Diagnosis of Subglottic Stenosis and Edema in Neonates Using OCT

OCT 诊断新生儿声门下狭窄和水肿

• 批准号: 7950291
• 负责人: Brian WONG
• 金额: $ 56.28万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7950291
• 关键词: 3-Dimensional; Acute; Anatomy; Architecture; Bronchoscopy; Cardiac; Child; Cicatrix; Clinical; County; Cricoid cartilage structure; Critical Illness; Development; Diagnosis; Diagnostic; Diagnostic Imaging; Disease; Disease Progression; Early Diagnosis; Edema; Endoscopes; Endoscopic Surgical Procedures; Epithelial; Epithelium; Evaluation; Event; Excision; General Anesthesia; Gestational Age; Gold; Growth and Development function; Health Care Costs; Histologic; Hypoxia; Image; Incidence; Infant; Inflammation; Intratracheal Intubation; Intubation; Laryngoscopy; Larynx; Lead; Life; Light; Lung; Magnetic Resonance Imaging; Medical; Metric; Microscopy; Modeling; Monitor; Morbidity - disease rate; Nature; Neonatal; Neonatal Intensive Care; Neonatal Intensive Care Units; New Zealand; Newborn Infant; Onset of illness; Operative Surgical Procedures; Optical Coherence Tomography; Optics; Oranges; Oryctolagus cuniculus; Patients; Pediatric Hospitals; Physiological; Population; Premature Infant; Property; Resolution; Respiratory distress; Role; Scanning; Site; Source; Speed; Stenosis; Stress; Subglottis structure; Surface; System; Techniques; Technology; Time; Tissues; Tracheal Stenosis; Tracheostomy procedure; Tracheotomy procedure; Trauma; Tube; Ultrasonography; Weight; base; critically ill newborn; design and construction; early onset; endotracheal; imaging modality; improved; in vivo; instrumentation; neonate; prevent; public health relevance

DESCRIPTION (provided by applicant): We seek to develop critical technology to help pre-mature infants and newborns in the first days of life survive and avoid serious airway complications that arise from subglottic stenosis (SGS), the most common acquired anomaly of the larynx in children and the most common abnormality requiring tracheotomy in infants. SGS is preventable and is caused by endotracheal intubation during the critical first days of life. In the premature infant and newborn, this condition may pass undetected or present as a life-threatening event. The ability to better treat and even prevent subglottic stenosis has improved with technical advances in neonatal intensive care, but diagnosis remains a source of continued controversy and debate. The tissues of the subglottis are delicate in nature, easily damaged, and rapidly develop edematous changes, and are predisposed to inflammation, scar formation, and stenosis. Surgical endoscopy has remained the gold standard in the diagnosis of SGS. Unfortunately, surgery requires general anesthesia and is limited to the characterization of the surface anatomy and does not provide detailed analysis of the sub-epithelial tissues. This clinical circumstance is often complicated as the pulmonary, cardiac, and hypoxic thresholds in the newborn population may postpone the evaluation of the airway due to limited tolerances to physiologic stress. In essence, the ultimate challenge in the evaluation of the newborn airway is to minimize diagnostic trauma and physiologic stress while accurately characterizing the laryngeal tissues. Optical Coherence Tomography (OCT) is an imaging modality that utilizes light to produce high-resolution images of living tissues with a resolution in excess of 10 5m. OCT allows for one to distinguish the epithelium from the underlying tissue microstructures based on tissue optical properties with real-time frame rates. Using OCT one can non-invasively characterize living tissues well beyond the current imaging capacities of MRI, CT and ultrasound. We propose to design and construct high speed, high resolution OCT technology combined with 3-D MEMs based probes to image the newborn and infant airways in the neonatal intensive care unit, and define the potential role of OCT in diagnosing the onset and progression of subglottic airway disease in these critically ill patients. First we will optimize the technology in a New Zealand white rabbit model of SGS and compare OCT with conventional microscopy. Then, we will image the subglottic airway in 200 intubated neonates at the UC Irvine-Children's of Hospital of Orange County ICUs and correlate morphologic and structural features obtained with OCT with physiologic and functional variables such as gestational age, weight, and number of failed extubations in order to identify variables that can be used to better predict successful airway extubation, monitor progression of pathophysiologic changes during intubation, and understand the in vivo growth and development of the neonatal airway. We believe we will be able to establish OCT as a viable diagnostic imaging modality that can be used to monitor the neonatal airway and diagnose the early the onset SGS and other ICU acquired laryngeal and upper airway diseases that lead to failed extubation and ultimately tracheostomy. PUBLIC HEALTH RELEVANCE: Subglottic stenosis is the most common indication for tracheostomy in critically ill neonates. Early diagnosis of disease onset may lead to reduction in the incidence of tracheostomy and other airway complications. Development of an office-based treatment technology to diagnosis subglottic stenosis or monitor its development would reduce the need for morbidity and decrease health care costs.

描述（由申请人提供）：我们试图开发关键的技术来帮助成熟的婴儿和新生儿在生命的头几天生存，并避免由亚震荡狭窄（SGS）引起的严重气道并发症（SGS），这是儿童喉部最常见的喉部异常，是婴儿的最常见异常，对婴儿的trache骨hote术最常见。 SG是可以预防的，是由气管插管在生命的关键第一天引起的。在早产的婴儿和新生儿中，这种情况可能会通过未被发现或作为威胁生命的事件。随着新生儿重症监护的技术进步，更好地治疗甚至预防次瓣狭窄的能力已提高，但诊断仍然是持续争议和争论的根源。亚球体的组织本质上是微妙的，很容易受损，并且迅速发展了水肿的变化，并且易于发炎，疤痕形成和狭窄。手术内窥镜检查仍然是SG诊断的金标准。不幸的是，手术需要全身麻醉，并且仅限于表面解剖结构的表征，并且不提供对上皮下组织的详细分析。这种临床情况通常很复杂，因为新生儿人口中的肺，心脏和低氧阈值可能会推迟对生理压力的公差有限，因此对气道的评估。从本质上讲，评估新生气道的最终挑战是最大程度地减少诊断创伤和生理压力，同时准确地表征喉组织。光学相干断层扫描（OCT）是一种成像模态，它利用光产生高分辨率的活组织图像，分辨率超过10 5m。 OCT允许基于实时帧速率的组织光学特性，将上皮与基础组织微结构区分开。使用OCT可以非侵入性地表征远远超出MRI，CT和超声的当前成像能力的活性组织。我们建议设计和构建高速分辨率OCT技术与3-D MEMS基于基于3-M MEMS的探针，以对新生儿重症监护病房中的新生儿和婴儿气道进行成像，并确定OCT在诊断这些重症患者中诊断和整个呼吸道疾病的发作和进展方面的潜在作用。首先，我们将在新西兰白兔子模型中优化该技术，并将OCT与常规显微镜进行比较。然后，我们将在UC Irvine-Children的200次新生儿的次级新生儿中进行映像橙县伊克斯医院的医院，并与OCT相关的形态和结构特征与OCT一起获得的形态和结构特征，生理和功能变量，生理和功能变量，例如，妇女的年龄，重量和范围的范围不断变化，以确定可变性的范围，以确定变化的范围，以确定变化的变化，以确定空中的变化数量插管并了解新生儿气道的体内生长和发育。我们认为，我们将能够将OCT建立为可行的诊断成像方式，可用于监测新生儿气道，并诊断出发作SGS和其他ICU获得的早期喉部和上呼吸道疾病，从而导致脱毛失败，并最终导致tr术。 公共卫生相关性：次瓣狭窄是重症新生儿气管切开术最常见的指示。疾病发作的早期诊断可能导致气管切开术和其他气道并发症的发生率降低。开发基于办公室的治疗技术来诊断亚平狭窄或监测其发育，将减少对发病率的需求并降低医疗保健成本。