Upper Airway Obstruction

 Potentially fatal  Misdiagnosed as Asthma or COPD  Multiple etiologies

Upper Airway Obstruction  Consists of the air conducting system Mouth  Carina Mouth  Carina  Divided by the thoracic inlet into extrathoracic & intrathoracic extrathoracic & intrathoracic  Extrathoracic Airway  pharynx +larynx & extrathoracic trachea & extrathoracic trachea

Upper Airway Obstruction  The extrathoracic trachea 2-4 cm intrathoracic trachea 9-12 cm intrathoracic trachea 9-12 cm  Caliber mm men mm women  Stridor indicate severe obstruction <5 mm but not the location of narrowing but not the location of narrowing

Upper Airway Obstruction Post intubation or Tracheostomy Post intubation or Tracheostomy local edema,ulceration & granuloma local edema,ulceration & granuloma most resolve 8-12 weeks most resolve 8-12 weeks Closely related to Duration Closely related to Duration & Use High Pressure small volume cuff & Use High Pressure small volume cuff post extubation edema  common in children post extubation edema  common in children

Upper Airway Obstruction Inhalation Injury Could be gradual 2-12hours Could be gradual 2-12hours Mucosal edema Mucosal edema increased secretions increased secretions obstruction by the sloughed epithelium obstruction by the sloughed epithelium Fire, explosion in closed space Fire, explosion in closed space Facial burns,Hoarse voice Facial burns,Hoarse voice Erythema oropharynx Erythema oropharynx ? Effect of steroid ? Effect of steroid

Upper Airway Obstruction Foreign Body aspiration Common in children Common in children Adults with decreased LOC Adults with decreased LOC CNS diseases CNS diseases Drugs Drugs ETOH ETOH

Upper Airway Obstruction Angioedema Hereditary C1 esterase deficiency Hereditary C1 esterase deficiency IgE Mediated IgE Mediated Non IgE Mediated (NSAID & ACEI ) Non IgE Mediated (NSAID & ACEI ) Rx Epinepherine Rx Epinepherine Steroids Steroids Antihistamines Antihistamines

Upper Airway Obstruction Infections Croup children URTI viral infection Croup children URTI viral infection Epiglotitis bacterial absence of cough & Epiglotitis bacterial absence of cough & hoarseness of voice hoarseness of voice Ludwig's Angina cellulitis of mouth floor Ludwig's Angina cellulitis of mouth floor & submandibular area & submandibular area poor dentition poor dentitionMalignancy

Upper Airway Obstruction Diagnosis CXR sometimes helpful CXR sometimes helpful Spirometry insensitive till advanced stage Spirometry insensitive till advanced stage shape changes even before volumes shape changes even before volumes CT define the location 3D reconstruction CT define the location 3D reconstruction MRI superior estimating length & degree MRI superior estimating length & degree

Upper Airway Obstruction Treatment Racemic Epi Croup vasoconstriction Racemic Epi Croup vasoconstriction decreasing edema decreasing edema Steroids Croup & Post extubation ? Steroids Croup & Post extubation ? Helium postextubation, tracheal stenosis Helium postextubation, tracheal stenosis extrinsic compression extrinsic compression Lower density & viscosity Lower density & viscosity Laser, Stenting & Dilatation Laser, Stenting & Dilatation