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Dennis M Super - One of the best experts on this subject based on the ideXlab platform.
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the air leak test around the endotracheal tube as a predictor of postextubation Stridor is age dependent in children
Critical Care Medicine, 2002Co-Authors: Maroun J Mhanna, Yaacov B Zamel, Cathleen M Tichy, Dennis M SuperAbstract:OBJECTIVES: The airleak test is measured with a manometer as the pressure necessary to generate an audible airleak around the endotracheal tube. Our objectives were to determine whether the airleak test predicts postextubation Stridor in children and if age affects its sensitivity and specificity. DESIGN: A retrospective study. SETTING: Pediatric intensive care unit. PATIENTS: We studied all intubated patients admitted to our pediatric intensive care unit between July 1998 and December 1999. Patients were excluded if they had acute viral croup, tracheal surgery, hypotonic airway, or vocal cord paralysis or if they died before extubation. INTERVENTIONS: Medical records were reviewed for patient demographics, presence of an airleak on the day of extubation, airleak values, presence of postextubation Stridor, and extubation failure secondary to upper airway obstruction. MEASUREMENTS AND MAIN RESULTS: One hundred and five patients met our inclusion criteria and had an airleak test at the time of extubation. In children 20 mm Hg (50% vs. 67.7%; >.05) with a sensitivity of 65.6% (95% confidence interval, 46.9-80.8). In children >or=7 yrs of age, the incidence of postextubation Stridor was greater in patients with an airleak at >20 mm Hg (55.5% vs. 5.8%; p=.01) with a sensitivity of 83.3% (95% confidence interval, 36.8-99) in predicting postextubation Stridor. CONCLUSIONS: Our study suggests that the airleak test has a low sensitivity when used as a screening test to predict postextubation Stridor in young children ( or=7 yrs old) the airleak test may predict postextubation Stridor.
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the air leak test around the endotracheal tube as a predictor of postextubation Stridor is age dependent in children
Critical Care Medicine, 2002Co-Authors: Maroun J Mhanna, Yaacov B Zamel, Cathleen M Tichy, Dennis M SuperAbstract:Objectives: The airleak test is measured with a manometer as the pressure necessary to generate an audible airleak around the endotracheal tube. Our objectives were to determine whether the airleak test predicts postextubation Stridor in children and if age affects its sensitivity and specificity. Design: A retrospective study. Setting: Pediatric intensive care unit. Patients: We studied all intubated patients admitted to our pediatric intensive care unit between July 1998 and December 1999. Patients were excluded if they had acute viral croup, tracheal surgery, hypotonic airway, or vocal cord paralysis or if they died before extubation. Interventions: Medical records were reviewed for patient demographics, presence of an airleak on the day of extubation, airleak values, presence of postextubation Stridor, and extubation failure secondary to upper airway obstruction. Measurements and Main Results: One hundred and five patients met our inclusion criteria and had an airleak test at the time of extubation. In children 20 mm Hg (50% vs. 67.7%; p >.05) with a sensitivity of 65.6% (95% confidence interval, 46.9-80.8). In children ≥7 yrs of age, the incidence of postextubation Stridor was greater in patients with an airleak at >20 mm Hg (55.5% vs. 5.8%; p =.01) with a sensitivity of 83.3% (95% confidence interval, 36.8-99) in predicting postextubation Stridor. Conclusions: Our study suggests that the airleak test has a low sensitivity when used as a screening test to predict postextubation Stridor in young children (<7 yrs old), whereas in older children (≥7 yrs old) the airleak test may predict postextubation Stridor.
Malcolm Brodlie - One of the best experts on this subject based on the ideXlab platform.
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oesophageal foreign body presenting with Stridor associated with feeding
Archives of Disease in Childhood, 2013Co-Authors: Zheyi Liew, Michael C Mckean, Jennifer Townshend, C Obrien, Malcolm BrodlieAbstract:A 19-month-old girl was referred with intermittent biphasic Stridor that occurred after feeding. The Stridor was first noted at the age of 9 months, coinciding with the introduction of more solid weaning foods. There was a history of a choking episode while playing with a polystyrene toy plane around this time. After the episode, she was assessed acutely at her local hospital and discharged following a normal chest radiograph and examination. Feeding problems then progressed over time with regurgitation of solid foods along with Stridor after feeding. She was reviewed in a clinic and listed for examination of her airway under …
Federica Provini - One of the best experts on this subject based on the ideXlab platform.
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Stridor-related gray matter alterations in multiple system atrophy: A pilot study.
Parkinsonism & Related Disorders, 2018Co-Authors: Claudia Testa, Giulia Giannini, Annagrazia Cecere, Federica Provini, Giovanna Calandra-buonaura, Stefania Evangelisti, Stefano Ratti, Lia Talozzi, David Neil Manners, Raffaele LodiAbstract:Abstract Introduction The neuroanatomical substrate of Stridor associated with Multiple System Atrophy (MSA) remains unclear. We evaluated Stridor-related gray matter (GM) changes in MSA. Methods 36 MSA patients underwent standardized nocturnal video-polysomnography and brain MRI. Differences in GM density between MSA patients with and without Stridor and a sample of 22 matched healthy controls were evaluated with Voxel Based Morphometry protocol supplemented by a specific tool (SUIT) for analysing infratentorial structures. Results Stridor was confirmed in 14 patients (10 MSA-cerebellar variant; 10 M; mean ± SD age = 61.6 ± 8.9years; disease duration = 5.2 ± 2.9years) and absent in 22 (11 MSA-cerebellar variant; 18 M; age = 61.4 ± 9.9years; disease duration = 4.8 ± 3.4years). Compared to MSA without Stridor, patients with Stridor showed higher GM density in the cerebellum (p Conclusions This preliminary study has demonstrated for the first time in MSA Stridor-related GM changes in striatal and cerebellar regions. Abnormalities in these regions were previously reported in dystonic disorders affecting laryngeal muscles, suggesting the hypothesis that Stridor pathophysiology is dystonia-related. These results need however to be confirmed in a larger sample of patients.
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early Stridor onset and Stridor treatment predict survival in 136 patients with msa
Neurology, 2016Co-Authors: Giulia Giannini, Giovanna Calandrabuonaura, Francesca Mastrolilli, Matteo Righini, Maria Letizia Bacchireggiani, Annagrazia Cecere, Giorgio Barletta, Pietro Guaraldi, Federica Provini, Pietro CortelliAbstract:Objective: To evaluate the predictive value of Stridor and its latency of onset and to investigate the role of Stridor treatment in a cohort of patients with multiple system atrophy (MSA) referred to a tertiary center. Methods: We retrospectively identified patients diagnosed with MSA referred to our department beginning in 1991 and evaluated at least yearly during the disease course. Stridor was defined as present when confirmed by a whole night video-polysomnography and as early if presenting within 3 years of disease onset. Survival data, from disease onset to time of death, were calculated with Kaplan-Meier curves. Predictors were identified in univariate and multivariable Cox regression analyses. Results: We included 136 patients with MSA; 113 were deceased at the time of study. Stridor was diagnosed in 42 patients, and 22 presented early Stridor onset. Twelve of the 31 patients treated for Stridor received tracheostomy, and 19 received continuous positive airway pressure. Overall survival did not differ between patients with and without Stridor, while patients with early Stridor onset had a worse prognosis than those developing this symptom later. In the Stridor subgroup, early Stridor onset was an unfavorable survival predictor. Stridor treatment was significantly associated with survival in our population. The Kaplan-Meier curve did not reveal significant differences in survival between the 2 treatments even though there was a trend toward longer disease duration in patients receiving tracheostomy. Conclusions: Our results demonstrated that early Stridor onset is an independent predictor for shorter survival and that tracheostomy could control Stridor, influencing disease duration.
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sleep related Stridor due to dystonic vocal cord motion and neurogenic tachypnea tachycardia in multiple system atrophy
Movement Disorders, 2007Co-Authors: Roberto Vetrugno, Federica Provini, Pietro Cortelli, Rocco Liguori, Giuseppe Plazzi, Claudio Vicini, A Campanini, Roberto Dangelo, Pasquale MontagnaAbstract:Sleep-disordered breathing and sleep-related motor phenomena are part of the clinical spectrum of multiple system atrophy (MSA). Stridor has been attributed to denervation of laryngeal muscles or instead to dystonic vocal cord motion. We studied 3 patients with nocturnal Stridor in the setting of MSA. All patients underwent nocturnal videopolysomnography (VPSG) with breathing and heart rate, O2 saturation and intra-esophageal pressure recordings, and simultaneous EMG recordings of the posterior cricoarytenoid, cricothyroid, and thyroarytenoid muscles and continuous vocal cord motion evaluation by means of fiberoptic laryngoscopy. VPSG/EMG and fiberoptic laryngoscopy documented normal vocal cord motion without denervation during wake and Stridor only during sleep when hyperactivation of vocal cords adductors appeared in the absence of significant O2 desaturation. All patients had tachycardia and tachypnea and paradoxical breathing during sleep, erratic intercostalis and diaphragmatic EMG activity and Rem sleep behavior disorder. One of the patients had restless legs syndrome with periodic limb movement during sleep and excessive fragmentary hypnic myoclonus. In conclusion, our patients with MSA had nocturnal Stridor due to sleep-related laryngeal dystonia. Stridor was associated with other abnormal sleep-related respiratory and motor disorders, suggesting an impairment of homeostatic brainstem integration in MSA. © 2007 Movement Disorder Society
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sleep related Stridor due to dystonic vocal cord motion and neurogenic tachypnea tachycardia in multiple system atrophy
Movement Disorders, 2007Co-Authors: Roberto Vetrugno, Federica Provini, Pietro Cortelli, Rocco Liguori, Giuseppe Plazzi, Claudio Vicini, A Campanini, Roberto Dangelo, Pasquale MontagnaAbstract:Sleep-disordered breathing and sleep-related motor phenomena are part of the clinical spectrum of multiple system atrophy (MSA). Stridor has been attributed to denervation of laryngeal muscles or instead to dystonic vocal cord motion. We studied 3 patients with nocturnal Stridor in the setting of MSA. All patients underwent nocturnal videopolysomnography (VPSG) with breathing and heart rate, O(2) saturation and intra-esophageal pressure recordings, and simultaneous EMG recordings of the posterior cricoarytenoid, cricothyroid, and thyroarytenoid muscles and continuous vocal cord motion evaluation by means of fiberoptic laryngoscopy. VPSG/EMG and fiberoptic laryngoscopy documented normal vocal cord motion without denervation during wake and Stridor only during sleep when hyperactivation of vocal cords adductors appeared in the absence of significant O(2) desaturation. All patients had tachycardia and tachypnea and paradoxical breathing during sleep, erratic intercostalis and diaphragmatic EMG activity and Rem sleep behavior disorder. One of the patients had restless legs syndrome with periodic limb movement during sleep and excessive fragmentary hypnic myoclonus. In conclusion, our patients with MSA had nocturnal Stridor due to sleep-related laryngeal dystonia. Stridor was associated with other abnormal sleep-related respiratory and motor disorders, suggesting an impairment of homeostatic brainstem integration in MSA.
Maroun J Mhanna - One of the best experts on this subject based on the ideXlab platform.
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the air leak test around the endotracheal tube as a predictor of postextubation Stridor is age dependent in children
Critical Care Medicine, 2002Co-Authors: Maroun J Mhanna, Yaacov B Zamel, Cathleen M Tichy, Dennis M SuperAbstract:OBJECTIVES: The airleak test is measured with a manometer as the pressure necessary to generate an audible airleak around the endotracheal tube. Our objectives were to determine whether the airleak test predicts postextubation Stridor in children and if age affects its sensitivity and specificity. DESIGN: A retrospective study. SETTING: Pediatric intensive care unit. PATIENTS: We studied all intubated patients admitted to our pediatric intensive care unit between July 1998 and December 1999. Patients were excluded if they had acute viral croup, tracheal surgery, hypotonic airway, or vocal cord paralysis or if they died before extubation. INTERVENTIONS: Medical records were reviewed for patient demographics, presence of an airleak on the day of extubation, airleak values, presence of postextubation Stridor, and extubation failure secondary to upper airway obstruction. MEASUREMENTS AND MAIN RESULTS: One hundred and five patients met our inclusion criteria and had an airleak test at the time of extubation. In children 20 mm Hg (50% vs. 67.7%; >.05) with a sensitivity of 65.6% (95% confidence interval, 46.9-80.8). In children >or=7 yrs of age, the incidence of postextubation Stridor was greater in patients with an airleak at >20 mm Hg (55.5% vs. 5.8%; p=.01) with a sensitivity of 83.3% (95% confidence interval, 36.8-99) in predicting postextubation Stridor. CONCLUSIONS: Our study suggests that the airleak test has a low sensitivity when used as a screening test to predict postextubation Stridor in young children ( or=7 yrs old) the airleak test may predict postextubation Stridor.
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the air leak test around the endotracheal tube as a predictor of postextubation Stridor is age dependent in children
Critical Care Medicine, 2002Co-Authors: Maroun J Mhanna, Yaacov B Zamel, Cathleen M Tichy, Dennis M SuperAbstract:Objectives: The airleak test is measured with a manometer as the pressure necessary to generate an audible airleak around the endotracheal tube. Our objectives were to determine whether the airleak test predicts postextubation Stridor in children and if age affects its sensitivity and specificity. Design: A retrospective study. Setting: Pediatric intensive care unit. Patients: We studied all intubated patients admitted to our pediatric intensive care unit between July 1998 and December 1999. Patients were excluded if they had acute viral croup, tracheal surgery, hypotonic airway, or vocal cord paralysis or if they died before extubation. Interventions: Medical records were reviewed for patient demographics, presence of an airleak on the day of extubation, airleak values, presence of postextubation Stridor, and extubation failure secondary to upper airway obstruction. Measurements and Main Results: One hundred and five patients met our inclusion criteria and had an airleak test at the time of extubation. In children 20 mm Hg (50% vs. 67.7%; p >.05) with a sensitivity of 65.6% (95% confidence interval, 46.9-80.8). In children ≥7 yrs of age, the incidence of postextubation Stridor was greater in patients with an airleak at >20 mm Hg (55.5% vs. 5.8%; p =.01) with a sensitivity of 83.3% (95% confidence interval, 36.8-99) in predicting postextubation Stridor. Conclusions: Our study suggests that the airleak test has a low sensitivity when used as a screening test to predict postextubation Stridor in young children (<7 yrs old), whereas in older children (≥7 yrs old) the airleak test may predict postextubation Stridor.
Pietro Cortelli - One of the best experts on this subject based on the ideXlab platform.
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early Stridor onset and Stridor treatment predict survival in 136 patients with msa
Neurology, 2016Co-Authors: Giulia Giannini, Giovanna Calandrabuonaura, Francesca Mastrolilli, Matteo Righini, Maria Letizia Bacchireggiani, Annagrazia Cecere, Giorgio Barletta, Pietro Guaraldi, Federica Provini, Pietro CortelliAbstract:Objective: To evaluate the predictive value of Stridor and its latency of onset and to investigate the role of Stridor treatment in a cohort of patients with multiple system atrophy (MSA) referred to a tertiary center. Methods: We retrospectively identified patients diagnosed with MSA referred to our department beginning in 1991 and evaluated at least yearly during the disease course. Stridor was defined as present when confirmed by a whole night video-polysomnography and as early if presenting within 3 years of disease onset. Survival data, from disease onset to time of death, were calculated with Kaplan-Meier curves. Predictors were identified in univariate and multivariable Cox regression analyses. Results: We included 136 patients with MSA; 113 were deceased at the time of study. Stridor was diagnosed in 42 patients, and 22 presented early Stridor onset. Twelve of the 31 patients treated for Stridor received tracheostomy, and 19 received continuous positive airway pressure. Overall survival did not differ between patients with and without Stridor, while patients with early Stridor onset had a worse prognosis than those developing this symptom later. In the Stridor subgroup, early Stridor onset was an unfavorable survival predictor. Stridor treatment was significantly associated with survival in our population. The Kaplan-Meier curve did not reveal significant differences in survival between the 2 treatments even though there was a trend toward longer disease duration in patients receiving tracheostomy. Conclusions: Our results demonstrated that early Stridor onset is an independent predictor for shorter survival and that tracheostomy could control Stridor, influencing disease duration.
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sleep related Stridor due to dystonic vocal cord motion and neurogenic tachypnea tachycardia in multiple system atrophy
Movement Disorders, 2007Co-Authors: Roberto Vetrugno, Federica Provini, Pietro Cortelli, Rocco Liguori, Giuseppe Plazzi, Claudio Vicini, A Campanini, Roberto Dangelo, Pasquale MontagnaAbstract:Sleep-disordered breathing and sleep-related motor phenomena are part of the clinical spectrum of multiple system atrophy (MSA). Stridor has been attributed to denervation of laryngeal muscles or instead to dystonic vocal cord motion. We studied 3 patients with nocturnal Stridor in the setting of MSA. All patients underwent nocturnal videopolysomnography (VPSG) with breathing and heart rate, O2 saturation and intra-esophageal pressure recordings, and simultaneous EMG recordings of the posterior cricoarytenoid, cricothyroid, and thyroarytenoid muscles and continuous vocal cord motion evaluation by means of fiberoptic laryngoscopy. VPSG/EMG and fiberoptic laryngoscopy documented normal vocal cord motion without denervation during wake and Stridor only during sleep when hyperactivation of vocal cords adductors appeared in the absence of significant O2 desaturation. All patients had tachycardia and tachypnea and paradoxical breathing during sleep, erratic intercostalis and diaphragmatic EMG activity and Rem sleep behavior disorder. One of the patients had restless legs syndrome with periodic limb movement during sleep and excessive fragmentary hypnic myoclonus. In conclusion, our patients with MSA had nocturnal Stridor due to sleep-related laryngeal dystonia. Stridor was associated with other abnormal sleep-related respiratory and motor disorders, suggesting an impairment of homeostatic brainstem integration in MSA. © 2007 Movement Disorder Society
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sleep related Stridor due to dystonic vocal cord motion and neurogenic tachypnea tachycardia in multiple system atrophy
Movement Disorders, 2007Co-Authors: Roberto Vetrugno, Federica Provini, Pietro Cortelli, Rocco Liguori, Giuseppe Plazzi, Claudio Vicini, A Campanini, Roberto Dangelo, Pasquale MontagnaAbstract:Sleep-disordered breathing and sleep-related motor phenomena are part of the clinical spectrum of multiple system atrophy (MSA). Stridor has been attributed to denervation of laryngeal muscles or instead to dystonic vocal cord motion. We studied 3 patients with nocturnal Stridor in the setting of MSA. All patients underwent nocturnal videopolysomnography (VPSG) with breathing and heart rate, O(2) saturation and intra-esophageal pressure recordings, and simultaneous EMG recordings of the posterior cricoarytenoid, cricothyroid, and thyroarytenoid muscles and continuous vocal cord motion evaluation by means of fiberoptic laryngoscopy. VPSG/EMG and fiberoptic laryngoscopy documented normal vocal cord motion without denervation during wake and Stridor only during sleep when hyperactivation of vocal cords adductors appeared in the absence of significant O(2) desaturation. All patients had tachycardia and tachypnea and paradoxical breathing during sleep, erratic intercostalis and diaphragmatic EMG activity and Rem sleep behavior disorder. One of the patients had restless legs syndrome with periodic limb movement during sleep and excessive fragmentary hypnic myoclonus. In conclusion, our patients with MSA had nocturnal Stridor due to sleep-related laryngeal dystonia. Stridor was associated with other abnormal sleep-related respiratory and motor disorders, suggesting an impairment of homeostatic brainstem integration in MSA.
