The Experts below are selected from a list of 7236 Experts worldwide ranked by ideXlab platform
Christopher J L Newth - One of the best experts on this subject based on the ideXlab platform.
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subglottic post extubation Upper Airway Obstruction is associated with long term Airway morbidity in children
2021Co-Authors: Jack Green, Patrick A Ross, Christopher J L Newth, Robinder G KhemaniAbstract:Objectives Post-extubation Upper Airway Obstruction is the most common cause of extubation failure in children, but there are few data regarding long-term morbidity. We aim to describe the frequency of long-term Airway sequelae in intubated children and determine the association with post-extubation Upper Airway Obstruction. Design Retrospective, post hoc analysis of previously identified prospective cohort of children in the pediatric/cardiothoracic ICU at Children's Hospital Los Angeles from July 2012 to April 2015. A single provider blinded to the Upper Airway Obstruction classification reviewed the electronic medical records of all patients in the parent study, before and after the index extubation (extubation during parent study), to identify pre-index and post-index Upper Airway disease. Primary outcomes were prevalence of newly diagnosed Airway anomalies following index extubation. Setting Single center, tertiary, 391-bed children's hospital. Patients From the parent study, 327 children younger than 18 years (intubated for at least 12 hr) were included if they received subsequent care (regardless of specialty) after the index extubation. Interventions None. Measurements and main results New Airway anomalies were identified in 40 of 327 children (12.2%). Patients labeled with subglottic Upper Airway Obstruction at the index extubation were more likely to be diagnosed with new Airway anomalies on subsequent follow-up, receive long-term Otolaryngology follow-up, or receive Airway surgery (all p ≤ 0.006). In multivariable modeling, Upper Airway Obstruction as the primary reason for initial intubation (odds ratio, 3.71; CI, 1.50-9.19), reintubation during the index ICU admission (odds ratio, 4.44; CI, 1.67-11.80), pre-index Airway anomaly (odds ratio, 3.31; CI, 1.36-8.01), and post-extubation subglottic Upper Airway Obstruction (odds ratio, 3.50; CI, 1.46-8.34) remained independently associated with the diagnosis of new Airway anomalies. Conclusions Post-extubation subglottic Upper Airway Obstruction is associated with a three-fold greater odds of long-term Airway morbidity. These patients may represent an at-risk population that should be monitored closely after leaving the ICU.
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evaluating risk factors for pediatric post extubation Upper Airway Obstruction using a physiology based tool
2016Co-Authors: Patrick A Ross, Christopher J L Newth, Robinder G Khemani, Rutger Flink, Justin Hotz, Rica Morzov, Asavari KamerkarAbstract:Rationale: Subglottic edema is the most common cause of pediatric extubation failure, but few studies have confirmed risk factors or prevention strategies. This may be due to subjective assessment of stridor or inability to differentiate supraglottic from subglottic disease.Objectives: Objective 1 was to assess the utility of calibrated respiratory inductance plethysmography (RIP) and esophageal manometry to identify clinically significant post-extubation Upper Airway Obstruction (UAO) and differentiate subglottic from supraglottic UAO. Objective 2 was to identify risk factors for subglottic UAO, stratified by cuffed versus uncuffed endotracheal tubes (ETTs).Methods: We conducted a single-center prospective study of children receiving mechanical ventilation. UAO was defined by inspiratory flow limitation (measured by RIP and esophageal manometry) and classified as subglottic or supraglottic based on Airway maneuver response. Clinicians performed simultaneous blinded clinical UAO assessment at the bedside....
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respiratory inductance plethysmography calibration for pediatric Upper Airway Obstruction an animal model
2015Co-Authors: Robinder G Khemani, Patrick A Ross, Christopher J L Newth, Rutger Flink, Justin Hotz, Anoopindar GhumanAbstract:Respiratory inductance plethysmography calibration for pediatric Upper Airway Obstruction: an animal model
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pediatric Upper Airway Obstruction interobserver variability is the road to perdition
2013Co-Authors: Robinder G Khemani, Christopher J L Newth, Rica Morzov, James Schneider, Barry P MarkovitzAbstract:Abstract Purpose The purposes of the study are to determine the interobserver variability in the clinical assessment of pediatric Upper Airway Obstruction (UAO) and to explore how variability in assessment of UAO may contribute to risk factors and incidence of postextubation UAO. Materials This is a prospective trial in 2 tertiary care pediatric intensive care units. Bedside practitioners performed simultaneous, blinded UAO assessments on 112 children after endotracheal extubation. Results Agreement among respiratory therapists, pediatric intensive care nurses, and pediatric intensive care physicians was poor for cyanosis (κ = 0.01) and hypoxemia at rest (κ = 0.14) and fair for consciousness (κ = 0.27), air entry (κ = 0.32), hypoxemia with agitation (κ = 0.27), and pulsus paradoxus (κ = 0.23). When looking at “stridor” and “retractions,” defined using more than 2 grades of severity from the Westley Croup Score, the interrelater reliability was moderate (κ = 0.43 and κ = 0.47, respectively). This could be improved marginally by dichotomizing the presence or absence of stridor (κ = 0.54) or retractions (κ = 0.53). The overall incidence of UAO after extubation (stridor plus retractions) could range from 7% to 22%, depending on how many providers were required to agree. Conclusions Physical findings routinely used for UAO have poor interobserver reliability among bedside providers. This variability may contribute to inconsistent findings regarding incidence, risk factors, and therapies for postextubation UAO.
Robinder G Khemani - One of the best experts on this subject based on the ideXlab platform.
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subglottic post extubation Upper Airway Obstruction is associated with long term Airway morbidity in children
2021Co-Authors: Jack Green, Patrick A Ross, Christopher J L Newth, Robinder G KhemaniAbstract:Objectives Post-extubation Upper Airway Obstruction is the most common cause of extubation failure in children, but there are few data regarding long-term morbidity. We aim to describe the frequency of long-term Airway sequelae in intubated children and determine the association with post-extubation Upper Airway Obstruction. Design Retrospective, post hoc analysis of previously identified prospective cohort of children in the pediatric/cardiothoracic ICU at Children's Hospital Los Angeles from July 2012 to April 2015. A single provider blinded to the Upper Airway Obstruction classification reviewed the electronic medical records of all patients in the parent study, before and after the index extubation (extubation during parent study), to identify pre-index and post-index Upper Airway disease. Primary outcomes were prevalence of newly diagnosed Airway anomalies following index extubation. Setting Single center, tertiary, 391-bed children's hospital. Patients From the parent study, 327 children younger than 18 years (intubated for at least 12 hr) were included if they received subsequent care (regardless of specialty) after the index extubation. Interventions None. Measurements and main results New Airway anomalies were identified in 40 of 327 children (12.2%). Patients labeled with subglottic Upper Airway Obstruction at the index extubation were more likely to be diagnosed with new Airway anomalies on subsequent follow-up, receive long-term Otolaryngology follow-up, or receive Airway surgery (all p ≤ 0.006). In multivariable modeling, Upper Airway Obstruction as the primary reason for initial intubation (odds ratio, 3.71; CI, 1.50-9.19), reintubation during the index ICU admission (odds ratio, 4.44; CI, 1.67-11.80), pre-index Airway anomaly (odds ratio, 3.31; CI, 1.36-8.01), and post-extubation subglottic Upper Airway Obstruction (odds ratio, 3.50; CI, 1.46-8.34) remained independently associated with the diagnosis of new Airway anomalies. Conclusions Post-extubation subglottic Upper Airway Obstruction is associated with a three-fold greater odds of long-term Airway morbidity. These patients may represent an at-risk population that should be monitored closely after leaving the ICU.
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evaluating risk factors for pediatric post extubation Upper Airway Obstruction using a physiology based tool
2016Co-Authors: Patrick A Ross, Christopher J L Newth, Robinder G Khemani, Rutger Flink, Justin Hotz, Rica Morzov, Asavari KamerkarAbstract:Rationale: Subglottic edema is the most common cause of pediatric extubation failure, but few studies have confirmed risk factors or prevention strategies. This may be due to subjective assessment of stridor or inability to differentiate supraglottic from subglottic disease.Objectives: Objective 1 was to assess the utility of calibrated respiratory inductance plethysmography (RIP) and esophageal manometry to identify clinically significant post-extubation Upper Airway Obstruction (UAO) and differentiate subglottic from supraglottic UAO. Objective 2 was to identify risk factors for subglottic UAO, stratified by cuffed versus uncuffed endotracheal tubes (ETTs).Methods: We conducted a single-center prospective study of children receiving mechanical ventilation. UAO was defined by inspiratory flow limitation (measured by RIP and esophageal manometry) and classified as subglottic or supraglottic based on Airway maneuver response. Clinicians performed simultaneous blinded clinical UAO assessment at the bedside....
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respiratory inductance plethysmography calibration for pediatric Upper Airway Obstruction an animal model
2015Co-Authors: Robinder G Khemani, Patrick A Ross, Christopher J L Newth, Rutger Flink, Justin Hotz, Anoopindar GhumanAbstract:Respiratory inductance plethysmography calibration for pediatric Upper Airway Obstruction: an animal model
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pediatric Upper Airway Obstruction interobserver variability is the road to perdition
2013Co-Authors: Robinder G Khemani, Christopher J L Newth, Rica Morzov, James Schneider, Barry P MarkovitzAbstract:Abstract Purpose The purposes of the study are to determine the interobserver variability in the clinical assessment of pediatric Upper Airway Obstruction (UAO) and to explore how variability in assessment of UAO may contribute to risk factors and incidence of postextubation UAO. Materials This is a prospective trial in 2 tertiary care pediatric intensive care units. Bedside practitioners performed simultaneous, blinded UAO assessments on 112 children after endotracheal extubation. Results Agreement among respiratory therapists, pediatric intensive care nurses, and pediatric intensive care physicians was poor for cyanosis (κ = 0.01) and hypoxemia at rest (κ = 0.14) and fair for consciousness (κ = 0.27), air entry (κ = 0.32), hypoxemia with agitation (κ = 0.27), and pulsus paradoxus (κ = 0.23). When looking at “stridor” and “retractions,” defined using more than 2 grades of severity from the Westley Croup Score, the interrelater reliability was moderate (κ = 0.43 and κ = 0.47, respectively). This could be improved marginally by dichotomizing the presence or absence of stridor (κ = 0.54) or retractions (κ = 0.53). The overall incidence of UAO after extubation (stridor plus retractions) could range from 7% to 22%, depending on how many providers were required to agree. Conclusions Physical findings routinely used for UAO have poor interobserver reliability among bedside providers. This variability may contribute to inconsistent findings regarding incidence, risk factors, and therapies for postextubation UAO.
Andrés Esteban - One of the best experts on this subject based on the ideXlab platform.
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cuff leak test for the diagnosis of Upper Airway Obstruction in adults a systematic review and meta analysis
2009Co-Authors: Maria Elena Ochoa, Maria Del Carmen Marin, Fernando Frutosvivar, Federico Gordo, Jaime Latourperez, Enrique Calvo, Andrés EstebanAbstract:Purpose To evaluate, in adults, the diagnostic accuracy of the cuff-leak test for the diagnosis of Upper Airway Obstruction secondary to laryngeal edema and for reintubation secondary to Upper Airway Obstruction.
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cuff leak test for the diagnosis of Upper Airway Obstruction in adults a systematic review and meta analysis
2009Co-Authors: Maria Elena Ochoa, Fernando Frutosvivar, Federico Gordo, Jaime Latourperez, Enrique Calvo, Maria Del Carmen Marin, Andrés EstebanAbstract:To evaluate, in adults, the diagnostic accuracy of the cuff-leak test for the diagnosis of Upper Airway Obstruction secondary to laryngeal edema and for reintubation secondary to Upper Airway Obstruction. Systematic review without language restrictions based on electronic databases and manual review of the literature up to December 2008. When appropriate, a random-effects meta-analysis and meta-regression (Moses’ method) were performed. Upper Airway Obstruction was the outcome in nine studies with an overall incidence of 6.9%. There was significant heterogeneity among studies. The pooled sensitivity was 0.56 (95% confidence interval: 0.48–0.63), the specificity was 0.92 (95% CI: 0.90–0.93), the positive likelihood ratio was 5.90 (95% CI: 4.00–8.69), the negative likelihood ratio was 0.48 (95% CI: 0.33–0.72), and the diagnostic odds ratio was 18.78 (95% CI: 7.36–47.92). The area under the curve of the summary receiver-operator characteristic (SROC) was 0.92 (95% CI: 0.89–0.94). Only three studies have evaluated the accuracy of the cuff-leak test for reintubation secondary to Upper Airway Obstruction. Overall incidence was 7%. The pooled sensitivity was 0.63 (95% CI: 0.38–0.84), the specificity was 0.86 (95% CI: 0.81–0.90), the positive likelihood ratio was 4.04 (95% CI: 2.21–7.40), the negative likelihood ratio was 0.46 (95% CI: 0.26–0.82), and the diagnostic odds ratio was 10.37 (95% CI: 3.70–29.13). A positive cuff-leak test (absence of leak) should alert the clinician of a high risk of Upper Airway Obstruction.
Patrick A Ross - One of the best experts on this subject based on the ideXlab platform.
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subglottic post extubation Upper Airway Obstruction is associated with long term Airway morbidity in children
2021Co-Authors: Jack Green, Patrick A Ross, Christopher J L Newth, Robinder G KhemaniAbstract:Objectives Post-extubation Upper Airway Obstruction is the most common cause of extubation failure in children, but there are few data regarding long-term morbidity. We aim to describe the frequency of long-term Airway sequelae in intubated children and determine the association with post-extubation Upper Airway Obstruction. Design Retrospective, post hoc analysis of previously identified prospective cohort of children in the pediatric/cardiothoracic ICU at Children's Hospital Los Angeles from July 2012 to April 2015. A single provider blinded to the Upper Airway Obstruction classification reviewed the electronic medical records of all patients in the parent study, before and after the index extubation (extubation during parent study), to identify pre-index and post-index Upper Airway disease. Primary outcomes were prevalence of newly diagnosed Airway anomalies following index extubation. Setting Single center, tertiary, 391-bed children's hospital. Patients From the parent study, 327 children younger than 18 years (intubated for at least 12 hr) were included if they received subsequent care (regardless of specialty) after the index extubation. Interventions None. Measurements and main results New Airway anomalies were identified in 40 of 327 children (12.2%). Patients labeled with subglottic Upper Airway Obstruction at the index extubation were more likely to be diagnosed with new Airway anomalies on subsequent follow-up, receive long-term Otolaryngology follow-up, or receive Airway surgery (all p ≤ 0.006). In multivariable modeling, Upper Airway Obstruction as the primary reason for initial intubation (odds ratio, 3.71; CI, 1.50-9.19), reintubation during the index ICU admission (odds ratio, 4.44; CI, 1.67-11.80), pre-index Airway anomaly (odds ratio, 3.31; CI, 1.36-8.01), and post-extubation subglottic Upper Airway Obstruction (odds ratio, 3.50; CI, 1.46-8.34) remained independently associated with the diagnosis of new Airway anomalies. Conclusions Post-extubation subglottic Upper Airway Obstruction is associated with a three-fold greater odds of long-term Airway morbidity. These patients may represent an at-risk population that should be monitored closely after leaving the ICU.
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evaluating risk factors for pediatric post extubation Upper Airway Obstruction using a physiology based tool
2016Co-Authors: Patrick A Ross, Christopher J L Newth, Robinder G Khemani, Rutger Flink, Justin Hotz, Rica Morzov, Asavari KamerkarAbstract:Rationale: Subglottic edema is the most common cause of pediatric extubation failure, but few studies have confirmed risk factors or prevention strategies. This may be due to subjective assessment of stridor or inability to differentiate supraglottic from subglottic disease.Objectives: Objective 1 was to assess the utility of calibrated respiratory inductance plethysmography (RIP) and esophageal manometry to identify clinically significant post-extubation Upper Airway Obstruction (UAO) and differentiate subglottic from supraglottic UAO. Objective 2 was to identify risk factors for subglottic UAO, stratified by cuffed versus uncuffed endotracheal tubes (ETTs).Methods: We conducted a single-center prospective study of children receiving mechanical ventilation. UAO was defined by inspiratory flow limitation (measured by RIP and esophageal manometry) and classified as subglottic or supraglottic based on Airway maneuver response. Clinicians performed simultaneous blinded clinical UAO assessment at the bedside....
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respiratory inductance plethysmography calibration for pediatric Upper Airway Obstruction an animal model
2015Co-Authors: Robinder G Khemani, Patrick A Ross, Christopher J L Newth, Rutger Flink, Justin Hotz, Anoopindar GhumanAbstract:Respiratory inductance plethysmography calibration for pediatric Upper Airway Obstruction: an animal model
Maria Elena Ochoa - One of the best experts on this subject based on the ideXlab platform.
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cuff leak test for the diagnosis of Upper Airway Obstruction in adults a systematic review and meta analysis
2009Co-Authors: Maria Elena Ochoa, Maria Del Carmen Marin, Fernando Frutosvivar, Federico Gordo, Jaime Latourperez, Enrique Calvo, Andrés EstebanAbstract:Purpose To evaluate, in adults, the diagnostic accuracy of the cuff-leak test for the diagnosis of Upper Airway Obstruction secondary to laryngeal edema and for reintubation secondary to Upper Airway Obstruction.
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cuff leak test for the diagnosis of Upper Airway Obstruction in adults a systematic review and meta analysis
2009Co-Authors: Maria Elena Ochoa, Fernando Frutosvivar, Federico Gordo, Jaime Latourperez, Enrique Calvo, Maria Del Carmen Marin, Andrés EstebanAbstract:To evaluate, in adults, the diagnostic accuracy of the cuff-leak test for the diagnosis of Upper Airway Obstruction secondary to laryngeal edema and for reintubation secondary to Upper Airway Obstruction. Systematic review without language restrictions based on electronic databases and manual review of the literature up to December 2008. When appropriate, a random-effects meta-analysis and meta-regression (Moses’ method) were performed. Upper Airway Obstruction was the outcome in nine studies with an overall incidence of 6.9%. There was significant heterogeneity among studies. The pooled sensitivity was 0.56 (95% confidence interval: 0.48–0.63), the specificity was 0.92 (95% CI: 0.90–0.93), the positive likelihood ratio was 5.90 (95% CI: 4.00–8.69), the negative likelihood ratio was 0.48 (95% CI: 0.33–0.72), and the diagnostic odds ratio was 18.78 (95% CI: 7.36–47.92). The area under the curve of the summary receiver-operator characteristic (SROC) was 0.92 (95% CI: 0.89–0.94). Only three studies have evaluated the accuracy of the cuff-leak test for reintubation secondary to Upper Airway Obstruction. Overall incidence was 7%. The pooled sensitivity was 0.63 (95% CI: 0.38–0.84), the specificity was 0.86 (95% CI: 0.81–0.90), the positive likelihood ratio was 4.04 (95% CI: 2.21–7.40), the negative likelihood ratio was 0.46 (95% CI: 0.26–0.82), and the diagnostic odds ratio was 10.37 (95% CI: 3.70–29.13). A positive cuff-leak test (absence of leak) should alert the clinician of a high risk of Upper Airway Obstruction.
