Search citation statements
Paper Sections
Citation Types
Year Published
Publication Types
Relationship
Authors
Journals
Objective/HypothesisPatients with laryngeal disorders often exhibit changes to cough function contributing to aspiration episodes. Two primary cough variables (peak cough flow: PCF and compression phase duration: CPD) were examined within a biomechanical model to determine their impact on characteristics that impact airway compromise.Study DesignComputational studyMethodsA Computational Fluid Dynamics (CFD) technique was used to simulate fluid flow within an upper airway model reconstructed from patient CT images. The model utilized a finite‐volume numerical scheme to simulate cough‐induced airflow, allowing for turbulent particle interaction, collision, and break‐up. Liquid penetrants at 8 anatomical release locations were tracked during the simulated cough. Cough flow velocity was computed for a base case and four simulated cases. Airway clearance was evaluated through assessment of the fate of particles in the airway following simulated cough.ResultsPeak‐expiratory phase resulted in very high airway velocities for all simulated cases modelled. The highest velocity predicted was 49.96 m/s, 88 m/s, and 117 m/s for Cases 1 and 3, Base case, and Cases 2 and 4 respectively. In the base case, 25% of the penetrants cleared the laryngeal airway. The highest percentage (50%) of penetrants clearing the laryngeal airway are observed in Case 2 (with −40% CPD, +40% PCF), while only 12.5% cleared in Case 3 (with +40% CPD, −40% PCF). The proportion that cleared in Cases 1 and 4 was 37.5%.ConclusionAirway modelling may be beneficial to the study of aspiration in patients with impaired cough function including those with upper airway and neurological diseases. It can be used to enhance understanding of cough flow dynamics within the airway and to inform strategies for treatment with “cough‐assist devices” or devices to improve cough strength.Level of EvidenceN/A.
Objective/HypothesisPatients with laryngeal disorders often exhibit changes to cough function contributing to aspiration episodes. Two primary cough variables (peak cough flow: PCF and compression phase duration: CPD) were examined within a biomechanical model to determine their impact on characteristics that impact airway compromise.Study DesignComputational studyMethodsA Computational Fluid Dynamics (CFD) technique was used to simulate fluid flow within an upper airway model reconstructed from patient CT images. The model utilized a finite‐volume numerical scheme to simulate cough‐induced airflow, allowing for turbulent particle interaction, collision, and break‐up. Liquid penetrants at 8 anatomical release locations were tracked during the simulated cough. Cough flow velocity was computed for a base case and four simulated cases. Airway clearance was evaluated through assessment of the fate of particles in the airway following simulated cough.ResultsPeak‐expiratory phase resulted in very high airway velocities for all simulated cases modelled. The highest velocity predicted was 49.96 m/s, 88 m/s, and 117 m/s for Cases 1 and 3, Base case, and Cases 2 and 4 respectively. In the base case, 25% of the penetrants cleared the laryngeal airway. The highest percentage (50%) of penetrants clearing the laryngeal airway are observed in Case 2 (with −40% CPD, +40% PCF), while only 12.5% cleared in Case 3 (with +40% CPD, −40% PCF). The proportion that cleared in Cases 1 and 4 was 37.5%.ConclusionAirway modelling may be beneficial to the study of aspiration in patients with impaired cough function including those with upper airway and neurological diseases. It can be used to enhance understanding of cough flow dynamics within the airway and to inform strategies for treatment with “cough‐assist devices” or devices to improve cough strength.Level of EvidenceN/A.
HighlightsPatients with chronic hypersecretion (CH) of tracheobronchial mucus are a clinical challenge. They have an impaired quality of life, frequent exacerbations, and hospitalizations with need of antibiotics and other type of expensive treatments.Chest physical therapy evolved along the last decades and new techniques are currently used to help patients clear the airways efficiently. Among these airway clearance techniques (ACTs), the use of positive expiratory pressure (PEP) is considered one of the most effective.We report the retrospective evaluation of 162 patients with CH due to chronic obstructive pulmonary disease or bronchiectasis undergoing ACT in our Pulmonary Rehabilitation Department. They were treated either with PEP or with a new PEP device called UNIKO®, which applies PEP in a temporary manner (TPEP).Comparing the two groups of patients, both treatments (i.e., PEP and TPEP) were followed by great improvements in physiological parameters of spirometry and gas exchange. However, subdividing patients, it was evident that TPEP had better effects than PEP in patients with emphysema and in patients on long-term oxygen treatment, while PEP was superior at least in some parameters in patients on mechanical ventilation.This study, albeit retrospective and calling for controlled clinical trials, suggests that different ACTs can be applied in different populations of patients.
This review describes a framework for providing a personalised approach to selecting the most appropriate airway clearance technique (ACT) for each patient. It is based on a synthesis of the physiological evidence that supports the modulation of ventilation and expiratory airflow as a means of assisting airway clearance. Possession of a strong understanding of the physiological basis for ACTs will enable clinicians to decide which ACT best aligns with the individual patient's pathology in diseases with anatomical bronchiectasis and mucus hypersecretion.The physiological underpinning of postural drainage is that by placing a patient in various positions, gravity enhances mobilisation of secretions. Newer ACTs are based on two other physiological premises: the ability to ventilate behind obstructed regions of the lung and the capacity to achieve the minimum expiratory airflow bias necessary to mobilise secretions. After reviewing each ACT to determine if it utilises both ventilation and expiratory flow, these physiological concepts are assessed against the clinical evidence to provide a mechanism for the effectiveness of each ACT. This article provides the clinical rationale necessary to determine the most appropriate ACT for each patient, thereby improving care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.