3. INTRODUCTION
• Upper airway obstruction is defined as occlusion or narrowing of the
airways leading to compromise in ventilation.
• Obstruction can vary from acute to chronic, from congenital to
acquired, and in many cases, can be fatal if left untreated.
• The obstruction can lead to respiratory failure, arrhythmias, cardiac
arrest or death within minutes.
4. ANATOMY
• The upper airway consists of the
nasal cavities, oral cavity, pharynx,
and larynx
• The pharynx is further subdivided
into the nasopharynx, oropharynx,
and hypopharynx.
• The larynx is divided into three
regions, dependent on their
relationship to the vocal cords
(glottis). These areas are the
supraglottis, glottis, and subglotti
5.
6. ETIOLOGY
• Congenital
• Laryngomalacia: Is a congenital softening of the tissues of the
larynx. It results in collapse of the supraglottic structures during
inspiration , leading to airway obstruction
• Laryngeal webs: They are anteriorly situated and if large can cause
obstruction
• Foreign body aspiration
• Occurs most common in children
• Example: Bone fragments, coins, pins
7. • Infections
• Croup (laryngotracheobronchitis): Viral illness affecting children
• Ludwig angina: Rapdily progressive gangrenous cellulitis of the soft
tissues of the neck and floor of the mouth
• Epiglotittis, laryngitis
• Tonsillar hypertrophy
• Peritonsillar abscess
• Retropharyngeal abscess
• Trauma
• Acute laryngeal injury
• Facial trauma (mandibular or maxillary fractures)
• Airway burn (inhalation of smoke, superheated air)
8. • Tumors
Laryngeal tumors (benign or malignant)
Laryngeal papillomatosis
Tracheal stenosis (caused by intrinsic or extrinsic tumors)
• Allergic reactions: This includes allergic reactions to a bee sting,
antibiotics(such as penicillin), and antihypertensives(such as ACE
inhibitors)
9. CLINICAL PRESENTATION
The main symptoms of airway obstruction are dyspnea and stridor
(noisy breathing)
• Agitation
• Cyanosis
• Chocking
• Increasing anxiety, restlessness, and confusion
• Gasping for air
10. CONT…..
• Panic
• Refusing to lie flat
• Altered voice
• Use of accessory muscles
• Flaring of the nostrils
• Labored breathing
11. History and physical examination
• Clear “history” of onset, progression and details of exacerbating or
relieving features
• FULL examination of mouth & nose - oropharynx - larynx – trachea
EXAMINATION
• Endoscopy - Gold standard
Evaluate nasal passages, nasopharynx, oropharynx, larynx and
trachea
• General anaesthetic if require
12.
13. INVESTIGATIONS
• Plain neck and chest radiographs
• Anteroposterior and lateral
• Useful in identifying radiopaque foreign bodies.
• Bronchoscopy
• Bronchoscopy with direct visualization is the most effective tool in
establishing diagnosis and frequently provides the best way to
correct upper airway obstruction
15. CONT…
• Spirometry: In gradual and mild cases of obstruction, not in
acute cases
• CT Scan
• Important in stable or in unstable patients with secured airway
• Useful in identifying intrinsic and extrinsic tumors and foreign
bodies.
16. MANAGEMENT.
• Establishing a secure and patent airway is the most
important goal in the resuscitation of a patient with acute
upper airway obstruction
• Heimlich maneuver is recommended for relief of the airway
obstruction in adults and children 1-8yo
• Subdiaphragmatic abdominal thrust can force air from the lungs;
this may be sufficient to create an artificial cough and expel a
foreign body from the airway.
18. CONT..
• Medical interventions include:-
• Oropharyngeal airways
• Endotracheal intubation(Trans-nasally or orally)
• Corticosteroids: Effective in reducing airway edema
• Helium-oxygen mixture(Heliox):is effective in reducing the work of
breathing by decreasing airway resistance to turbulent
flow.
19. CONT…
• Surgical interventions include:-
• Fiberoptic intubation
• Cricothyroidotomy
• Tracheostomy
• Airway stenting: Tracheal stents placed using either rigid or flexible
bronchoscopy can be helpful to maintain a patent airway in
patients with tracheal obstruction caused by benign or malignant
conditions
20. PREVENTION
• Eat slowly and chew food completely
• Keep small objects away from young children
• Make sure dentures fit properly.
21. TRACHEOSTOMY
• Is an opening surgically created through the anterior of the neck into the
trachea to allow direct access to the breathing tube
Types of Tracheostomy technique
1) Cricothyrotomy
2) Open surgical tracheotomy
3) Percutaneous dilatation tracheotomy
22. Indications
• Airway access for prolonged mechanical ventilation
• Mechanical upper airway obstruction
• Decreased/incompetent clearence of tracheobronchial secretions
• Emergency airway access
• Facial fractures that may lead to upper airway obstruction (eg,
comminuted fractures of the mid face and mandible)
• Upper airway edema from trauma, burns, infection, or anaphylaxis
23. Contraindications
• Active cellulitis of the anterior neck skin
• A strong relative contraindication to discrete surgical access to the
airway is the anticipation that the blockage is a laryngeal carcinoma.
• The definitive procedure (usually a laryngectomy) is planned, and
prior manipulation of the tumor is avoided because it may lead to
increased incidence of stomal recurrence.
• Temporary tracheostomy may be performed just under the first
tracheal ring in anticipation of a laryngectomy at a later time.
24. Complications
Early complications:
• Air trapped around the lungs (pneumothorax)
• Air trapped in the deeper layers of the chest (pneumomediastinum)
• Air trapped underneath the skin around the tracheostomy
(subcutaneous emphysema)
• Injury to the nerve that moves your vocal cords (recurrent laryngeal
nerve)
• Bleeding
• Cardiac arrest
25. CONT…
Late complications:
• Accidental removal of the tracheostomy tube (accidental
decannulation)
• Infection in the trachea and around the tracheostomy tube
26. CONT…
Delayed complications
• Thinning (erosion) of the trachea from the tube rubbing against it
(tracheomalacia)
• Development of a small connection from the trachea to the
esophagus (tracheo-esophageal fistula)
• Development of bumps (granulation tissue) that may need to be
surgically removed before decannulation can occur
