Abstract
Acute upper airway obstruction presents an immediate threat to life. Following loss of the upper airway, hypoxemia with resultant cardiac arrest and death can ensue within minutes. Inspiratory stridor (a harsh, usually high-pitched sound) is the hallmark of upper airway obstruction. This is not to say, however, that upper airway obstruction cannot occur in the absence of stridor, because profound degrees of obstruction may manifest silently if airflow is nearly absent. When confronted with a child who has acute upper airway obstruction, the practitioner must assess the degree of obstruction quickly and accurately. The possibility of progression to complete airway obstruction with hypoxemia and cardiac arrest must be appreciated. Delaying intervention in a child whose airway is unstable may be costly, but unnecessary instrumentation in a child who has stable upper airway obstruction may precipitate a crisis.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Readings
American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–70.
Balaban O, Tobias JD. Videolaryngoscopy in neonates, infants, and children. Pediatr Crit Care Med. 2017;18:477–85.
Black AE, Flynn PE, Smith HL, et al. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Pediatr Anesth. 2015;25:346–62.
Chaten FC, Lucking SE, Young ES, et al. Stridor: intracranial pathology causing postextubation vocal cord paralysis. Pediatrics. 1991;87:39.
Coté CJ, Hartnick CJ. Pediatric transtracheal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children? Paediatr Anaesth. 2009;19(Suppl 1):66–76.
Fiadjoe J, Strickler P. Pediatric difficult airway management; current devices and techniques. Anesthesiol Clin. 2009;27:185–95.
Ghai B, Wig J. Comparison of different techniques of laryngeal mask placement in children. Curr Opin Anaesthesiol. 2009;22:400–4.
Grisaru-Soen G, Komisar O, Aizenstein O, et al. Retropharyngeal and parapharyngeal abscess in children--epidemiology, clinical features and treatment. Int J Pediatr Otorhinolaryngol. 2010;74:1016–20.
Hadjikoutis S, Wiles CM. Respiratory complications related to bulbar dysfunction in motor neuron disease. Acta Neurol Scand. 2001;103:207–13.
Jefferson ND, Cohen AP, Rutter MJ. Subglottic stenosis. Semin Pediatr Surg. 2016;25:138–43.
Kamin W. Diagnosis and management of respiratory involvement in Hunter syndrome. Acta Paediatr Suppl. 2008;97(457):57–60.
Levin R, Kissoon N, Froese N. Fibreoptic and videoscopic indirect intubation techniques for intubation in children. Pediatr Emerg Care. 2009;25:479; quiz 480–2.
Mace SE, Khan N. Needle cricothyrotomy. Emerg Med Clin North Am. 2008;26:1085–101, xi.
Masters IB. Congenital airway lesions and lung disease. Pediatr Clin N Am. 2009;56:227–42, xii.
McNiece WL, Dierdorf SF. The pediatric airway. Semin Pediatr Surg. 2004;13:152–65.
Pohunek P. Development, structure and function of the upper airways. Paediatr Respir Rev. 2004;5:2–8.
Qureshi MJ, Kumar M. Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation. Cochrane Database Syst Rev. 2018;3:CD003314.
Raj D, Luginbuehl I. Managing the difficult airway in the syndromic child. Contin Educ Anaesth Crit Care Pain. 2015;15:7–13.
Rutter MJ. Evaluation and management of upper airway disorders in children. Semin Pediatr Surg. 2006;15:116–23.
Schweiger C, Manica D, Rotta Rutkay D, et al. Undersedation is a risk factor for the development of subglottic stenosis in intubated children. J Pediatr. 2017;93:351–5.
Setlur J, Hartnick CJ. Management of unilateral true vocal cord paralysis in children. Curr Opin Otolaryngol Head Neck Surg. 2012;20:497–501.
Sims C, von Ungern-Sternberg. The normal and the challenging pediatric airway. Pediatr Anesth. 2012;22:521–6.
Sunder RA, Haile DT, Farrell PT, et al. Pediatric Airway management: current practices and future directions. Pediatr Anesth. 2012;22:1008–15.
Terada M, Hotoda K, Toma M, et al. Surgical management of congenital tracheal stenosis. Gen Thorac Cardiovasc Surg. 2009;57:175–83.
Weiss M, Engelhardt T. Proposal for the management of the unexpected difficult pediatric airway. Paediatr Anaesth. 2010;20:454–64.
Worley G, Witsell DL, Hulka GF. Laryngeal dystonia causing inspiratory stridor in children with cerebral palsy. Laryngoscope. 2003;113:2192–5.
Zur KB, Litman RS. Pediatric airway foreign body retrieval: surgical and anesthetic perspectives. Paediatr Anaesth. 2009;19(Suppl 1):109–17.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lucking, S.E. (2021). Upper Airway Obstruction. In: Lucking, S.E., Maffei, F.A., Tamburro, R.F., Zaritsky, A. (eds) Pediatric Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-53363-2_9
Download citation
DOI: https://doi.org/10.1007/978-3-030-53363-2_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-53362-5
Online ISBN: 978-3-030-53363-2
eBook Packages: MedicineMedicine (R0)