathologies, but the sedation and instrumentation required during the procedure raise oxygen demand while reducing ventilation, which can lead to hypoxemia. Conventional oxygen therapy (COT) may not adequately prevent desaturations in high-risk groups, as patients with moderate respiratory deficiency. High-flow nasal cannula (HFNC) can deliver heated, humidified oxygen at high flow rates, generating low-level positive airway pressure, improving oxygenation, reducing dead-space, and enhancing procedure tolerance. Prior studies have shown that HFNC can improve gas exchange and reduce desaturations during bronchoscopy. However, evidence remains limited for patients with moderate respiratory deficiency, who are particularly vulnerable. Evaluating the feasibility and safety of HFNC in this population is essential to guide safe procedural practice. Methods: A retrospective observational study including patients undergoing FB with HFNC support between January and May 2025. Inclusion criteria were BMI between 18 and 30; age > 18 years old; moderate respiratory dysfunction, defined by pulse oximetry, Pulmonary Functional Tests (PFTs) and Arterial Blood Gas (ABG) analysis. Exclusion criteria were intolerance/contraindication to HFNC. Procedures were performed under basic monitoring. Primary outcome was occurrence of severe hypoxemia (SpO2 < 90%). Secondary outcomes were needed for rescue maneuvers, interruption for conversion to other ventilatory strategies, and hemodynamic instability. Results: No severe desaturations were recorded, all procedures were completed without rescue maneuvers or other ventilatory strategies, and no hypoxemia occurred. Mean duration of the procedure was 9 min. Vital parameters were maintained within the normal ranges, with a mean SpO₂ during bronchoscopy of 98%. Conclusions: HFNC enables oxygenation and ventilation without adverse events in sedations for FB in patients with moderate respiratory deficiency. Full article

Background: Data on high flow nasal oxygenation (HFNO) efficacy in hypoxia prevention in transcatheter aortic valve replacement (TAVR) are conflictive. We aimed to determine the benefit of HFNO in preventing the occurrence of desaturations during TAVR. Methods: An investigator-initiated, proof of concept, single-centre, randomised, and controlled trial on 132 adult patients who were scheduled to undergo transfemoral TAVR was conducted. Patients were randomised (1:1) to HFNO (H-group) with a flow rate of 50 L min⁻¹ and FiO₂ 0.6 or standard of care oxygen therapy (S-group). The primary endpoint was the number of patients with a desaturation episode (SpO₂ < 93%) for >10 s during TAVR. Secondary outcomes included arterial partial pressure of oxygen (pO₂) 45 min from sedation start and changes in glomerular filtration rate from baseline to 12 h post-procedure. Results: Between 23 November and 24 July, a per-protocol analysis was performed in a total of 125 patients (H-group n = 64; S- group n = 61; 49 females). The number of patients with any desaturation episode was significantly lower in the H-group [13/64 (20%, 95% CI: 12–32%)] than in the S-group [31/61 (51%, 95% CI: 39–63%), RR: 0.39 (95%CI: 0.23–0.68)]. At 45 min, mean (SD) pO₂ was higher in the H-group (24(9.8) kPa vs. 16.7(7.5) kPa; p < 0.005). A significant improvement in delta median (IQR) difference on glomerular filtration rate was observed in the H-group [1.6(−1–7.9) mL min⁻¹ 1.73 m⁻²] with respect to the S-group [0.2(−6.1–3.1) mL min⁻¹ 1.73 m⁻²; p-value: 0.013]. Conclusions: This trial demonstrated that HFNO provides a better oxygenation pattern than standard oxygen therapy during TAVR. Larger studies focusing on long-term clinical outcomes are warranted to evaluate the benefit of HFNO during sedation for TAVR procedures. Full article

Objectives: This study aimed to evaluate how non-invasive ventilation (NIV) and high-flow nasal cannula therapy (HFT) versus conventional oxygen therapy (COT) affect neural ventilatory drive during exercise in patients with severe chronic obstructive pulmonary disease (COPD). Methods: We conducted an experimental, controlled study with one arm and three different conditions for the same cohort. After initial testing on conventional oxygen therapy (COT), patients exercised under NIV and HFT in sequential days and a random order. Participants: Twenty patients (mean age 60 years old (SD 3.9), 6 female) with severe COPD (30% women) on home NIV as a bridge to lung transplantation were enrolled in this study, with a mean FEV₁ of 19.78% predicted and marked hyperinflation. Protocol: Participants performed constant-load cycling exercises at 75% maximum tolerated workload under three conditions: COT, NIV, and HFT. Neuro-respiratory drive (NRD) was measured using surface parasternal and sternocleidomastoid electromyography, and mixed ANOVA was performed to analyze repeated measures across conditions. Results: In total, 20 patients were included in this study. NIV demonstrated superior performance, with 60% lower NRD compared to COT (488.81 µV vs. 1180.63 µV, p < 0.05). HFT showed intermediate effects (807.8 µV). NIV also achieved greater reduction in respiratory rate (4.2 breaths/min), lower perceived exertion (Borg score decrease: 1.8 points), and more pronounced CO₂ reduction (5.3 mmHg) compared to both COT and HFT. Conclusions: NIV significantly reduces NRD during exercise in severe COPD patients compared to HFT and COT. This supports its use as a valuable adjunct to pulmonary rehabilitation in severe COPD. Full article

Background/Objectives: Rigid bronchoscopy poses safety challenges due to airway leakage. Although apnoeic oxygenation is a potential strategy, concerns over carbon dioxide (CO₂) retention have limited its adoption. The introduction of high-flow nasal cannula (HFNC) has renewed interest by potentially mitigating CO₂ accumulation during prolonged apnoea. This study investigated changes in the arterial partial pressure of CO₂ (PaCO₂) during apnoeic oxygenation using Optiflow™. Methods: We retrospectively analysed patients undergoing rigid bronchoscopy with HFNC (70 L·min⁻¹) from 2020 to 2022. The apnoeic period was defined from the onset of apnoeic oxygenation to ventilation resumption. Arterial blood gas levels and complications, including arrhythmia and desaturation, were evaluated. Regression analysis was used to evaluate changes over time. Results: Apnoeic oxygenation was performed in 10 male patients (mean age 65 ± 14 years; body mass index 24.75 ± 4.18 kg·m⁻²). The mean duration of apnoea was 33.7 ± 13.7 min, with PaCO₂ rising linearly at 1.50 mmHg/min. No interventions were required to maintain SpO₂ above 91% for all patients. Except for one case of atrial fibrillation that occurred during emergence rather than the apnoeic period, no significant complications were observed. Conclusions: The observed increase in PaCO₂ was lower than in previously reported studies using HFNC via the nares, suggesting that direct delivery of oxygen to the distal airway via bronchoscopy may enhance CO₂ clearance through more effective washout. Apnoeic oxygenation with HFNC could potentially overcome airway leakage for selected patients, but vigilant monitoring remains essential throughout the apnoeic period. Further research is warranted to enhance patient safety. Full article

Background/Objectives: At Fiona Stanley Hospital’s pulmonary rehabilitation program, people awaiting lung transplantation (LTx), whose exertional oxygen requirements are unable to be met with traditional oxygen interfaces, utilize high-flow nasal oxygen (HFNO) to exercise. In this paper, we aim to: (i) describe the characteristics of our service and of the people who have utilized HFNO; and (ii) explore differences between those who survived vs. did not survive whilst awaiting LTx. Methods: We conducted a description of the service and a retrospective analysis (from January 2021 to April 2024). The service description included: facility, equipment/cost, staffing/patient ratio, exercise program characteristics, and safety. Inclusion criteria for the analysis were: people actively listed for LTx and completion of three or more exercise sessions on HFNO. Data extracted included patient characteristics, comorbidities, 6-min walk distance (6MWD) prior to commencing HFNO, and survival pre-LTx. Differences between those who survived vs. did not survive whilst awaiting LTx were explored. Results: Nineteen patients were included (13 males; age 60 ± 12 yr; 18 with interstitial lung disease). The median [IQR] number of exercise sessions on HFNO was 15 [9; 25]. Eight (42%) patients died whilst awaiting LTx. In those who survived, the median time to LTx was 46 [25; 268] days. Compared to those who died, those who underwent LTx had fewer comorbidities (median: 2 [1; 4] vs. 4 [3; 5], p = 0.03). They also tended to be younger and have greater absolute 6MWD prior to commencing HFNO (mean difference, 95%CI: age −8.6 yr, −19.3 to 2.1; 6MWD 55 m, −74 to 185). Associations between dyspnea or body mass index with survival were not demonstrated. This analysis is hypothesis-generating rather than inferential, given the limited sample size. Conclusions: Our unique service of high-flow nasal oxygen (HFNO) use in patients participating in pulmonary rehabilitation whilst awaiting lung transplantation is described. Preliminary analysis suggests that, in people utilizing HFNO whilst awaiting LTx, those who underwent LTx had fewer comorbidities than those who did not survive the waitlist period. Larger studies are needed to explore further differences between those who survive vs. those who do not survive whilst awaiting LTx. Full article

Background/Objectives: Pediatric postoperative pulmonary complication is a major event associated with increased in-hospital morbidity and mortality. However, data is limited regarding the specific timing and spectrum of postoperative pulmonary complications in the pediatric population. Utilizing data in a cohort of high-risk patients aged ≤ 6 years, we sought to evaluate the timing and incidence of a composite of postoperative pulmonary complications. We hypothesized that ASA physical status, emergent case type, and procedure duration would be associated with pulmonary complications in high-risk children and that these complications would, in turn, be associated with a prolonged length of stay. Methods: Data from patients ≤ 6 years of age who were intubated for major abdominal surgery at the authors’ institution were collected from 1 January 2019 to 28 March 2022. The primary outcome was postoperative pulmonary complication, defined as the occurrence/use of reintubation, non-invasive positive pressure ventilation, high-flow nasal cannula, mask, or nasal cannula beyond phase 1 of recovery after anesthesia and within 7 postoperative days. The secondary outcome was hospital length of stay. We performed multivariable logistic regression with backward selection to identify independent predictors for postoperative pulmonary complications after adjusting for covariates. For hospital length of stay, a multivariate linear regression model was used after adjusting for covariates. Results: A total of 88 (26.1%) patients experienced 117 occurrences of postoperative oxygen dependence events, and 80 (90.9%) experienced this event in the first 48 h after surgery. The results of this model demonstrated independent associations between patients with an ASA class of IV (OR 9.86, 95% CI: 1.22–79, p-value = 0.03202) and longer operative time (OR: 1.05, 95% CI: 1.03–1.08, p = 0.00001) and postoperative pulmonary complication. On adjusted analysis, the occurrence of a postoperative pulmonary complication was associated with prolonged postoperative length of stay (adjusted geometric mean ratio of 1.39 (95% CI 1.10–1.75, p = 0.0062). Conclusions: Pediatric postoperative pulmonary complication remains a significant event for many patients and results in a prolonged length of stay. This study lays the groundwork for further investigations of interventions targeted at optimizing and monitoring at-risk individuals. Full article

Objective: To investigate the relationship between respiratory function, functionality, and mortality in amyotrophic lateral sclerosis (ALS) patients and to determine which respiratory parameters show the strongest correlation with functionality and mortality. Methods: The study was conducted in Rio Grande do Norte, Northeast Brazil, between January 2018 and December 2023. This was a retrospective cohort, following individuals with ALS who were evaluated at the University Laboratory. Results: A total of 74 ALS patients were included in the analysis, with a mean age of 55.7 ± 13.5 years. Most were male (66.2%) and predominantly presented with spinal-onset ALS (51.3%). Respiratory variables (except peak expiratory flow (PEF)) showed a weak but significant inverse correlation with mortality (FVC% predicted (r_pb = −0.260; p < 0.001), SNIP (r_pb = −0.235; p = 0.001), MEP (r_pb = −0.207; p = 0.007), MIP (r_pb = −0.198; p = 0.009), and PEF% predicted (r_pb = −0.156; p = 0.013)). When analyzing their correlation with ALSFRS-R, all variables showed a significant positive correlation (ranging from weak to moderate) with functionality. A reduction of one unit in the respiratory variables PEF% of predicted, maximal inspiratory pressure (MIP), and sniff nasal inspiratory pressure (SNIP) increased the risk of death by an average of 300% (OR = 2.99; 95% CI: 2.05–4.35), 2% (OR = 1.02; 95% CI: 1.01–1.03), and 1% (OR = 1.01; 95% CI: 1.00–1.02), respectively. Conclusions: Our findings suggest that direct measurements of respiratory function and muscle strength, particularly PEF and SNIP, may serve as more useful markers to guide early interventions such as non-invasive ventilation, thereby improving quality of life and potentially prolonging survival. Full article

Over time, endoscopic retrograde cholangiopancreatography (ERCP) evolved into the preferred method for both diagnosing and treating diseases of the biliary, pancreatic, and ampullary systems. Traditionally performed under “conscious” sedation, anesthesiological management during ERCP increasingly involves the use of general anesthesia (GA) due to the complexity of procedures and patient comorbidities. This narrative review aims to underscore the current absence of definitive evidence supporting a single airway management strategy during ERCP. In each section, we examine the strengths and limitations of various airway management strategies, including spontaneous breathing, endotracheal intubation, and newer techniques such as high-flow nasal oxygen (HFNO) and supraglottic airway devices (SGAs), tailored for endoscopic procedures. We explore and discuss the multifactorial determinants that influence clinical decision-making, including patient-specific risk factors, procedural complexity, resource availability, and potential complications. Any anesthesiological choice must guarantee the immobility of the patient and the versatility of the position and must be integrated with the preferences and skills of the endoscopist, the available means in the endoscopic suite, and the internal protocols. Spontaneous breathing with sedation may be appropriate for low-risk, short-duration procedures but carries risks of hypoventilation and aspiration, while GA with a device to manage airways improves procedural conditions and perioperative risks. Still, it is resource-intensive and may delay recovery. Transitions between different strategies are inherently fluid, reflecting the need for a flexible, patient-centered approach tailored to the specific clinical context. Rigorous future research is essential to establish evidence-based guidelines that enhance both safety and efficiency of airway management in this setting. Full article

Background/objectives: Optic nerve bending and chiasmal compression impair vision in patients with sellar lesions; however, their effect on optic nerve head (ONH) blood flow remains unclear. This study used laser speckle flowgraphy to examine the relationship between clinical features and ONH blood flow in patients with optic nerve bending and chiasmal compression. Methods: This retrospective study included 32 eyes (16 eyes with and 16 without optic nerve bending on the contralateral side) from 16 patients with sellar lesions. The best-corrected visual acuity (BCVA), simple visual field impairment score (SVFIS), optic nerve head mean blur rate (ONH-MBR), and six-segmented macular ganglion cell layer + inner plexiform layer (GCL + IPL) thickness were examined. Results: Preoperative BCVA and SVFIS in eyes with optic nerve bending were significantly worse than those in eyes without bending, and significantly correlated with the optic nerve-canal bending angle (ONCBA). After tumor resection, BCVA and SVFIS significantly improved in both groups. Preoperative ONH-MBR was significantly lower in bending eyes but increased significantly post-treatment in both groups. Preoperative ONH-MBR correlated with ONCBA, while postoperative ONH-MBR correlated with nasal GCL + IPL thickness. Conclusions: Optic nerve bending and chiasmal compression showed reduced blood flow to the ONH. These changes in blood flow may be associated with GCL + IPL thickness and optic nerve bending angle. Full article

Background/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities. Full article