Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 367
Filter
1.
Arch. argent. pediatr ; 120(3): 209-216, junio 2022. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1368241

ABSTRACT

La laringe se localiza en la encrucijada aerodigestiva; cualquier patología que la comprometa tendrá repercusión en la respiración, la deglución y/o la voz. Se divide en tres regiones: la supraglotis (comprende la epiglotis, las bandas ventriculares y los ventrículos laríngeos), la glotis (espacio limitado por las cuerdas vocales) y la subglotis (zona más estrecha de la vía aérea pediátrica y único punto rodeado en su totalidad por cartílago: el anillo cricoides). La obstrucción laríngea se puede presentar como una condición aguda potencialmente fatal o como un proceso crónico. El síntoma principal es el estridor inspiratorio o bifásico. La etiología varía mucho según la edad y puede ser de origen congénito, inflamatorio, infeccioso, traumático, neoplásico o iatrogénico. Se describen las patologías que ocasionan obstrucción laríngea con más frecuencia o que revisten importancia por su gravedad, sus síntomas orientadores para el diagnóstico presuntivo, los estudios complementarios y el tratamiento.


The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three regions: supraglottis (includes epiglottis, ventricular bands and laryngeal ventricles), glottis (space limited by the vocal cords) and subglottis (narrowest area of pediatric airway and the only point of larynx completely surrounded by cartilage: the cricoid ring). Laryngeal obstruction can present as a potentially fatal acute condition or as a chronic process. The main symptom is inspiratory or biphasic stridor. The etiology varies widely according to age and it may be of congenital, inflammatory, infectious, traumatic, neoplastic or iatrogenic origin. We describe the pathologies that cause laryngeal obstruction, either those that occur very often or those which are important for their severity, their guiding symptoms to the presumptive diagnosis, additional studies and treatment.


Subject(s)
Humans , Child , Pediatrics , Laryngeal Diseases/diagnosis , Laryngeal Diseases/etiology , Airway Obstruction/etiology , Larynx/pathology , Algorithms , Laryngeal Diseases/therapy
2.
Ars méd ; 47(2): 42-46, jun. 03, 2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1399638

ABSTRACT

El manejo especializado de la vía aérea (VA) es fundamental en las unidades de urgencia donde la intubación orotraqueal ha sido la técnica de elección para lograrlo. Una VA difícil se define como una situación clínica en la cual un equipo médico entrenado experimenta dificultades en la ventilación y/o en intubación. La obstrucción aguda de la VA constituye una de las emergencias médicas más extremas, requiriendo intervención inmediata. Se pre-senta el caso de un paciente con estridor inspiratorio con criterios inmediatos de intubación donde se evidencia un tumor en cuerdas vocales con obstrucción de la vía aérea.


Specialized airway management is essential in emergency units where endotracheal intubation has been the technique of choice. The difficult airway is defined as a clinical situation in which a trained medical team experiences difficulties in ventilation and, or intubation. Acute airway obstruction is one of the most extreme medical emergencies, requiring immediate intervention. We present the case of a patient with inspiratory stridor with quick criteria for intubation where a tumour in the vocal cords with airway obstruction is found.

3.
Rev. chil. obstet. ginecol. (En línea) ; 87(1): 77-80, feb. 2022. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388713

ABSTRACT

Resumen El síndrome de obstrucción congénita de vías áreas superiores (CHAOS) es una condición que se caracteriza por la existencia de una obstrucción en las vías áreas altas en el feto, la cual puede ser parcial o completa. Comúnmente es una situación incompatible con la vida, por lo que su diagnóstico prenatal es importante considerando el pronóstico y los diferentes manejos prenatales y posnatales que existen. Presentamos un caso de CHAOS diagnosticado en la semana 21, con una breve revisión de la literatura sobre su diagnóstico, pronóstico y alternativas terapéuticas.


Abstract Congenital high airway obstruction syndrome (CHAOS) is a condition characterized by the existence of an obstruction of the fetal upper airways, which may be partial or complete. It is commonly incompatible with life, so its prenatal diagnosis is important due to the prognosis and the recently described pre and postnatal management options. We present a case of CHAOS in a pregnancy of 21 weeks with a brief review of the current literature about its diagnosis, prognosis and therapeutic alternatives.


Subject(s)
Humans , Male , Female , Pregnancy , Adult , Airway Obstruction/congenital , Airway Obstruction/diagnosis , Larynx/abnormalities , Syndrome , Ultrasonography, Prenatal , Perinatal Death
4.
Rev. CEFAC ; 24(5): e6522, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1406709

ABSTRACT

ABSTRACT This study aimed at investigating the effects of nasal cleansing and massage maneuvers on upper airway patency in mouth-breathing children. This is a case report on eight children, aged 7 to 10 years, with a speech-language-hearing diagnosis of mouth breathing and otorhinolaryngological assessment and clinical diagnosis of rhinitis. Nasal airflow and patency were respectively assessed with the Glatzel mirror and Peak Nasal Inspiratory Flow (PNIF). Then, they were submitted to nasal cleansing and massage maneuvers with a saline solution, followed by reassessment with the Glatzel mirror and PNIF to compare results. The medians of total nasal airflow quantification were significant. Data on unilateral nasal cavity measurement indicated a sharp increase in nasal airflow in each nostril, with statistically significant differences between before and after nasal cleansing and massage maneuvers. The medians of the total PNIF were significant after the cleansing. It is concluded that the nasal airflow increased in PNIF after the cleansing maneuver.


RESUMO Esse estudo objetivou investigar o efeito da manobra de limpeza e massagem nasal na permeabilidade da via aérea superior de crianças com respiração oral. Trata-se de um relato de caso no qual foram selecionadas oito crianças com idade entre 7 a 10 anos apresentando diagnóstico fonoaudiológico de respiração oral, com avaliação otorrinolaringológica e diagnóstico clínico de rinites. Realizou-se as avaliações da aeração nasal e permeabilidade nasal, utilizando o espelho milimetrado de Altmann e o Peak Nasal Inspiratory Flow (PNIF), respectivamente. Em seguida, executou-se as manobras de limpeza e massagem nasal com soro fisiológico. Ao término, utilizou-se novamente o espelho de Altmann e o PNIF para comparar os resultados. Os resultados obtidos pelas medianas na quantificação da aeração nasal total foram significantes. Os dados da mensuração das cavidades nasais unilateralmente indicaram aumento acentuado na aeração nasal em cada narina, tendo diferenças estatisticamente significante quando comparados com os valores antes e depois das manobras de limpeza e massagem nasal. Os valores obtidos pelas medianas no Fluxo Nasal Máximo Inspiratório Total foram significantes após a limpeza. Concluiu-se que houve aumento da aeração nasal no fluxo nasal máximo inspiratório após manobra de limpeza.

5.
Rev. med. (Säo Paulo) ; 101(1): e-179989, jan.-fev. 2022.
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1381425

ABSTRACT

Introdução: Amiloidose é o termo utilizado para designar doenças que fazem deposição extracelular de proteínas fibrilares patológicas em órgãos e tecidos, podendo ser sistêmica ou restrita a um único órgão. As manifestações clínicas são diversas, como cardiomiopatia, falência renal, esplenomegalia, problemas intestinais, neuropatias, problemas pulmonares, entre outros. Objetivo: relatar um caso clínico de paciente com amiloidose traqueobrônquica. Metodologia: revisão de bibliografias em comparação ao relato de caso, o qual foi descrito a partir de dados retirados do prontuário e de exames complementares da paciente. Caso clínico: paciente do sexo feminino, 70 anos, procurou assistência médica por dorsalgia, apresentando também chiado, tosse seca, dispneia paroxística noturna e ortopneia. Realizou-se investigação diagnóstica durante a internação, na qual biópsia da mucosa traqueobrônquica e coleta de lavado alveolar foram positivos para o teste Vermelho Congo, o que confirmou o diagnóstico de amiloidose. A paciente, então, foi encaminhada para terapia de ablação a laser. Conclusão: portanto, diante de um paciente com quadro clínico inespecífico e suspeita diagnóstica principal de amiloidose pulmonar, é imprescindível investigar e descartar diagnósticos diferenciais como neoplasia ou discrasia de células plasmáticas. Para isso, é necessário que haja alta precisão na análise dos exames de imagem, de modo a sugerir esse diagnóstico, o qual deve ser confirmado através da fibrobroncoscopia com biópsia de tecido brônquico, que através da coloração Vermelho do Congo, evidenciará presença de substância amorfa e birrefringente, compatível com substância amiloide [au]


Introduction: Amyloidosis is the term used to describe diseases that cause extracellular deposition of pathological fibrillar proteins in organs and tissues, which can be systemic or restricted to a single organ. The clinical manifestations are diverse, such as cardiomyopathy, renal failure, splenomegaly, intestinal problems, neuropathies, lung problems, among others. Objective: to report a clinical case of a patient with pulmonary amioloidosis. Methodology: review of bibliographies in comparison to the case report, which was described based on data taken from the patient's record and complementary exams. Clinical case: a seventy-year-old female patient sought medical assistance because of back pain, also presenting wheezing, dry cough, paroxysmal nocturnal dyspnea and orthopnea. Diagnostic investigation was carried out during hospitalization, in which biopsy of the tracheobronchial mucosa and collection of alveolar lavage were positive for the Congo Red test,wich confirmed the amyloidosis diagnosis. The patient was then referred for laser ablation therapy.Conclusion: hence, in a patient with a nonspecific clinical presentation and main diagnostic suspicion of pulmonary amyloidosis, it is essential to investigate and rule out differential diagnoses such as malignancy or plasma cell dyscrasia. Therefore, it is necessary to use high precision in the analysis of image exams in order to suggest this diagnosis, which should be confirmed through fibrobronchoscopy with bronchial tissue biopsy, that through the Congo Red dye, will show the presence of amorphous and birefringent substance, compatible with amyloid substance [au]

6.
Autops. Case Rep ; 12: e2021377, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1374488

ABSTRACT

ABSTRACT Endobronchial lipomas are rare benign lung tumors that can cause bronchial obstruction and parenchymal damage. While an uncommon etiology, they are often misdiagnosed due to a clinical presentation similar to obstructive pulmonary pathologies such as COPD and asthma. Upon review of English-language literature, under 50 cases of endobronchial lipomas were documented in the prior 10 years (2011-2021). There are no clear guidelines regarding the management of this particular entity, but typically interventional debulking is the treatment of choice. Here we present another unique case of endobronchial lipoma along with our diagnostic and therapeutic methodology. The patient underwent bronchoscopic debulking via a cryotherapy probe. Based on the histopathologic analysis, a diagnosis of endobronchial lipoma was made. Endobronchial lipomas must remain in any clinician's differential when a patient presents with dyspnea. We report the unique location of this lipoma based on our literature review and the importance of investigating endobronchial lesions due to a possible diagnosis of endobronchial lipoma.

7.
Einstein (Säo Paulo) ; 20: eMD8035, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394329

ABSTRACT

ABSTRACT Obstructive sleep apnea is a disorder characterized by complete or incomplete and recurrent upper airway collapse induced by sleep. Several diagnostic methods for obstructive sleep apnea are used, but only sleep endoscopy allows an endoscopic assessment of pharyngeal collapse during sedation. It is essential to carry out sleep endoscopy following a systematic institutional protocol, in preestablished stages, to ensure better reproducibility and reliability of the results found. Sleep endoscopy has few limitations and is a safe test, with a low risk of complications.

8.
Acta Paul. Enferm. (Online) ; 35: eAPE039007434, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1374036

ABSTRACT

Resumo Objetivo Identificar os indicadores clínicos mais relevantes para o Diagnóstico de Enfermagem Desobstrução ineficaz de vias aéreas. Método Estudo metodológico de análise de conteúdo organizado em três fases: definição conceitual do fenômeno de interesse, construção da estrutura do fenômeno de interesse e análise dos juízes sobre a estrutura construída. Resultados Foram identificados 21 indicadores clínicos. Apenas Sons respiratórios aumentados e Retração subcostal não foram indicadores significativamente relevantes para o diagnóstico. Conclusão Os indicadores de maior relevância para o diagnóstico Desobstrução ineficaz de vias aéreas foram: Dispneia, Mudanças no ritmo respiratório, Ruídos adventícios respiratórios, Taquipneia, Acúmulo excessivo de muco, Tosse ineficaz, Sons respiratórios diminuídos, Ortopneia, Cianose, Inquietação, Dificuldade para verbalizar e Uso da musculatura acessória para respirar.


Resumen Objetivo Identificar a los indicadores clínicos más relevantes para el Diagnóstico de Enfermería Desobstrucción ineficaz de las vías aéreas. Métodos Estudio metodológico de análisis de contenido organizado em tres fases: definición conceptual del fenómeno de interés, construcción de la estructura del fenómeno de interés y análisis de los jueces sobre la estructura construida. Resultados Se identificaron 21 indicadores clínicos. Únicamente Sonidos respiratorios aumentados y Retracción subcostal no fueron indicadores significantemente relevantes para el diagnóstico. Conclusión Los indicadores de mayor relevancia para el diagnóstico Desobstrucción ineficaz de las vías aéreas fueron: Disnea, Cambios en el ritmo respiratorio, Ruidos adventicios respiratorios, Taquipnea, Acúmulo excesivo de mucosidad, Tos ineficaz, Sonidos respiratorios disminuidos, Ortopnea, Cianosis, Inquietud, Dificultad para verbalizar y Uso de la musculatura accesoria para respirar.


Abstract Objective To identify the most relevant clinical indicators for the Ineffective airway clearance Nursing Diagnosis. Method This is a methodological study of content analysis organized into a conceptual definition of the phenomenon of interest, construction of the phenomenon of interest structure and analysis by judges on the constructed structure. Results Twenty-one clinical indicators were identified. Only Increased breath sounds and Subcostal retraction were not significantly relevant for the diagnosis. Conclusion The most relevant indicators for the Ineffective airway clearance diagnosis were: Dyspnea, Alteration in respiratory rate, Adventitious respiratory noises, Tachypnea, Excessive sputum, Ineffective cough, Decreased breathing sounds, Orthopnea, Cyanosis, Restlessness, Difficulty verbalizing and Use of accessory muscles to breathe.


Subject(s)
Humans , Signs and Symptoms, Respiratory , Nursing Diagnosis , Nursing Diagnosis/standards , Telemedicine , Airway Obstruction , Permeability , Indicators (Statistics) , Validation Studies as Topic
9.
Cambios rev. méd ; 20(2): 89-93, 30 Diciembre 2021. ilus, tabs.
Article in Spanish | LILACS | ID: biblio-1368391

ABSTRACT

La aspiración de cuerpos extraños es una de las principales causas de ingreso a urgencias y de morbi-mortalidad en Ecuador en pacientes pediátricos. El diagnóstico suele ser tardío, por falta de interés de los cuidadores, o por errores en la valoración. Es importante detectar el cuadro a tiempo, para evitar complicaciones. OBJETIVO. Demostrar la necesidad de un diagnóstico acertado ante la alta sospecha en un cuadro dudoso de aspiración de cuerpo extraño. SERIE DE CASOS. Evaluación de cuatro pacientes de ambos sexos, de entre 11 meses a 15 años de edad con antecedente de ingesta de cuerpo extraño, atendidos en la Unidad Técnica de Cirugía Pediátrica, del Hospital de Especialidades Carlos Andrade Marín, durante el periodo 2019-2020. Se realizó la extracción exitosa mediante broncoscopia rígida en tres de ellos. DISCUSIÓN. La mayoría de pacientes con aspiración de cuerpo extraño suelen ser menores de 5 años de edad, en contraste con éste estudio, donde sólo un paciente estuvo dentro de este rango, y el resto fueron escolares y adolescentes. El cuerpo extraño más común es de origen orgánico; el 50% de los casos observados fue de origen inorgánico. CONCLUSIÓN. El diagnóstico de aspiración de cuerpo extraño se condiciona a la obtención completa de datos sobre la Historia Clínica; requiere una valoración rápida y manejo adecuado por emergencias.


INTRODUCTION. Foreign body aspiration is one of the main causes of emergency room admissions and morbidity and mortality in pediatric patients in Ecuador. Diagnosis is usually late, due to lack of interest of caregivers, or due to errors in the assessment. It is important to detect the condition in time to avoid complications. OBJECTIVE. To demonstrate the need for an accurate diagnosis in the presence of high suspicion in a doubtful picture of foreign body aspiration. CASE SERIES. Evaluation of four patients of both sexes, between 11 months and 15 years of age with a history of foreign body ingestion, attended at the Pediatric Surgery Technical Unit of the Carlos Andrade Marin Specialties Hospital, during 2019-2020 period. Successful extraction by rigid bronchoscopy was performed in three of them. DISCUSSION. Most patients with foreign body aspiration are usually under 5 years of age, in contrast to this study, where only one patient was within this range, and the rest were schoolchildren and adolescents. The most common foreign body is of organic origin; 50% of the cases observed were of inorganic origin. CONCLUSION. The diagnosis of foreign body aspiration is conditioned to the complete collection of data on the Clinical History; it requires a rapid assessment and appropriate emergency management.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Trachea , Airway Obstruction/diagnostic imaging , Delayed Diagnosis , Foreign Bodies/diagnostic imaging , Lung , Pneumonia/diagnostic imaging , Bronchoscopy , Tomography, X-Ray Computed , Cough/diagnostic imaging , Airway Obstruction/surgery
10.
Rev. colomb. anestesiol ; 49(1): e301, Jan.-Mar. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1149795

ABSTRACT

Abstract Complications in airway management remain a common cause of anesthesia-associated mortality. When a patient is considered with anticipated difficult airway, the management depends on several variables, however, at present, the standard of management continues to be the patient awake approach. In scenarios of acute upper airway obstruction, the only way to guarantee adequate ventilation is to obtain a translaryngeal or transtracheal access, for which, it is necessary to use local anesthesia and grade I / II sedation, avoiding loss of spontaneous ventilation. For this purpose, we propose ultrasound-guided superior laryngeal nerve block, in order to standardize an ultrasound landmark that is reproduceable, with a high success rate, which allows limiting complications related to regional anatomic techniques and thus facilitating the securing of the airway in these patients.


Resumen Las complicaciones en el manejo de la vía aérea siguen siendo una causa frecuente de mortalidad relacionada con anestesia. Cuando un paciente se considera con vía aérea difícil anticipada, el manejo depende de diversas variables, sin embargo, en la actualidad, el estándar de manejo sigue siendo el abordaje con paciente despierto. En escenarios de obstrucción aguda de la vía aérea superior, la única forma de garantizar una adecuada ventilación es obtener un acceso translaríngeo o transtraqueal, para lo cual, es necesario el uso de anestesia local y de sedación grado I/II evitando la pérdida de ventilación espontánea. Con este propósito, planteamos el bloqueo del nervio laríngeo superior guiado por ultrasonografía, con el fin de estandarizar una referencia ecográfica reproducible, con alto índice de éxito, la cual permita limitar complicaciones relacionadas con las técnicas regionales anatómicas y así facilitar el aseguramiento de la vía aérea en estos pacientes.


Subject(s)
Humans , Ultrasonography , Anesthesia, Local , Laryngeal Nerves , Nerve Block , Airway Obstruction , Anesthesiologists , Intubation
11.
Braz. j. otorhinolaryngol. (Impr.) ; 87(1): 74-79, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1153589

ABSTRACT

Abstract Introduction: Upper airway obstruction, secondary to neoplasms presenting with stridor, is traditionally treated by tracheostomy. However, this common procedure can potentially have an impact on the long-term outcome, with tumor implantation into the tracheostomized wound leading to peristomal recurrence after laryngectomy, with the risk of stomal recurrence. Objective: To describe our clinical experience with tumor debulking as an alternative treatment choice of tracheotomy in patients with advanced larynx cancer at a tertiary referral center. Methods: A retrospective chart review of 87 subjects who had advanced larynx cancer (T3/4) with airway obstruction from our institutional database was conducted. Medical records including demographics, daily notes during hospitalization, and operative notes were used for clinical data of patients. The strategy for maintaining the airway patency was tracheotomy (emergency or awake) and tumor debulking (laser or coblation). Endophytic and exophytic laryngeal tumors were also noted. Results: In 41/87 (47.1%) patients, a tracheotomy was performed as an initial treatment (11 were emergency, 30 were planned) to maintain airway patency. Tumor debulking was performed in 28 exophytic and 18 endophytic lesions by laser or coblation (17 and 29 patients, respectively). Tracheotomy was performed in 5 patients (4 endophytic, 1 exophytic) who could not tolerate debulking surgery due to aspiration, edema and dyspnea. Three of the them who required subsequent tracheotomy was in the laser group and two in the coblation group. The success rate of laser debulking was 82.35% (14/17) and 93.1% (27/29) for coblation. Conclusion: Tumor debulking is a safe and effective method to avoid awake tracheotomy in patients suffering from airway obstruction due to advanced larynx cancer.


Resumo Introdução: A obstrução das vias aéreas superiores com estridor, secundária a neoplasias, é tradicionalmente tratada com traqueotomia. No entanto, este procedimento comum pode potencialmente ter um impacto sobre o desfecho a longo prazo, com a implantação do tumor na ferida cirúrgica da traqueotomia, o que leva à recorrência peristomal após laringectomia, com o risco de recorrência do estoma. Objetivo: Descrever nossa experiência clínica com a redução do volume tumoral como tratamento alternativo à traqueotomia em pacientes com câncer avançado de laringe em um centro de referência terciário. Método: Foi realizada uma revisão retrospectiva de prontuários de 87 indivíduos com câncer avançado de laringe (T3/T4) com obstrução das vias aéreas em nosso banco de dados institucional. Registros médicos incluindo dados demográficos, anotações diárias durante a hospitalização e anotações operacionais foram utilizados como dados clínicos dos pacientes. A estratégia para manter a patência das vias aéreas foi a traqueotomia (emergência ou em pacientes acordados) e redução do volume tumoral (por laser ou coblation). Tumores endofíticos e exofíticos da laringe também foram anotados. Resultados: Uma traqueotomia foi realizada como tratamento inicial em 41/87 (47,1%) pacientes (11 foram de emergência, 30 foram eletivas) para manter a patência das vias aéreas. A redução do volume tumoral foi realizada em 28 lesões exofíticas e 18 endofíticas por laser ou coblation (17 e 29 pacientes, respectivamente). A traqueotomia foi realizada em 5 pacientes (4 endofíticos, 1 exofítico) que não podiam tolerar a cirurgia de redução de volume devido à aspiração, edema e dispneia. Três deles que necessitaram de uma traqueotomia subsequente estavam no grupo de laser e dois no grupo coblation. A taxa de sucesso da redução tumoral foi de 82,35% (14/17) para o laser e 93,1% (27/29) para coblation. Conclusão: A redução do volume tumoral é um método seguro e eficaz para evitar a traqueotomia com paciente acordado, nos casos de obstrução das vias aéreas devido ao câncer de laringe avançado.


Subject(s)
Humans , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/complications , Airway Obstruction/surgery , Airway Obstruction/etiology , Tracheotomy , Tracheostomy , Retrospective Studies , Cytoreduction Surgical Procedures , Neoplasm Recurrence, Local
12.
Arch. argent. pediatr ; 119(1): e45-e48, feb. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1147260

ABSTRACT

Cuando los recién nacidos presentan obstrucción de la vía aérea, requieren un manejo urgente y experto para evitar la mortalidad y la morbilidad. La definición de vía aérea difícil se relaciona con problemas en la intubación endotraqueal o en la ventilación a presión positiva con bolsa y máscara o reanimador de pieza en T. El manejo debe basarse en la comprensión del mecanismo fisiopatológico responsable de la vía aérea difícil. Las causas en el recién nacido pueden ser congénitas y/o adquiridas.Se presenta el caso de una recién nacida con síndrome de Treacher-Collins tipo 1 [OMIM #154500] con una disostosis mandibulofacial, micrognatia, hipoplasia malar, paladar hendido, sin cardiopatía congénita, asociado con intubación extremadamente difícil


f newborns have an airway obstruction, they require urgent and expert management to avoid mortality and morbidity. The definition of difficult airway includes problems in endotracheal intubation or positive pressure ventilation with bag and mask or T-piece resuscitator. Management should be based on an understanding of the pathophysiological mechanism responsible for difficult airway. The causes of difficult airway in the newborn can be congenital or acquired.We present the case of a newborn with Treacher-Collins syndrome Type 1 [OMIM # 154500] with a mandibulofacial dysostosis, micrognathia, malar hypoplasia, cleft palate, without congenital heart disease, associated with extremely difficult intubation


Subject(s)
Humans , Female , Infant, Newborn , Airway Management , Mandibulofacial Dysostosis , Respiratory Distress Syndrome, Newborn , Congenital Abnormalities , Osteogenesis, Distraction , Airway Obstruction , Intubation, Intratracheal
13.
Metro cienc ; 29(1 (2021): Enero- Marzo): 44-50, 2021-01-29.
Article in Spanish | LILACS | ID: biblio-1337679

ABSTRACT

La secuencia de Pierre Robin (SPR) es una enfermedad rara, caracterizada por una tríada de malformaciones orofaciales como retrognatia, glosoptosis y fisura velopalatina media (paladar hendido); las cuales, generalmente provocan obstrucción de la vía aérea (OVA). La corrección de los defectos palatinos requiere en ocasiones varias intervenciones quirúrgicas, por esta razón el cuidado anestésico y abordaje de la vía aérea en forma adecuada, evita complica-ciones asociadas a esta enfermedad. Se presenta el caso de un paciente de 1 año y 20 días de edad, con antecedentes de vía aérea difícil, intentos fallidos de intubaciones preliminares e intervenido quirúrgicamente para corrección de paladar hendido, luego de una técnica combinada de intubación nasal con fibrobroncoscopio, desplazamiento de glosoptosis con ayuda de pala número 2 de videolaringoscopio (Glidescope®); manejo transoperatorio anestésico y proceso de extubación con excelentes resultados. Destacamos la importancia de realizar una adecuada planificación multidisciplinaria prequirúrgica con valoración exhaustiva de la vía aérea (VA) por laringoscopía directa o fibrobroncospia flexible para conocer el sitio exacto de la obstrucción y evitar desen-laces adversos.


Pierre Robin Sequence (PRS) is a rare disease characterized by a triad of orofacial malformations such as retrognathia, glossoptosis and velopalatine fissure (cleft palate). The malformations in PRS can lead into airway obstruction. The correction of the palatal defects sometimes requires several surgical interven-tions. Proper anesthetic care and a carefully planned approach to the airway can avoid complications associated with this disease. We present the case of a 1 year and 20 days old patient, with history of difficult airway, unsuccessful prior attempts of intubation, who underwent surgery to correct a cleft palate. We used a combined approach that included nasal intubation technique with a fiberoptic bronchoscope aided with a number 2 video laryngoscope blade (Gli-descope®) for displacement of the glossoptosys. Details of the intraoperative anesthetic management and subsequent successful extubation are provided. We highlight the importance of developing an adequate preoperative multidisciplinary plan of action, after a careful and detailed evaluation of the airway with direct laryngoscopy or fiberoptic bronchoscopy in order to identify the exact location of the obstruction and avoid adverse outcomes.


Subject(s)
Humans , Male , Infant , Pierre Robin Syndrome , Cleft Palate , Airway Management , Glossoptosis , Intubation , Laryngoscopy
14.
Rev. méd. Minas Gerais ; 31: 31407, 2021.
Article in English, Portuguese | LILACS | ID: biblio-1291382

ABSTRACT

Objetivo: relatar e descrever a evolução satisfatória de uma Angina de Ludwig decorrente de uma infecção amigdaliana, que evoluiu para mediastinite e choque séptico. O trabalho visa detalhar os aspectos clínicos e diagnósticos desta grave doença, além da terapêutica empregada neste caso. Método: as informações foram obtidas do prontuário do paciente, bem como dos laudos dos exames de imagem realizados. A revisão da literatura foi feita na base de dados PUBMED. Considerações finais: o caso estudado relata um raro desfecho favorável de uma Angina de Ludwig que evoluiu para mediastinite, cuja taxa de mortalidade é de até 50% dos casos. A abordagem cirúrgica combinada com antibioticoterapia precoce se mostra ser a melhor conduta para estes casos.


Objective: report and describe the satisfactory evolution of Ludwig's Angina due to a tonsillary infection, which evolved to mediastinitis and sept shock. The work aims to detail the clinical and diagnostic aspects of this serious illness, in addition to the therapy used in this case. Method: the information was obtained from the patient's medical record, as well as from the reports of the imaging tests performed. The literature review was carried out in the PUBMED database. Final considerations: the case studied has great importance for the medical community, since it reports a rare favorable outcome for a case of Ludwig's Angina complicated with an mediastinitis, whose mortality is described up to 50% of the cases. The surgical approach combined with early antibiotic therapy is shown to be the best approach for these cases.


Subject(s)
Humans , Male , Middle Aged , Ludwig's Angina , Mediastinitis , Osteomyelitis , Tonsillitis , Airway Obstruction , Infections , Anti-Bacterial Agents/therapeutic use
15.
Rev. Esc. Enferm. USP ; 55: e03778, 2021. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1279635

ABSTRACT

RESUMO Objetivo Analisar as tecnologias desenvolvidas para educação em saúde sobre obstrução das vias aéreas. Método Revisão integrativa realizada mediante busca nas bases de dados Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science e Scopus. Selecionaram-se estudos originais, sem restrições de tempo e idioma. Os dados foram extraídos por dois pesquisadores independentes e organizados em quadros sinópticos. A integração dos resultados fundamentou-se no método de redução de dados. Resultados Foram incluídos oito artigos, publicados em periódicos nacionais e internacionais, com predominância de estudos metodológicos. As tecnologias evidenciadas foram dos tipos aplicativos, cursos online, animação 3D, cartilha e website. A temática foi abordada entre os conteúdos do Suporte Básico de Vida. Observou-se ausência de tecnologias que abordassem o tema com acessibilidade. Conclusão As tecnologias identificadas eram no formato digital e impresso e possuíam validade de conteúdo e efetividade para utilização na educação e saúde. Ainda assim, há lacuna de estudos que evidenciem tecnologias educacionais específicas sobre obstrução das vias aéreas.


RESUMEN Objetivo Analizar las tecnologías desarrolladas para la educación en salud sobre la obstrucción de la vía aérea. Método Revisión integradora realizada mediante búsquedas en las bases de datos Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science y Scopus. Se seleccionaron estudios originales, sin restricciones de tiempo ni de idioma. Los datos fueron extraídos por dos investigadores independientes y organizados en cuadros sinópticos. La integración de los resultados se basó en el método de reducción de datos. Resultados Se incluyeron ocho artículos publicados en revistas brasileñas e internacionales, con predominio de estudios metodológicos. Las tecnologías evidenciadas fueron de los tipos aplicaciones, cursos en línea, animación 3D, cartilla y sitio web. El tema se abordó entre los contenidos del Soporte Vital Básico. Se ha observado la carencia de tecnologías que aborden el tema con accesibilidad. Conclusión Las tecnologías identificadas estaban en formato digital e impreso y tenían validez de contenido y eficacia para su uso en educación y salud. Sin embargo, hay una carencia de estudios que evidencien tecnologías educativas específicas sobre la obstrucción de la vía aérea.


ABSTRACT Objective To analyze technologies developed for health education about airway obstruction. Method Integrative review through search in the databases Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Scopus. Original studies, with no time and language restrictions, were selected. The data were extracted by two independent researchers and organized into synoptic tables. Result integration was based on the data reduction method. Results The eight included articles were published in Brazilian and international journals and were predominantly methodological. The identified technologies were applications, online courses, 3D animations, booklet, and website. The theme was approached among the contents of Basic Life Support. An absence of technologies approaching the theme with accessibility was observed. Conclusion The identified technologies were digital and printed, presenting content validity and effectivity for use in education and health. Even so, there is gap in studies highlighting specific educational technologies on airway obstruction.


Subject(s)
Health Education , Airway Obstruction , Teaching Materials , Review , Educational Technology , Gagging
16.
J. bras. pneumol ; 47(6): e20210124, 2021. tab, graf
Article in English | LILACS | ID: biblio-1356421

ABSTRACT

ABSTRACT Objective: The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC ratio < 70%-to define obstruction, although other guidelines suggest that a post-bronchodilator FEV1/FVC ratio < the lower limit of normal (LLN) is the most accurate criterion. Methods: This was an observational study of individuals ≥ 40 years of age with risk factors for COPD who were referred to our pulmonary function laboratory for spirometry. Respiratory symptoms were also recorded. We calculated the prevalence of airway obstruction and of no airway obstruction, according to the GOLD criterion (GOLD+ and GOLD−, respectively) and according to the LLN criterion (LLN+ and LLN−, respectively). We also evaluated the level of agreement between the two criteria. Results: A total of 241 individuals were included. Airway obstruction was identified according to the GOLD criterion in 42 individuals (17.4%) and according to the LLN criterion in 23 (9.5%). The overall level of agreement between the two criteria was good (k = 0.67; 95% CI: 0.52-0.81), although it was lower among the individuals ≥ 70 years of age (k = 0.42; 95% CI: 0.12-0.72). The proportion of obese individuals was lower in the GOLD+/LLN+ category than in the GOLD+/LLN− category (p = 0.03), as was the median DLCO (p = 0.04). Conclusions: The use of the GOLD criterion appears to be associated with a higher prevalence of COPD. The agreement between the GOLD and LLN criteria also appears to be good, albeit weaker in older individuals. The use of different criteria to define airway obstruction seems to identify individuals with different characteristics. It is essential to understand the clinical meaning of discordance between such criteria. Until more data are available, we recommend a holistic, individualized approach to, as well as close follow-up of, patients with discordant results for airway obstruction.


RESUMO Objetivo: A identificação de obstrução persistente das vias aéreas é fundamental para o diagnóstico de DPOC. As diretrizes da GOLD sugerem um critério fixo - relação VEF1/CVF pós-broncodilatador < 70% - para definir obstrução, embora outras diretrizes sugiram que a relação VEF1/CVF pós-broncodilatador < o limite inferior da normalidade (LIN) é o critério mais preciso. Métodos: Estudo observacional com indivíduos ≥ 40 anos de idade com fatores de risco para DPOC encaminhados ao nosso laboratório de função pulmonar para espirometria. Também foram registrados sintomas respiratórios. Calculamos a prevalência de obstrução e de ausência de obstrução das vias aéreas segundo o critério GOLD (GOLD+ e GOLD−, respectivamente) e segundo o critério LIN (LIN+ e LIN−, respectivamente). Avaliamos também o grau de concordância entre os dois critérios. Resultados: Foram incluídos 241 indivíduos. Obstrução das vias aéreas foi identificada segundo o critério GOLD em 42 indivíduos (17,4%) e segundo o critério LIN em 23 (9,5%). A concordância global entre os dois critérios foi boa (k = 0,67; IC95%: 0,52-0,81), embora tenha sido menor entre os indivíduos ≥ 70 anos de idade (k = 0,42; IC95%: 0,12-0,72). A proporção de obesos foi menor na categoria GOLD+/LIN+ do que na categoria GOLD+/LIN− (p = 0,03), assim como a mediana de DLCO (p = 0,04). Conclusões: A utilização do critério GOLD parece estar associada a uma maior prevalência de DPOC. A concordância entre os critérios GOLD e LIN também parece ser boa, embora seja mais fraca em indivíduos mais velhos. A utilização de diferentes critérios para definir obstrução das vias aéreas parece identificar indivíduos com diferentes características. É essencial compreender o significado clínico da discordância entre esses critérios. Até que mais dados estejam disponíveis, recomendamos uma abordagem holística e individualizada e também um acompanhamento cuidadoso dos pacientes com resultados discordantes para obstrução das vias aéreas.


Subject(s)
Humans , Aged , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/epidemiology , Spirometry , Vital Capacity , Forced Expiratory Volume , Risk Factors
17.
Rev. bras. anestesiol ; 70(5): 553-555, Sept.-Oct. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1143970

ABSTRACT

Abstract Hydatid cyst in the cervical region is an extremely rare condition that can create challenges for anesthesiologists. Timely recognition of difficult airway and preparing the management plan is crucial to avoid life-threatening complications such as hypoxic brain damage. We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low-dose ketamine-propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst.


Resumo O cisto hidático na região cervical é uma condição extremamente rara que pode criar desafios para os anestesiologistas. O reconhecimento oportuno das vias aéreas difíceis e a preparação do plano de manejo são cruciais para evitar complicações com risco de vida, como danos cerebrais hipóxicos. Descrevemos um caso de difícil controle das vias aéreas em um paciente com cisto hidático cervical maciço. Utilizamos sedação com cetamina-propofol em baixa dose e spray de lidocaína para anestesia local orofaríngea. Relaxantes musculares não foram utilizados e a respiração espontânea foi mantida durante a intubação. O reconhecimento, a avaliação e o planejamento perioperatório são essenciais para o manejo difícil das vias aéreas em pacientes com cisto hidático cervical.


Subject(s)
Humans , Male , Adult , Airway Obstruction/parasitology , Echinococcosis/complications , Cervical Cord/parasitology , Propofol/administration & dosage , Echinococcosis/surgery , Airway Management , Intubation, Intratracheal , Ketamine/administration & dosage , Anesthesia, Local/adverse effects , Lidocaine/administration & dosage
18.
Rev. pediatr. electrón ; 17(3): 49-56, oct. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1367347

ABSTRACT

El neuroblastoma es uno de los tumores sólidos extracraneales más comunes en la edad pediátrica, y se origina en células precursoras del sistema nervioso simpático. La ubicación cervical corresponde a un 2-5% del total de los neuroblastomas y puede tener distintas manifestaciones clínicas, tales como masa cervical, disnea, estridor, síndrome de Horner o disfagia. Esta entidad debe ser considerada dentro del diagnóstico diferencial de una masa cervical pediátrica, especialmente ante la presencia de masas sólidas, laterales o paramedianas, palpables o no al examen físico. El tratamiento específico del neuroblastoma depende de la clasificación de riesgo del paciente, pudiendo ser expectante en casos específicos, exclusivamente quirúrgico, o bien requerir complementarse con otras terapias. En este artículo se presentan 2 casos clínicos de pacientes pediátricos con neuroblastoma cervical tratados de forma exclusiva y exitosa con cirugía, y una revisión del tema.


Neuroblastoma is one of the commonest extracranial solid tumors at pediatric age, originating from sympathetic nervous system precursor cells. Cervical position stands for 2-5% of all neuroblastomas, with variable clinical expression that includes cervical mass, dyspnea, stridor, Horner syndrome and dysphagia. This condition must be considered in the differential diagnosis of a pediatric cervical mass, specially in those solid, lateral/paramedian masses that could be palpable or not at physical examination. The specific treatment in neuroblastoma depends on patient´s risk group, including conservative follow-up in selected cases, surgery alone, or complementary perioperative therapy with chemotherapy and others. In this article, the group report two cases of cervical neuroblastoma exclusively treated with surgery with good results, and a literature review.


Subject(s)
Humans , Male , Infant, Newborn , Infant , Head and Neck Neoplasms/diagnosis , Neuroblastoma/surgery , Neuroblastoma/diagnosis , Horner Syndrome , Diagnosis, Differential , Airway Obstruction/etiology , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/complications , Neuroblastoma/complications
19.
Arch. argent. pediatr ; 118(5): e491-e494, oct 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1122539

ABSTRACT

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente


Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient


Subject(s)
Humans , Female , Infant, Newborn , Nasal Polyps/diagnostic imaging , Resuscitation , Nasal Polyps/surgery , Nasopharyngeal Diseases , Cyanosis , Airway Obstruction , Intubation, Intratracheal , Neoplasms
20.
Article | IMSEAR | ID: sea-208035

ABSTRACT

Congenital high airway obstruction syndrome (CHAOS) is an extremely rare and life-threatening condition. It occurs due to obstruction in fetal respiratory tract and is characterized by typical ultrasonographic findings. Risk of recurrence is low, so antenatal diagnosis can help in counselling regarding risk of recurrence. A retrospective record review of all cases referred to our institution for antenatal ultrasound over a period of 5 years from January, 2014 to December, 2018 was done. Cases diagnosed as CHAOS were reviewed in detail regarding the radiological findings, information regarding delivery, fetal karyotype and postnatal/ fetal examination. Between the period of 2014 to 2018 three fetuses with CHAOS were identified. All of them had characteristic radiological features. Two of them were associated with hydrops and one fetus had oligohydramnios. All the pregnancies were terminated after antenatal diagnosis. Amniocentesis was done in 2 out of 3 cases and fetal karyotype was found to be normal. Fetal autopsy was done in one case and site of upper airway obstruction was identified. Confirmation of diagnosis by antenatal ultrasound and if possible, by post-mortem examination is essential for providing estimation of risk of recurrence to the family and genetic counselling.

SELECTION OF CITATIONS
SEARCH DETAIL