-
American Journal of Respiratory and... Jun 2004Central airway obstruction is a problem facing all medical and surgical subspecialists caring for patients with chest diseases. The incidence of this disorder appears to... (Review)
Review
Central airway obstruction is a problem facing all medical and surgical subspecialists caring for patients with chest diseases. The incidence of this disorder appears to be rising because of the epidemic of lung cancer; however, benign causes of central airway obstruction are being seen more frequently as well. The morbidity is significant and if left untreated, death from suffocation is a frequent outcome. Management of these patients is difficult, but therapeutic and diagnostic tools are now available that are beneficial to most patients and almost all airway obstruction can be relieved expeditiously. This review examines current approaches in the workup and treatment of patients suffering from airway impairment. Although large, randomized, comparative studies are not available, data show significant improvement in patient outcomes and quality of life with treatment of central airway obstruction. Clearly, more studies assessing the relative utility of specific airway interventions and their impact on morbidity and mortality are needed. Currently, the most comprehensive approach can be offered at centers with expertise in the management of complex airway disorders and availability of all endoscopic and surgical options.
Topics: Airway Obstruction; Review Literature as Topic
PubMed: 15187010
DOI: 10.1164/rccm.200210-1181SO -
Pediatrics in Review Feb 2015
Review
Topics: Airway Obstruction; Child; Child, Preschool; Diagnosis, Differential; Humans; Infant
PubMed: 25646310
DOI: 10.1542/pir.36-2-62 -
The Veterinary Clinics of North... Apr 2003Heaves, or recurrent airway obstruction (RAO), is a chronic respiratory disease featuring lower airway inflammation, bronchoconstriction, and mucus accumulation. Inhaled... (Review)
Review
Heaves, or recurrent airway obstruction (RAO), is a chronic respiratory disease featuring lower airway inflammation, bronchoconstriction, and mucus accumulation. Inhaled organic dusts and T helper 2 type immunologic reactions are involved in the complex pathophysiology of RAO. Clinical signs vary and alternate with remission periods. The diagnosis is often based on history and clinical examination in severe cases, but bronchoalveolar lavage may be useful for the detection of early cases. The most important aspect of treatment is to avoid exposure to allergens. Corticosteroids may be administered systemically or by inhalation in combination with bronchodilators and environmental control.
Topics: Adrenal Cortex Hormones; Airway Obstruction; Animals; Bronchoalveolar Lavage; Chronic Disease; Horse Diseases; Horses; Mucus; Prognosis; Recurrence; Respiratory Function Tests; Respiratory Hypersensitivity
PubMed: 12747662
DOI: 10.1016/s0749-0739(02)00067-6 -
Indian Journal of Pediatrics Aug 2015Children with upper airway obstruction are both unique and variable in their presentation and management, often posing a challenge to the pediatrician. Several... (Review)
Review
Children with upper airway obstruction are both unique and variable in their presentation and management, often posing a challenge to the pediatrician. Several anatomical and physiologic peculiarities make a child vulnerable to develop an obstruction of upper airways. The characteristic finding in upper airway obstruction is stridor-inspiratory, biphasic or expiratory. The etiologies vary widely throughout the age groups and according to the mode of presentation. The approach starts with suspicion, mandates careful clinical evaluation of the degree of obstruction and many a times emergency measures precede any investigation or even precise diagnosis. Maintaining an open and stable airway is of the utmost importance, often requiring a team approach of emergency physician, pediatrician, otorhinolaryngologist and pediatric pulmonologist. The commonest condition presenting with upper airway obstruction in pediatric population is viral croup. Croup is a clinical diagnosis in a febrile child, with barking cough and stridor preceded by upper respiratory infection. It is treated with systemic or inhaled steroids and nebulized epinephrine. Epiglottitis and bacterial tracheitis are acute bacterial infections of upper airways, presenting as true airway emergencies. Though the mainstay of therapy is IV antibiotics, the prime concern is maintenance of airway, which frequently requires endotracheal intubation. Rigid bronchoscopy is the procedure of choice for airway foreign bodies, a common cause of upper airway obstruction in children below 3 y of age. Airway malacias are the commonest cause of chronic stridor and are mostly managed conservatively.
Topics: Airway Obstruction; Bronchoscopy; Child; Child, Preschool; Humans
PubMed: 26104110
DOI: 10.1007/s12098-015-1811-6 -
Anesthesiology Jun 2021
Comparative Study Review
Topics: Airway Obstruction; Fiber Optic Technology; Head and Neck Neoplasms; Humans; Intubation, Intratracheal; Tracheostomy; Wakefulness
PubMed: 33684214
DOI: 10.1097/ALN.0000000000003744 -
Indian Journal of Pediatrics 1996The airways in infants and children are anatomically different from adults, thus predisposing them to more acute upper airway obstruction. The causes of upper airway... (Review)
Review
The airways in infants and children are anatomically different from adults, thus predisposing them to more acute upper airway obstruction. The causes of upper airway obstruction may be infective or non-infective. The presence of dysphonia, dysphagia, abnormal respiratory pattern, cough and abnormal posture suggests upper airway obstruction. The general management consist of supportive care with minimal invasive procedures. The specific treatment depends on the causes and is discussed in text.
Topics: Adolescent; Adult; Age Factors; Airway Obstruction; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Male
PubMed: 10830037
DOI: 10.1007/BF02730817 -
Prague Medical Report 2021Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery... (Review)
Review
Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery with significant or even total perioperative airway obstruction represents an indication for this technique to prevent/overcome a critical period of severe hypoxaemia, hypoventilation, and/or apnea. This review summarizes the current published scientific evidence on the utility of extracorporeal respiratory support in airway obstruction associated with hypoxaemia, describes the available methods, their clinical indications, and possible limitations. Extracorporeal membrane oxygenation using veno-arterial or veno-venous mode is most commonly employed in such scenarios caused by endoluminal, external, or combined obstruction of the trachea and main bronchi.
Topics: Adult; Airway Obstruction; Extracorporeal Membrane Oxygenation; Humans
PubMed: 34137682
DOI: 10.14712/23362936.2021.7 -
Paediatric Respiratory Reviews Mar 2004
Topics: Age Factors; Airway Obstruction; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Incidence; Male; Prognosis; Risk Assessment; Severity of Illness Index
PubMed: 15222947
DOI: 10.1016/j.prrv.2003.09.001 -
Indian Journal of Pediatrics Oct 2011Upper airway obstruction is defined as blockage of any portion of the airway above the thoracic inlet. Stridor, suprasternal retractions, and change of voice are the... (Review)
Review
Upper airway obstruction is defined as blockage of any portion of the airway above the thoracic inlet. Stridor, suprasternal retractions, and change of voice are the sentinel signs of upper airway obstruction. Most of the common causes among children presenting to emergency department are of acute infectious etiology. Among these, croup is the commonest while diphteria remains the most serious life-threatening cause. Recent reports indicate that bacterial tracheitis has become increasingly common. In ER evaluation the key clinical data in determining the cause and the site of obstruction are the onset, presence of fever, character of the stridor, retractions, the voice and the ability to handle secretions. After assessment of the severity of respiratory distress and resuscitative or supportive therapy including oxygen and emergent airway, specific treatment is directed at underlying etiology. All patients with audible stridor require early endotracheal intubation/tracheostomy. In croup the mainstay of treatment are cold humidified oxygen, budesonide nebulization ( in mild cases), Dexamethasone 0.6 mg/kg iv or im (in moderate and severe cases), and Adrenaline 5 ml 1:1000 (5 mg) solution as nebulization ( in severe cases). In diphtheria, early tracheostomy, anti-diphtheric serum and injectable penicillin are critical. Bacterial Tracheitis and Retropharyngeal abscess need early administration of injectable Cloxacillin, Amikacin and Clindamycin. ENT consultation should be obtained for early surgical drainage of retropharyngeal abscess. Angioneurotic edema is treated with subcutaneous adrenaline (1:1000, 0.01 ml/kg); hydrocortisone 10 mg/kg IV and antihistamines. Patients with severe obstruction and those with endotracheal tube/ trachesotomy should be transferred to PICU.
Topics: Airway Obstruction; Child; Humans; Medical History Taking; Physical Examination; Respiratory Sounds
PubMed: 21559808
DOI: 10.1007/s12098-011-0414-0 -
BMC Pulmonary Medicine Feb 2022Central airway obstruction (CAO) represents a pathological condition that can lead to airflow limitation of the trachea, main stem bronchi, bronchus intermedius or lobar...
INTRODUCTION
Central airway obstruction (CAO) represents a pathological condition that can lead to airflow limitation of the trachea, main stem bronchi, bronchus intermedius or lobar bronchus.
MAIN BODY
It is a common clinical situation consensually considered under-diagnosed. Management of patients with CAO can be difficult and deciding on the best treatment approach represents a medical challenge. This work intends to review CAO classifications, causes, treatments and its therapeutic limitations, approaching benign and malign presentations. Three illustrative cases are further presented, supporting the clinical problem under review.
CONCLUSION
Management of CAO still remains a challenge. The available options are not always effective nor free from complications. A new generation of costume-tailored airway stents, associated with stem cell-based therapy, could be an option in specific clinical situations.
Topics: Airway Obstruction; Bronchi; Humans; Trachea
PubMed: 35183132
DOI: 10.1186/s12890-022-01862-x