0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Clinical Note |

An Adverse Effect of Positive Airway Pressure on the Upper Airway Documented With Magnetic Resonance Imaging

Robert J. Fleck Jr, MD; Mohamed Mahmoud, MD; Keith McConnell, MS; Sally R. Shott, MD; Ephraim Gutmark, PhD; Raouf S. Amin, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(6):636-638. doi:10.1001/jamaoto.2013.3279.
Text Size: A A A
Published online

Importance Positive pressure air is used during basic life support to provide respirations and applied as continuous positive airway pressure to maintain a patent airway during sleep or anesthesia. These functions are more critical in children with obstructive sleep apnea, who often have smaller airway dimensions and increased airway collapsibility.

Observations We report 2 cases of boys with Down syndrome and a history of obstructive sleep apnea in whom adverse narrowing of the retroglossal airway is caused by continuous positive airway pressure applied via face mask as documented with magnetic resonance imaging.

Conclusions and Relevance Administration of continuous positive airway pressure by means of face mask to patients can result in adverse effects on the airway patency by pushing the tongue posteriorly. Awareness of this effect on patients with open mouths and large tongues, as present in Down syndrome, is important for sleep apnea treatment, anesthesia, and emergency respiratory support. Generalization of our observation is not possible at this time. Additional prospective studies of the effects of continuous positive airway pressure on airway patency in sedated and/or anesthetized children are required to confirm our anecdotal observations.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Patients 1 and 2. All magnetic resonance images were obtained with 3-dimensional fast spin echo (proton density) with end inspiratory respiratory gating. Patient 1: A, With 0 cm H2O continuous positive airway pressure (CPAP) via face mask. Note patency between the oral airway and the retroglossal airway (arrowhead) and the tongue in neutral position with the mouth open. B, With 15 cm H2O CPAP via face mask, the retroglossal airway is narrowed by the tongue (short arrow), which is pushed back by the CPAP. Note the convexity of the anterior superior portion of the tongue (long arrow) and the occlusion of the oral airway (arrowhead) by opposition of the tongue and soft palate. Patient 2: C, With 15 cm H2O CPAP via face mask with the mouth open, the retroglossal airway is narrowed by the tongue (short arrow), which is pushed back by oral CPAP pressure. Similar to patient 1, there is convexity (long arrow) of the anterior superior tongue. D, With 15 cm H2O CPAP via face mask with the mouth closed, the pressure opens the nasopharyngeal airway (small arrows) and retroglossal airway (short arrow).

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com
brightcove.createExperiences();