Assessment of high-flow nasal cannula efficacy in humidification of infant airways: A computational fluid dynamics approach.

INTRODUCTION: High-flow nasal cannula therapy has garnered significant interest for managing pathologies affecting infants' airways, particularly for humidifying areas inaccessible to local treatments. This therapy promotes mucosal healing during the postoperative period. However, further data are needed to optimize the use of these devices. In vivo measurement of pediatric airway humidification presents a challenge; thus, this study aimed to investigate the airflow dynamics and humidification effects of high-flow nasal cannulas on an infant's airway using computational fluid dynamics. METHODS: Two detailed models of an infant's upper airway were reconstructed from CT scans, with high-flow nasal cannula devices inserted at the nasal inlets. The airflow was analyzed, and wall humidification was modeled using a film-fluid approach. RESULTS: Air velocities and pressure were very high at the airway inlet but decreased rapidly towards the nasopharynx. Maximum relative humidity-close to 100%-was achieved in the nasopharynx. Fluid film development along the airway was heterogeneous, with condensation primarily occurring in the nasal vestibule and larynx. CONCLUSION: This study provides comprehensive models of airway humidification, which pave the way for future studies to assess the impact of surgical interventions on humidification and drug deposition directly at operative sites, such as the nasopharynx or larynx, in infants.

Heliox simulations for initial management of congenital laryngotracheal stenosis.

OBJECTIVES: Congenital laryngotracheal stenosis is rare, potentially severe, and difficult to manage. Heliox is a medical gas effective in obstructive airway pathologies, given its physical properties. This study aims to model the interest of Heliox in reducing the respiratory work in congenital laryngotracheal stenosis, using numerical fluid flow simulations, before considering its clinical use. DESIGN: This is a retrospective study, performing Computational Fluid Dynamics numerical simulations of the resistances to airflow and three types of Heliox, on 3D reconstructions from CT scans of children presenting with laryngotracheal stenosis. PATIENTS: Infants and children who were managed in the Pediatric ENT department of a tertiary-care center and underwent CT scanning for laryngotracheal stenosis between 2008 and 2018 were included. RESULTS: Fourteen models of congenital laryngotracheal stenosis were performed in children aged from 16 days to 5 years, and one model of the normal trachea in a 5-year-old child. Tightest stenosis obtained the highest airway resistances, ranging from 40 to 10 kPa/L/s (up to 800 times higher than in the normal case). Heliox enabled a decrease in pressure drops and airway resistances in all stenosis cases, correlated to increasing Helium concentration. CONCLUSIONS: Heliox appears to reduce pressure drops and airway resistances in 3D models of laryngotracheal stenosis. It may represent a supportive treatment for laryngotracheal stenosis, while waiting for specialized care, thanks to the reduction of respiratory work.

Sessile drops in weightlessness: an ideal playground for challenging Young's equation.

Sessile drop creation in weightlessness is critical for designing scientific instruments for space applications and for manipulating organic or biological liquids, such as whole human blood or DNA drops. It requires perfect control of injection, spreading, and wetting; however, the simple act of creating a drop on a substrate is more complex than it appears. A new macroscopic model is derived to better understand this related behavior. We find that, for a given set of substrate, liquid, and surrounding gas properties, when the ratio of surface free energies to contact line free energy is on the macroscopic scale, the macroscopic contact angle can vary at static equilibrium over a broad volume range. It can increase or decrease against volume depending on the sign of this ratio up to an asymptotic value. Consequently, our model aims to explore configurations that challenge the faithful representativity of the classical Young's equation and extends the present understanding of wetting.

Sessile volatile drop evaporation under microgravity.

The evaporation of sessile drops of various volatile and non-volatile liquids, and their internal flow patterns with or without instabilities have been the subject of many investigations. The current experiment is a preparatory one for a space experiment planned to be installed in the European Drawer Rack 2 (EDR-2) of the International Space Station (ISS), to investigate drop evaporation in weightlessness. In this work, we concentrate on preliminary experimental results for the evaporation of hydrofluoroether (HFE-7100) sessile drops in a sounding rocket that has been performed in the frame of the MASER-14 Sounding Rocket Campaign, providing the science team with the opportunity to test the module and perform the experiment in microgravity for six consecutive minutes. The focus is on the evaporation rate, experimentally observed thermo-capillary instabilities, and the de-pinning process. The experimental results provide evidence for the relationship between thermo-capillary instabilities and the measured critical height of the sessile drop interface. There is also evidence of the effects of microgravity and Earth conditions on the sessile drop evaporation rate, and the shape of the sessile drop interface and its influence on the de-pinning process.

Numerical simulation of nasal airflows and thermal air modification in newborns.

Warming, filtering, and humidification of inspired air are major functions of the upper airway, which can be negatively altered by local disorders or surgical interventions. These functions have not been described in neonates because of ethical and technical problems difficult to solve. Numerical simulations can get around these limitations. The objective of this study was to analyze physiological nasal airflow and thermal distribution using computational fluid dynamics (CFD) techniques in neonates. CT imaging of neonates was collected from the Pediatric Radiology Department of our center. CFD has been used to simulate nasal airflow numerically, with ambient air set at 19 °C, following the recommendations for a neonate's bedroom. Thermal distribution within the nasal cavity was analyzed and coupled with airflow patterns over complete respiratory cycles. Sixteen patients have been included in the study. During inspiration, important air warming is noticed in the first centimeter of the nasal cavity (+ 8 °C at the anterior end of the inferior turbinate). During the expiration phase, the temperature decreases slightly (- 3 °C) between the pharynx and the nostrils. A model with asymmetric nasal fossae showed that nasal obstruction leads to decreased airflow and abnormally high temperatures in the obstructed side (+ 2 °C at the nasal valve, + 4 °C at the choana). According to our results, the nasal valve area is of crucial importance in air warming in neonates, when ambient air is 19 °C, since about 70% of air warming is performed in this area. When needed, surgical interventions should respect the anatomy of this zone and restore normal airflows and warming. Graphical abstract .

Boundary conditions for a one-sided numerical model of evaporative instabilities in sessile drops of ethanol on heated substrates.

The work is focused on obtaining boundary conditions for a one-sided numerical model of thermoconvective instabilities in evaporating pinned sessile droplets of ethanol on heated substrates. In the one-sided model, appropriate boundary conditions for heat and mass transfer equations are required at the droplet surface. Such boundary conditions are obtained in the present work based on a derived semiempirical theoretical formula for the total droplet's evaporation rate, and on a two-parametric nonisothermal approximation of the local evaporation flux. The main purpose of these boundary conditions is to be applied in future three-dimensional (3D) one-sided numerical models in order to save a lot of computational time and resources by solving equations only in the droplet domain. Two parameters, needed for the nonisothermal approximation of the local evaporation flux, are obtained by fitting computational results of a 2D two-sided numerical model. Such model is validated here against parabolic flight experiments and the theoretical value of the total evaporation rate. This study combines theoretical, experimental, and computational approaches in convective evaporation of sessile droplets. The influence of the gravity level on evaporation rate and contributions of different mechanisms of vapor transport (diffusion, Stefan flow, natural convection) are shown. The qualitative difference (in terms of developing thermoconvective instabilities) between steady-state and unsteady numerical approaches is demonstrated.

The very first cry: a multidisciplinary approach toward a model.

OBJECTIVES: In previous work, we showed that a rigid larynx-like geometry can generate a sound by itself. However, very little is known about the exact mechanisms and control of the larynx during the first cry of life. The goal of this work was to understand how the very first cry is generated. METHODS: Simultaneous high-speed imaging and sound recording on 2 excised 38-week term human fetus larynges were performed. The behaviors of the vocal folds and the false vocal folds were studied separately. The behavior of the vocal folds after resection of the supraglottic structures was also analyzed. A comparative acoustic analysis of the first cry and of the sound generated by the excised organs was performed. RESULTS: Our data showed that the vocal folds in a larynx with the pressure conditions of the first cry do not generate sound themselves, but induce aerodynamic conditions leading to vibrations of other parts of the larynx. CONCLUSIONS: The similarities between the sound generated by an excised larynx and the first cry suggest a lack of neurologic control of the larynx during production of the first cry. A model-algorithm is proposed.