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: 8144775
• 负责人: Stephanie Duggins Davis
• 金额: $ 91.55万
• 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 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8144775
• 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; Health; 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; abstracting; 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. PUBLIC HEALTH RELEVANCE: Upper airway problems in young children may lead to life threatening respiratory difficulties, poor growth, aspiration, delay in speech development and long term morbidity. Two common upper airway anomalies are Pierre Robin sequence (small jaw, cleft palate, downward displacement of the tongue) and subglottic stenosis (narrowing of the airway below the vocal cords). Management of these children is typically directed by the clinician's experience and preference, rather than on published protocols or quantitative measures of airway physiology and anatomy. Improved methods of evaluating and determining best management would benefit clinical care and outcomes. Novel research tools that measure structure, airflow and essentially create a virtual model of the airway would significantly improve care of these children. These computational models are now possible and can be modified to reflect medical or surgical intervention as well as normal growth and development. Improved quantitative measurements through computational modeling have enormous potential to significantly improve care in children with complicated upper airways. The researchers in this study hypothesize that a functional computational model may be developed that is similar to the mechanical and aerodynamic behavior of the upper airway in infants with complicated upper airways, specifically children with Pierre Robin Sequence and subglottic stenosis. The researchers also hypothesize that this model could be used as an effective diagnostic/treatment planning tool; thereby, reducing failed treatment and avoiding unnecessary future complications or 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 also be obtained to develop a Pediatric Airway Anatomical Atlas describing the aging airway and a workbench of the pediatric airway will also be developed allowing the physician to hear airway sounds and "virtually" interact with the airway (1b) validate the functional computational model using clinical, anatomic and physiologic measures that evaluate airway size and obstruction in the upper airway in children < 10 years of age with Pierre Robin Sequence and subglottic stenosis and (2) apply the computational model to infants and children being evaluated for Pierre Robin Sequence and subglottic stenosis, and determine the ability of the model to accurately predict the results of various potential interventions on clinical outcomes. The long term implications for the application of computational modeling for the entire airway, adult and pediatric, and to the broader range of pathologic airway problems has the potential to change the current approach to management. (End of Abstract)

描述（由申请人提供）：上呼吸道异常的婴儿和儿童有缺氧，呼吸不足和长期发病率的风险。这些疾病中遇到的多个气道阻塞导致空中交换中造成生命的困难，吞咽协调，生长和言语发展的问题。在这些气道疾病中，治疗通常是由临床医生的经验和偏爱指导的，而不是基于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管理的定量方法对于改善临床护理和结局将带来巨大的好处。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允许通过创建通过计算的气流，壁剪应力，压力分布和气道壁形变化的气道虚拟模型来合并动态解剖结构。该计算模型几乎可以修改以反映医疗干预，手术技术和正常生长，这可以预测气道壁合规性的变化，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。小儿呼吸道干预计划中使用计算建模工具时的结果改善是巨大的，尤其是在复杂的临床情况下。出于模型开发的目的，我们专注于在我们的中心遇到的两个非常特定的，通常遇到的高风险异常，Pierre Robin序列和宽平均狭窄。将研究有关上呼吸道增长和发展的规范数据。我们假设一个功能计算模型，该模拟Pierre Robin序列和喉病变儿童的上呼吸道的机械和空气动力学行为（例如，胶质狭窄）可以用作有效的诊断和治疗计划工具，减少初始治疗的失败，并避免潜在的不必要的未来的复杂性和互动的复杂性。该提案的具体目的是：（1A）开发小儿上呼吸道的功能计算模型，可用于诊断并预测Pierre Robin序列和次球狭窄的儿童的治疗结果；将获得正常气道的数据和建模，以帮助开发描述衰老气道的小儿气道解剖图集；还将开发一个集成的虚拟小儿气道工作台（1B）使用解剖学和生理措施来验证功能计算模型，以评估<10岁的儿童中的气道标准和气流限制，而Pierre Robin序列和（2）在Pierre Robin序列和（2）将计算序列应用于Piere robin的效率和（2）准确预测解剖和生理指标各种潜在干预措施的结果。公共卫生相关性：幼儿的上呼吸道问题可能导致呼吸困难，差，攻击性差，言语发展延迟和长期发病率的生命。 Pierre Robin序列（小颌骨，口感裂，舌头向下移位）和次骨狭窄（声带下方的气道狭窄）是两个常见的上呼吸道异常。这些儿童的管理通常是由临床医生的经验和偏爱指导的，而不是基于出版的规程或气道生理学和解剖学的定量措施。改进的评估和确定最佳管理方法将使临床护理和结果受益。测量结构，气流并基本上创建气道虚拟模型的新型研究工具将显着改善对这些孩子的护理。这些计算模型现在是可能的，可以修改以反映医学或手术干预以及正常的生长和发育。通过计算建模改进的定量测量具有巨大的潜力，可以显着改善上呼吸道复杂儿童的护理。这项研究的研究人员假设可能开发出一种功能计算模型，该模型与复杂的上呼吸道的婴儿，特别是患有皮埃尔·罗宾序列和次宽狭窄的儿童相似的机械和空气动力学行为。研究人员还假设该模型可以用作有效的诊断/治疗计划工具。从而减少治疗失败并避免不必要的未来并发症或干预措施。该提案的具体目的是：（1A）开发小儿上呼吸道的功能计算模型，可用于诊断并预测Pierre Robin序列和次球狭窄的儿童的治疗结果；还将获得正常气道的数据和建模，以开发描述衰老气道的小儿气道解剖图集，并将开发儿科气道的工作台，还将开发出良好的临床，障碍物的范围，从而允许医生听到气道的声音，并且实际上是“实际上”与呼吸道验证了功能范围，以验证临床，物理学的尺寸和物理学尺寸，以验证型号的尺寸尺寸，以验证型号的范围。 Pierre Robin序列和底部狭窄的10岁和（2）将计算模型应用于评估皮埃尔·罗宾序列和云狭窄的婴儿和儿童，并确定该模型准确预测各种潜在的临床结果中潜在干预措施的结果。对整个气道，成人和小儿以及更广泛的病理气道问题应用计算建模的长期影响有可能改变当前的管理方法。 （抽象的结尾）