Infections of the airway

Abstract

SummaryInfections of the airway in children may present to the anesthetist as an emergency in several locations: the Emergency Department, the Operating Department or on Intensive Care. In all of these locations, relevant and up to date knowledge of presentations, diagnoses, potential complications and clinical management will help the anesthetist and the surgical team, not only with the performance of their interventions, but also in buying time before these are undertaken, avoiding complications and altering the eventual outcome for the child. Diseases such as epiglottitis and diphtheria may show diminished incidence but they have not gone away and their clinical features and essential management remain unchanged. Paradoxically, perhaps, some conditions such as Lemierre's syndrome appear to be making a comeback. In these instances, clinicians need to be alert to these less common conditions, not only in regard to the disease itself but also to potentially serious complications. This article describes those infections of the airway that are most likely to present to the anesthetist, their attendant complications and recommendations for treatment.

Paediatric airway infections

“…The narrowing of the airway because of the oedematous epiglottis may make conventional tracheal intubation difficult and an ear, nose, and throat (ENT) surgeon should ideally be present during definitive airway management should tracheostomy be required. 12 Routine intubation of children with epiglottitis has been shown to result in significantly lower mortality rates compared with those managed medically without an artificial airway. 13 Intubation is usually required for 2-3 days before extubation is permissible.…”

“…Acute airway compromise purely as a result of tonsillitis may occur, but this is rare without associated extra-tonsillar spread of infection. 12 Figure 2 shows a significant degree of airway narrowing as a result of tonsillitis.…”

“…Inhalation induction has been suggested and a cuffed tracheal tube will help to prevent soiling of the lower airways. 12…”

Acute Infections that Produce Upper Airway Obstruction

“…72 The last childhood deaths reported in the United Kingdom were 1 in 1994 and 1 in 2008. 74 In 2013, in a refugee camp in Afghanistan, there were 50 cases and 3 deaths. Most life-threatening cases occurred in unvaccinated or inadequately vaccinated persons, and it is important for children traveling to these countries, particularly for extended periods, to be vaccinated.…”

Editorial

“…When assessment reveals a difficult pediatric airway (1), it is important to have a clear management plan and an approach is clearly explained by Walker (9). For most practitioners such cases will be relatively rare but all will encounter children with upper airway obstruction (10), obstructive sleep apnea (11), airway foreign body (12) and airway infections (13) so the reviews of these topics are particularly helpful. When managing the pediatric airway, we do need to be cognizant of ‘doing no harm’ and this is well illustrated by the review of iatrogenic damage by Holzki (14).…”