Anatomische Untersuchungen der oberen Atemwege an Präparaten von Früh- und Neugeborenen zur Verbesserung der Atemwegssicherung

Die Atemwegssicherung bei Früh- und Neugeborenen stellt in der medizinischen Praxis nach wie vor eine Herausforderung dar. In dieser Studie wurde die Anatomie der oberen Atemwege von totgeborenen Neugeborenen mit einem Gestationsalter von 25 bis 44 Wochen untersucht, um das Atemwegsmanagement zu verbessern und die Entwicklung von Atemwegshilfen, insbesondere supraglottischen Atemwegshilfen, zu fördern. Winkel und Durchmesser der oralen und nasalen Intubationswege von 22 anatomischen Präparaten Früh- und Reifgeborener wurden bestimmt, in Beziehung zum Gestationsalter gesetzt und auf statistische Signifikanz überprüft. Von den oralen und nasalen Intubationswegen wurden mit einem zahnärztlichen Silikonabformmaterial Abformmodelle hergestellt und anschließend 3D-Scans angefertigt. Keiner der untersuchten Winkel zeigte eine signifikante Korrelation mit dem Gestationsalter, jedoch wiesen vier der untersuchten Durchmesser im Bereich des harten und weichen Gaumens eine statistisch signifikante positive Korrelation mit dem Gestationsalter auf. Es lässt sich festhalten, dass die Winkel der Atemwege von Früh- und Neugeborenen nicht systematisch vom Gestationsalter abhängen. Aus anatomischer Sicht können daher Larynxmasken auch für Frühgeborene gut geeignete Atemwegshilfen sein. Das Design von Larynxmasken für kleine Frühgeborene sollte bezüglich der Größe, nicht jedoch bezüglich der Form angepasst werden. Die gewonnenen Daten können als Grundlage für die Entwicklung von supraglottischen Atemwegshilfen und Atemwegssimulatoren für die medizinische Ausbildung und das klinische Training dienen

Anatomical investigations on the upper airway in premature and newborn babies

Safe intubation of newborns remains a challenge. This investigates the upper airway anatomy of (pre-)term infants was investigated to improve airway management and the development of airway devices. Angles and diameters of both oral and nasal intubation pathways of 22 cadavers of premature and term stillborn infants were measured, relative to their gestational age (GA) and tested for statistical significance. The systematic influence of sex on the distribution of values was examined. Cast models of the oral and nasal intubation pathway were (produced using a silicone dental impression material) 3D-scanned. No significant correlation with GA was seen in the angles studied. However, four distances around the hard and soft palate did show statistically significant positive correlations with GA. Regarding differences between the sexes, only the angle between the entrance of the trachea and the esophagus was greater for male cadavers. The angles of the ventilation pathway of (pre-)term infants do not depend systematically on GA. Anatomically, laryngeal masks might therefore also be well-suited ventilators for preterm infants. Alterations in the size but not the shape of laryngeal masks for small preterm infants is recommended. The data obtained may thus be used as a basis for the development of airway devices and airway simulators for medical education and clinical training

Anatomic accuracy, physiologic characteristics, and fidelity of very low birth weight infant airway simulators

Background!#!Medical simulation training requires realistic simulators with high fidelity. This prospective multi-center study investigated anatomic precision, physiologic characteristics, and fidelity of four commercially available very low birth weight infant simulators.!##!Methods!#!We measured airway angles and distances in the simulators Premature AirwayPaul (SIMCharacters), Premature Anne (Laerdal Medical), Premie HAL S2209 (Gaumard), and Preterm Baby (Lifecast Body Simulation) using computer tomography and compared these to human cadavers of premature stillbirths. The simulators' physiologic characteristics were tested, and highly experienced experts rated their physical and functional fidelity.!##!Results!#!The airway angles corresponded to those of the reference cadavers in three simulators. The nasal inlet to glottis distance and the mouth aperture to glottis distance were only accurate in one simulator. All simulators had airway resistances up to 20 times higher and compliances up to 19 times lower than published reference values. Fifty-six highly experienced experts gave three simulators (Premature AirwayPaul: 5.1 ± 1.0, Premature Anne 4.9 ± 1.1, Preterm Baby 5.0 ± 1.0) good overall ratings and one simulator (Premie HAL S2209: 2.8 ± 1.0) an unfavorable rating.!##!Conclusion!#!The simulator physiology deviated significantly from preterm infants' reference values concerning resistance and compliance, potentially promoting a wrong ventilation technique.!##!Impact!#!Very low birth weight infant simulators showed physiological properties far deviating from corresponding patient reference values. Only ventilation with very high peak pressure achieved tidal volumes in the simulators, as aimed at in very low birth weight infants, potentially promoting a wrong ventilation technique. Compared to very low birth weight infant cadavers, most tested simulators accurately reproduced the anatomic angular relationships, but their airway dimensions were relatively too large for the represented body. The more professional experience the experts had, the lower they rated the very low birth weight infant simulators

Anatomic accuracy, physiologic characteristics, and fidelity of very low birth weight infant airway simulators

Background Medical simulation training requires realistic simulators with high fidelity. This prospective multi-center study investigated anatomic precision, physiologic characteristics, and fidelity of four commercially available very low birth weight infant simulators. Methods We measured airway angles and distances in the simulators Premature AirwayPaul (SIMCharacters), Premature Anne (Laerdal Medical), Premie HAL S2209 (Gaumard), and Preterm Baby (Lifecast Body Simulation) using computer tomography and compared these to human cadavers of premature stillbirths. The simulators' physiologic characteristics were tested, and highly experienced experts rated their physical and functional fidelity. Results The airway angles corresponded to those of the reference cadavers in three simulators. The nasal inlet to glottis distance and the mouth aperture to glottis distance were only accurate in one simulator. All simulators had airway resistances up to 20 times higher and compliances up to 19 times lower than published reference values. Fifty-six highly experienced experts gave three simulators (Premature AirwayPaul: 5.1 +/- 1.0, Premature Anne 4.9 +/- 1.1, Preterm Baby 5.0 +/- 1.0) good overall ratings and one simulator (Premie HAL S2209: 2.8 +/- 1.0) an unfavorable rating. Conclusion The simulator physiology deviated significantly from preterm infants' reference values concerning resistance and compliance, potentially promoting a wrong ventilation technique. Impact Very low birth weight infant simulators showed physiological properties far deviating from corresponding patient reference values. Only ventilation with very high peak pressure achieved tidal volumes in the simulators, as aimed at in very low birth weight infants, potentially promoting a wrong ventilation technique. Compared to very low birth weight infant cadavers, most tested simulators accurately reproduced the anatomic angular relationships, but their airway dimensions were relatively too large for the represented body. The more professional experience the experts had, the lower they rated the very low birth weight infant simulators

Fetal bovine serum impacts the observed N‐glycosylation defects in TMEM165 KO HEK cells

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