Acute Upper Airway Obstruction in Children

Background

• Acute upper airway obstruction in children may be due to many causes including congenital anomalies, infection, trauma, and anaphylaxis.

Evaluation

• Clinical evaluation should begin with a detailed history that includes:
  • Asking about airway and respiratory symptoms, including onset, duration and progression.
  • Assessing for evidence of infection, including presence of fever and preceding upper respiratory symptoms (such as cough or sore throat).
  • Asking about history of blunt or penetrating trauma or previous endotracheal intubation.
  • Asking about choking or gagging spells.
  • Asking if the child was burned or in a closed space fire.
• Physical examination should begin with checking vital signs, level of consciousness, and breathing.
  • Assess level of respiratory distress, skin color, presence of retractions, and air entry on auscultation.
  • Perform detailed head and neck exam to assess for craniofacial abnormalities, tonsillar size and masses in oropharynx, and masses or lymphadenopathy in the neck.
  • Perform limited physical exam in cases of severe respiratory distress, as it may cause agitation and worsen obstruction.
• Secure the airway in children with signs of severe upper airway obstruction or significant thermal injury before diagnostic testing.
• Obtain radiographs of neck soft-tissues, with or without chest radiographs, to help determine location and etiology of upper airway obstruction.

Management

• Allow the patient to choose preferred position to maintain the airway.
• Use pulse oximetry and noninvasive carbon dioxide monitoring (if available) to evaluate respiratory status.
• Consider giving nebulized epinephrine and systemic corticosteroids to provide temporary relief of symptoms from moderate-to-severe airway obstruction.
• Secure the airway rapidly for severe upper airway obstruction or significant injury to airway.
  • Consider consulting specialists with airway expertise such as otolaryngology, pediatric surgery, general surgery or anesthesia, depending on underlying etiology and available resources.
  • Consider stabilizing the airway in a controlled setting, such as the intensive care unit or operating room.
  • Consider intubating with endotracheal tube 0.5 to 1 mm smaller than typically used.
• Definitive treatment varies by underlying cause.