Relationship between degree of obstruction and airflow limitation in subglottic stenosis

Lin, Emily; Bock, Jonathan M.; Zdanski, Carlton J.; Kimbell, Julia S.; Garcia, Guilherme J. M.

doi:10.1002/lary.27006

Cited by 32 publications

(36 citation statements)

References 23 publications

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“…Based on this correlation, we concluded that CFD is a viable way for quantifying clinical observations in SGS. This conclusion specifically agrees with Lin et al, 16 which described their findings in older patients using a similar CFD approach based on chest computed tomography images to characterize a rapid increase in airway resistance at approximately the same value of %AO. In this sense, our study joins a growing body of literature that endorses CFD as a potentially powerful tool for quantifying respiratory changes observed in vivo.…”

Section: Discussionsupporting

confidence: 89%

“…Lin et al have used CFD simulations to assess SGS in patients ranging from 5 months old to adults. 16 They found good agreement between simulation results and clinical findings of airway limitation-airway resistance increases exponentially with increased airway occlusion. However, that study only considered axially central stenoses.…”

Section: Introductionmentioning

confidence: 71%

“…The longitudinal height of the stenoses was held constant at 1.5 mm; Lin et al have previously shown that the height of a stenosis does not significantly affect its influence on tracheal resistance at the %AO values used in this study. 16 Figure 1C demonstrates the smooth longitudinal profiles and varying degrees of %AO created in the center of the airway.…”

Section: Creating Virtual Stenoses Via Geometric Modificationmentioning

confidence: 99%

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Subglottic Stenosis Position Affects Work of Breathing

et al. 2020

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Objectives: Subglottic stenosis (SGS) is the most common type of laryngeal stenosis in neonates. SGS severity is currently graded based on percent area of obstruction (%AO) via the Myer-Cotton grading scale. However, patients with similar %AO can have widely different clinical courses. Computational fluid dynamics (CFD) based on patient-specific imaging can quantify the relationship between airway geometry and flow dynamics. We investigated the effect of %AO and axial position of SGS on work of breathing (WOB) in neonates using magnetic resonance imaging. Methods: High-resolution ultrashort echo-time MRI of the chest and airway was obtained in three neonatal patients with no suspected airway abnormalities; images were segmented to construct three-dimensional (3D) models of the neonatal airways. These models were then modified with virtual SGSs of varying %AO and axial positioning. CFD simulations of peak inspiratory flow were used to calculate patient-specific WOB in nonstenotic and artificially stenosed airway models. Results: CFD simulations demonstrated a relationship between stenosis geometry and WOB increase. WOB rapidly increased with %AO greater than about 70%. Changes in axial position could also increase WOB by approximately the same amount as a 10% increase in %AO. Increased WOB was particularly pronounced when the SGS lumen was misaligned with the glottic jet. Conclusion: The results indicate a strong, predictable relationship between WOB and axial position of the stenotic lumen relative to the glottis, which has not been previously reported. These findings may lead to precision diagnosis and treatment prediction tools in individual patients.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 71%

Section: Creating Virtual Stenoses Via Geometric Modificationmentioning

confidence: 99%

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Subglottic Stenosis Position Affects Work of Breathing

et al. 2020

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“…Clearly, the extent of the stenosis is the primary driver, but the length of the stenotic segment and the location of the stenosis in relationship with the glottis also impacts airway resistance. (57,58) The narrowing and increased airway resistance most commonly manifests with biphasic stridor and increased respiratory effort. Indeed, neonates with subglottic stenosis may not tolerate extubation and are at high risk of undergoing tracheotomy.…”

Section: Subglottic Stenosismentioning

confidence: 99%

Central Airway Issues in BPD

Hysinger¹

2020

Preprint

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While there is a very large focus on the abnormalities of parenchymal lung development and extensive efforts to minimize alveolar damage with "gentle ventilation" and non-invasive respiratory support for neonates with bronchopulmonary dysplasia (BPD), there is relatively little consideration for the implications of central airway disease in this patient population. There are significant changes in the structure and conformation of the central airway during the last half of gestation, and premature birth disrupts this natural developmental process. Arrest of maturation results in a smaller airway that is more compliant, easier to deform, and more susceptible to damage. Consequently, neonates with BPD are prone to developing central airway pathology, particularly for patient that require intubation and positive pressure ventilation. Central airway disease can be divided in dynamic and fixed airway obstruction and results in increased respiratory morbidity in neonates with chronic lung disease of prematurity.

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“…Several studies used computational fluid dynamics models to evaluate the effect of the severity of SGS on airway pressure drop [12][13][14][15] and flow resistance [16,17] (defined as ∆P/Q or ∆P/Q 2 , in which ∆P is the pressure drop and Q is the mean flow rate) during respiration; however, the effect of SGS on vocal fold vibration was not studied. To the best of the authors' knowledge, the only work focusing on the effect of SGS on vocal fold vibration was a study by Smith and Thomson [18].…”

Section: Introductionmentioning

confidence: 99%

Effect of Subglottic Stenosis on Vocal Fold Vibration and Voice Production Using Fluid–Structure–Acoustics Interaction Simulation

et al. 2021

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An in-house 3D fluid–structure–acoustic interaction numerical solver was employed to investigate the effect of subglottic stenosis (SGS) on dynamics of glottal flow, vocal fold vibration and acoustics during voice production. The investigation focused on two SGS properties, including severity defined as the percentage of area reduction and location. The results show that SGS affects voice production only when its severity is beyond a threshold, which is at 75% for the glottal flow rate and acoustics, and at 90% for the vocal fold vibrations. Beyond the threshold, the flow rate, vocal fold vibration amplitude and vocal efficiency decrease rapidly with SGS severity, while the skewness quotient, vibration frequency, signal-to-noise ratio and vocal intensity decrease slightly, and the open quotient increases slightly. Changing the location of SGS shows no effect on the dynamics. Further analysis reveals that the effect of SGS on the dynamics is primarily due to its effect on the flow resistance in the entire airway, which is found to be related to the area ratio of glottis to SGS. Below the SGS severity of 75%, which corresponds to an area ratio of glottis to SGS of 0.1, changing the SGS severity only causes very small changes in the area ratio; therefore, its effect on the flow resistance and dynamics is very small. Beyond the SGS severity of 75%, increasing the SGS severity, leads to rapid increases of the area ratio, resulting in rapid changes in the flow resistance and dynamics.

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Relationship between degree of obstruction and airflow limitation in subglottic stenosis

Abstract: 4. Laryngoscope, 128:1551-1557, 2018.

Cited by 32 publications

References 23 publications

Subglottic Stenosis Position Affects Work of Breathing

Subglottic Stenosis Position Affects Work of Breathing

Central Airway Issues in BPD

Effect of Subglottic Stenosis on Vocal Fold Vibration and Voice Production Using Fluid–Structure–Acoustics Interaction Simulation

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