Emergent evaluation of acute upper airway obstruction in children
- Laura L Loftis, MD
Laura L Loftis, MD
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Associate Professor of Anaesthesia
- Harvard Medical School
Acute upper airway obstruction from any cause can be a life-threatening emergency. Complete obstruction will result in respiratory failure followed by cardiac arrest in a matter of minutes. This situation requires an immediate, aggressive response.
In contrast, a child with a partial obstruction may initially have an adequate airway. However, this condition can deteriorate rapidly. Under these circumstances, providing supportive care and mobilizing resources for definitive airway management may be the most appropriate intervention.
Compared with adults, infants and young children have small airways and can quickly develop clinically significant upper airway obstruction. The increased work of breathing that results can rapidly progress to respiratory failure because these young patients have less respiratory reserve. Therefore, prompt recognition of airway compromise and the institution of appropriate therapy are necessary to prevent progressive deterioration in respiratory function and improve outcomes.
This topic will review an emergent diagnostic and therapeutic approach to acute severe upper airway obstruction in children. The emergent evaluation of children with acute respiratory distress and issues related to stridor, chronic upper airway problems, and airway management techniques for the difficult pediatric airway are discussed separately.
- (See "Emergent evaluation and immediate management of acute respiratory distress in children".)
- (See "Assessment of stridor in children".)
- (See "Hoarseness in children: Evaluation".)
- (See "The difficult pediatric airway".)
- (See "Devices for difficult endotracheal intubation in children".)
- (See "Emergency rescue devices for difficult pediatric airway management".)
- DeSoto, H. Epiglottitis and croup in airway obstruction in children. Anesthesiol Clin North Am 1998; 16:853.
- Centers for Disease Control and Prevention (CDC). Nonfatal choking-related episodes among children--United States, 2001. MMWR Morb Mortal Wkly Rep 2002; 51:945.
- Chan SC, Dawes PJ. The management of severe infectious mononucleosis tonsillitis and upper airway obstruction. J Laryngol Otol 2001; 115:973.
- Vilke GM, Smith AM, Ray LU, et al. Airway obstruction in children aged less than 5 years: the prehospital experience. Prehosp Emerg Care 2004; 8:196.
- Tan HK, Brown K, McGill T, et al. Airway foreign bodies (FB): a 10-year review. Int J Pediatr Otorhinolaryngol 2000; 56:91.
- Dalal FY, Schmidt GB, Bennett EJ, Levitsky S. Fractures of the larynx in children. Can Anaesth Soc J 1974; 21:376.
- Yen K, Flanary V, Estel C, et al. Traumatic epiglottitis. Pediatr Emerg Care 2003; 19:27.
- Fein A, Leff A, Hopewell PC. Pathophysiology and management of the complications resulting from fire and the inhaled products of combustion: review of the literature. Crit Care Med 1980; 8:94.
- Rahbar R, Rowley H, Perez-Atayde AR, et al. Delayed presentation of lymphatic malformation of the cervicofacial region: role of trauma. Ann Otol Rhinol Laryngol 2002; 111:828.
- Recognition of respiratory distress and failure. Pediatric Advanced Life Support Provider Manual. Chameides L, et al (Eds), American Heart Association, Dallas, 2011, p.37.
- Luten RC, Kisson N. The difficult pediatric airway. In: Manual of Emergency Airway Management, 2nd, Walls RM. (Ed), Williams & Wilkins, Philadelphia 2004. p.236.
- Perry H. Stridor. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.643.
- ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112:IV1.
- Langhelle A, Sunde K, Wik L, Steen PA. Airway pressure with chest compressions versus Heimlich manoeuvre in recently dead adults with complete airway obstruction. Resuscitation 2000; 44:105.
- Patel RG. Percutaneous transtracheal jet ventilation: a safe, quick, and temporary way to provide oxygenation and ventilation when conventional methods are unsuccessful. Chest 1999; 116:1689.
- Coté CJ, Eavey RD, Todres ID, Jones DE. Cricothyroid membrane puncture: oxygenation and ventilation in a dog model using an intravenous catheter. Crit Care Med 1988; 16:615.
- Pawar DK, Marraro GA. One lung ventilation in infants and children: experience with Marraro double lumen tube. Paediatr Anaesth 2005; 15:204.
- Riquelme M, Monnet E, Kudnig ST, et al. Cardiopulmonary changes induced during one-lung ventilation in anesthetized dogs with a closed thoracic cavity. Am J Vet Res 2005; 66:973.
- King CJ, Davey AJ, Chandradeva K. Emergency use of the laryngeal mask airway in severe upper airway obstruction caused by supraglottic oedema. Br J Anaesth 1995; 75:785.
- Bernstein T, Brilli R, Jacobs B. Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis 1998; 27:458.
- Hopkins A, Lahiri T, Salerno R, Heath B. Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics 2006; 118:1418.
- Sofer S, Dagan R, Tal A. The need for intubation in serious upper respiratory tract infection in pediatric patients (a retrospective study). Infection 1991; 19:131.
- Decreased muscle tone
- Infectious etiologies
- - Epiglottitis
- - Croup
- - Bacterial tracheitis
- - Retropharyngeal abscess
- - Peritonsillar abscess
- - Infectious mononucleosis
- Foreign bodies
- - Airway foreign body
- - Esophageal foreign body
- - Blunt and penetrating injury
- - Burn injuries
- Hereditary angioedema
- Vocal cord dysfunction
- Acute on chronic conditions
- Initial rapid assessment
- - Upper airway patency
- - Respiratory failure
- - Onset of symptoms
- - Fever
- Physical examination
- - Signs of airway obstruction
- - Associated findings
- Ancillary studies
- - Imaging
- - Microbiology
- - Direct laryngoscopy
- ALGORITHMIC APPROACH
- No airway, complete obstruction
- - Suspected foreign body
- - No foreign body suspected
- Severe upper airway obstruction
- - Imminent decompensation
- - Fever
- - No fever
- SUMMARY AND RECOMMENDATIONS