Predictive Modeling for Treatment of Upper Airway Obstruction in Young Children

幼儿上呼吸道阻塞治疗的预测模型

• 批准号: 8527828
• 负责人: Stephanie Duggins Davis
• 金额: $ 82.31万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-17 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8527828
• 关键词: 10 year old; Adult; Aging; Aging-Related Process; Air; Anatomy; Area; Atlases; Auditory; Behavior; Biomedical Engineering; Caring; Child; Child Care; Childhood; Cleft Palate; Clinical; Computer Simulation; Computers; Data; Deglutition; Development; Diagnosis; Diagnostic; Disease; Educational workshop; Failure; Future; Goals; Growth; Growth and Development function; Hearing; Hypoxia; Imagery; Infant; Intervention; Jaw; Larynx; Lead; Lesion; Life; Liquid substance; Measurement; Measures; Mechanics; Medical; Methods; Metric; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Obstruction; Operative Surgical Procedures; Outcome; Pathologic; Patients; Pattern; Physicians; Physiological; Physiology; Procedures; Protocols documentation; Publishing; Research; Research Personnel; Respiratory Insufficiency; Respiratory System; Respiratory tract structure; Risk; Robin bird; Scanning; Shapes; Simulate; Speech; Speech Development; Stenosis; Structure; Surgical Management; Techniques; Technology; Time; Tongue; Treatment Failure; Treatment outcome; X-Ray Computed Tomography; airway obstruction; airway remodeling; clinical care; cost; data modeling; digital; experience; haptics; high risk; improved; interdisciplinary approach; model development; novel; predictive modeling; preference; pressure; respiratory; shear stress; sound; tool; treatment planning; virtual; vocal cord

DESCRIPTION (provided by applicant): Infants and children with abnormalities of the upper airway are at risk for hypoxia, respiratory insufficiency and long term morbidity. Multiple levels of airway obstruction encountered in these disorders lead to life threatening difficulties in air exchange, problems with coordination of swallowing, growth, and speech development. In these airway disorders, therapy is typically directed by the clinician's experience and preference, rather than on normalized physiologic or anatomic metrics. Quantitative methods of evaluating and determining optimal management of these upper airway anomalies would be of tremendous benefit for improved clinical care and outcomes. New research tools can now measure computational fluid dynamics. These fluid-structure interaction models allow for the merger of dynamic anatomy with physiologic measures by creating a virtual model of the airway with computed measures of airflow, wall shear stress, pressure distribution, and airway wall shape change. This computational model can be virtually modified to reflect medical intervention, surgical techniques, and normal growth, which can predict changes in airway wall compliance, new airflow patterns, pressure distribution, and other physiologic variables to yield expected clinical results prior to intervention. Improvements in outcomes when computational modeling tools are used in pediatric upper airway intervention planning is enormous, particularly in complicated clinical scenarios. For purposes of model development, we focus on two very specific, commonly encountered, high risk anomalies encountered at our center, Pierre Robin sequence and subglottic stenosis. Normative data regarding growth and development of the upper airway will be studied. We hypothesize that a functional computational model that simulates the mechanical and aerodynamic behavior of the upper airway in children with Pierre Robin sequence and laryngeal lesions (e.g. subglottic stenosis) can be used as an effective diagnostic and treatment planning tool, reducing failures of initial treatment and avoiding potentially unnecessary future complications and interventions. Specific aims for this proposal are to: (1a) develop a functional computational model of the pediatric upper airway which can be used for diagnosis and to predict treatment outcomes in children < 10 years of age with Pierre Robin sequence and subglottic stenosis; data and modeling of normal airways will be obtained to help develop a Pediatric Airway Anatomical Atlas describing the aging airway; an integrated Virtual Pediatric Airway Workbench will also be developed (1b) validate the functional computational model using anatomic and physiologic measures that assess airway patency and airflow limitation in the upper airway in children < 10 years of age with Pierre Robin Sequence and subglottic stenosis and (2) apply the computational model to children being evaluated for Pierre Robin Sequence and subglottic stenosis, and determine the ability of the model to accurately predict results of various potential interventions on anatomic and physiologic metrics.

描述（由申请人提供）：患有上呼吸道异常的婴儿和儿童面临缺氧、呼吸功能不全和长期发病的风险。这些疾病中遇到的多级气道阻塞会导致危及生命的空气交换困难、吞咽协调问题、生长和语言发育问题。在这些气道疾病中，治疗通常根据临床医生的经验和偏好来指导，而不是根据标准化的生理或解剖指标。评估和确定这些上呼吸道异常的最佳治疗的定量方法将对改善临床护理和结果带来巨大益处。新的研究工具现在可以测量计算流体动力学。这些流体-结构相互作用模型通过创建气道虚拟模型以及气流、壁剪切应力、压力分布和气道壁形状变化的计算测量值，实现动态解剖学与生理测量的合并。该计算模型可以进行虚拟修改，以反映医疗干预、手术技术和正常生长，从而可以预测气道壁顺应性的变化、新的气流模式、压力分布和其他生理变量，以在干预之前产生预期的临床结果。当计算建模工具用于儿科上呼吸道干预计划时，结果的改善是巨大的，特别是在复杂的临床情况下。出于模型开发的目的，我们重点关注我们中心遇到的两种非常具体、常见的高风险异常：皮埃尔·罗宾序列和声门下狭窄。将研究有关上呼吸道生长和发育的规范数据。我们假设，模拟 Pierre Robin 序列和喉部病变（例如声门下狭窄）儿童上呼吸道机械和空气动力学行为的功能计算模型可以用作有效的诊断和治疗计划工具，减少初始治疗和治疗的失败。避免未来可能不必要的并发症和干预。该提案的具体目标是： (1a) 开发一个儿科上呼吸道功能计算模型，可用于诊断和预测 Pierre Robin 序列和声门下狭窄的 10 岁以下儿童的治疗结果；将获得正常气道的数据和模型，以帮助开发描述老化气道的儿科气道解剖图谱；还将开发一个集成的虚拟儿科气道工作台 (1b) 使用解剖学和生理学测量来验证功能计算模型，评估 10 岁以下儿童的气道通畅性和上呼吸道气流受限情况，并采用 Pierre Robin 序列和声门下狭窄，以及（ 2) 将计算模型应用于正在评估皮埃尔罗宾序列和声门下狭窄的儿童，并确定模型准确预测各种潜在结果的能力对解剖学和生理学指标的干预。

项目成果

Comparison of endoscopic versus 3D CT derived airway measurements.

• DOI: 10.1002/lary.23836
• 发表时间: 2013-09
• 期刊: LARYNGOSCOPE
• 影响因子: 2.6
• 作者: Calloway, Hollin E.;Kimbell, Julia S.;Davis, Stephanie D.;Retsch-Bogart, George Z.;Pitkin, Elizabeth A.;Abode, Kathleen;Superfine, Richard;Zdanski, Carlton J.
• 通讯作者: Zdanski, Carlton J.

A PEDIATRIC AIRWAY ATLAS AND ITS APPLICATION IN SUBGLOTTIC STENOSIS.

儿童气道图谱及其在声门下狭窄中的应用。

• DOI: 10.1109/isbi.2013.6556697
• 发表时间: 2013
• 期刊: Proceedings. IEEE International Symposium on Biomedical Imaging
• 作者: Hong,Yi;Niethammer,Marc;Andruejol,Johan;Kimbell,JuliaS;Pitkin,Elizabeth;Superfine,Richard;Davis,Stephanie;Zdanski,CarltonJ;Davis,Brad
• 通讯作者: Davis,Brad

Weighted functional boxplot with application to statistical atlas construction.

加权函数箱线图在统计图谱构建中的应用。

• DOI: 10.1007/978-3-642-40760-4_73
• 发表时间: 2013
• 期刊: Medical image computing and computer-assisted intervention : MICCAI ... International Conference on Medical Image Computing and Computer-Assisted Intervention
• 作者: Hong,Yi;Davis,Brad;Marron,JS;Kwitt,Roland;Niethammer,Marc
• 通讯作者: Niethammer,Marc

Statistical atlas construction via weighted functional boxplots.

通过加权函数箱线图构建统计图集。

• DOI: 10.1016/j.media.2014.03.001
• 发表时间: 2014
• 期刊: Medical image analysis
• 影响因子: 10.9
• 作者: Hong,Yi;Davis,Brad;Marron,JS;Kwitt,Roland;Singh,Nikhil;Kimbell,JuliaS;Pitkin,Elizabeth;Superfine,Richard;Davis,StephanieD;Zdanski,CarltonJ;Niethammer,Marc
• 通讯作者: Niethammer,Marc

Quantitative assessment of the upper airway in infants and children with subglottic stenosis.

• DOI: 10.1002/lary.25482
• 发表时间: 2016-05
• 期刊: The Laryngoscope
• 作者: Zdanski C;Davis S;Hong Y;Miao D;Quammen C;Mitran S;Davis B;Niethammer M;Kimbell J;Pitkin E;Fine J;Fordham L;Vaughn B;Superfine R
• 通讯作者: Superfine R