Severe upper airway obstruction in the tropics requiring intensive care

Chan, P. W. K.; Goh, Adrian; Lum, Lucy Chai-See

doi:10.1046/j.1442-200x.2001.01340.x

Cited by 10 publications

(8 citation statements)

References 18 publications

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“…Diseases leading to severe compromise of the upper airway are the most frequent causes of cardiac arrest in pediatric population. In one study, severe upper airway obstruction accounted for 3.3 % of all pediatric intensive care unit (PICU) admissions [1].…”

Section: Introductionmentioning

confidence: 99%

Upper Airway Obstruction in Children

2015

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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.

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Section: Introductionmentioning

confidence: 99%

Upper Airway Obstruction in Children

2015

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“…The study involved 160 patients out of a total number of 8560 patients seen within the study period giving a prevalence of 1.87%. In an earlier similar study in 2001, Chan et al found a prevalence of 3.3% [14]. This difference may stem from patient selection because they studied mainly patients requiring intensive care.…”

Section: Discussionmentioning

confidence: 95%

“…It is known that severe upper airway obstruction can be a reason for paediatric ICU admission. It accounts for 3.3% of such admissions [14]. Conservative medical therapy which included antibiotics, corticosteroids, decongestants, vitamins was employed in some of these patients.…”

Section: Discussionmentioning

confidence: 99%

Upper Airway Obstruction among the Paediatric Population in the University of Port Harcourt Teaching Hospital: The Place of Tracheostomy in the Management

Ibekwe

2020

IJTDH

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Background: The paediatric age group has very peculiar anatomic and physiologic airways therefore, obstruction which commonly occurs in this population, can pose serious challenges in this age group. Aim: To study the pattern and aetiology of acute upper airway obstruction in the paediatric age group in University of Port Harcourt teaching hospital and to determine the place of tracheostomy in the management. Patients and Methods: It is a descriptive hospital based study of all paediatric patients; aged 0-15 years with upper airway obstruction that presented to the ear, nose and throat department and the children emergency ward of university of Port Harcourt teaching hospital within the period of January 2014 to December 2019. Data on demographics, clinical presentations, causes and management were obtained using a Proforma. The diagnosis of upper airway obstruction is made in a child with any degree of respiratory difficulty with or without associated stridor or stertor arising from lesions above the thoracic inlet. Children with respiratory difficulty other than that from an upper airway obstruction were excluded from the study. Data obtained were analyzed with the IBM statistical package for social sciences SPSS version 20. Results were presented in simple descriptive forms with tables. Results: One hundred and sixty paediatric patients with upper air way obstruction with age ranging from 0-15 years were studied. The prevalence of upper airway obstruction was 1.87%. There were more males than females; male to female ratio was 1.2:1. Age group 4-7 years were the most affected, 43.75%. Foreign body aspiration was the commonest cause. Majority of the patients had tracheostomy done, 48.75%. Mortality was n=1(0.625%). Conclusion: Upper air way obstruction among the paediatric age group is still common with foreign body aspiration as a very important cause in our setting. The very young are the most affected and tracheostomy appears to still be the main option of securing airway in these cases in our environment.

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“…• Croup: Administer adrenaline (epinephrine) (1 mg/mL) 0.5 mL/kg (maximum dose 5 mL) in 3 mL NS via nebulizer PRN, repeat PRN, 24 dexamethasone 0.6 mg/kg oral/in-tramuscular (IM)/intravenous (IV) Â 1 dose (maximum dose 16 mg) 24 • Airway edema (allergy associated): Adrenaline (epinephrine) (1 mg/mL) 0.5 mL/kg (maximum dose 5 mL) in 3 mL NS via nebulizer, repeat PRN, 24 32 ; Unconscious: open airway, remove visible foreign body, avoid blind finger sweep, perform compressions/ventilations, 32 consider bronchoscopy, 18,33,34 and consider tracheostomy. 18,33,[35][36][37] Lower Airway Obstruction If a regular spacer device is not available for use with the MDI, consider use of a sealed-soda bottle as a suitable alternative. 40 Attach a face mask to the cap end for use in infants.…”

Section: Upper Airway Obstructionmentioning

confidence: 99%

Teaching Pediatric Life Support in Limited-Resource Settings: Contextualized Management Guidelines

Ralston

Caen

2016

J Pediatr Intensive Care

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Of the estimated 6.3 million global annual deaths in children younger than the age of 5 years, nearly all (99%) occur in low- to middle-income countries (LMIC). Existing management guidelines for children with emergency conditions as taught in a variety of current pediatric life support courses are mostly applicable to high-income countries with a different disease range and full resources compared with LMIC. A revised curriculum with evidence-based application to limited-resource settings would expand their potential for reducing pediatric mortality worldwide. This review provides a supplemental curriculum of standards for selected pediatric emergency conditions with attention to the context of disease range and level-specific resources in LMIC. During training sessions, contextualized management guidelines create the framework for realistic and fruitful case simulations.

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Severe upper airway obstruction in the tropics requiring intensive care

Abstract: There is marked heterogeneity in the causes of upper airway obstruction in the tropics with viral croup remaining the most common. A significant proportion required ventilation, but outcome is generally favorable, except in those with bacterial tracheitis and mediastinal malignancy.

Cited by 10 publications

References 18 publications

Upper Airway Obstruction in Children

Upper Airway Obstruction in Children

Upper Airway Obstruction among the Paediatric Population in the University of Port Harcourt Teaching Hospital: The Place of Tracheostomy in the Management

Teaching Pediatric Life Support in Limited-Resource Settings: Contextualized Management Guidelines

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