Relationship between degree of obstruction and airflow limitation in subglottic stenosis. Laryngoscope 2018 Jul;128(7):1551-1557
Date
11/25/2017Pubmed ID
29171660Pubmed Central ID
PMC5967982DOI
10.1002/lary.27006Scopus ID
2-s2.0-85035021303 (requires institutional sign-in at Scopus site) 27 CitationsAbstract
OBJECTIVES: Subglottic stenosis (SGS) is one of the most common airway disorders in pediatric patients. Currently, treatment decisions rely primarily on the Cotton-Myer scale, which classifies SGS severity based on percentage reduction in airspace cross-sectional area (CSA). However, the precise relationship between upper airway resistance and subglottic CSA is unknown. We hypothesize that airway resistance can be described by the Bernoulli Obstruction Theory, which predicts that airway resistance is inversely proportional to airspace CSA ( R∝A-1) in cases of severe constriction.
METHODS: Computed tomography (CT) scans of six healthy subjects and five SGS patients were used to create three-dimensional models of the respiratory tract from nostrils to carina. Cylindrical segments of varying lengths and varying diameters were digitally inserted in the subglottis of the healthy subjects to create simulated SGS models. Computational fluid dynamics simulations were run, and airway resistance was computed in the simulated SGS models and actual SGS models.
RESULTS: Constriction diameter had a greater impact in airway resistance than constriction length. In agreement with the Bernoulli Obstruction Theory, airway resistance in the simulated SGS models was well represented by the power law R=aAb, where a is a constant and the exponent b ranged from -0.85 to -1.07. The percentage reduction in airflow (QOBSTRUCTIONQHEALTHY) at a constant pressure drop was found to be directly proportional to the percentage reduction in CSA (AOBSTRUCTIONAHEALTHY) in the limit of severe constrictions, namely QOBSTRUCTIONQHEALTHY=kAOBSTRUCTIONAHEALTHY, where k=2.25 ± 0.15. Airway resistances in the simulated SGS models were similar to resistances in models based on CT scans of actual SGS patients, suggesting that our simulated SGS models were representative of airway resistance in actual SGS patients.
CONCLUSION: Our computer simulations suggest that the degree of airflow limitation in SGS patients may be estimated based on anatomic measurements alone. Future studies are recommended to test these predictions in larger cohorts.
LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1551-1557, 2018.
Author List
Lin EL, Bock JM, Zdanski CJ, Kimbell JS, Garcia GJMAuthors
Jonathan Bock MD Professor in the Otolaryngology department at Medical College of WisconsinGuilherme Garcia PhD Assistant Professor in the Biomedical Engineering department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAir Pressure
Airway Resistance
Case-Control Studies
Child
Child, Preschool
Glottis
Humans
Hydrodynamics
Infant
Laryngostenosis
