Acute upper airway obstruction

Author(s): Eskander A, de Almeida JR, Irish JC.

N Engl J Med 2019; 381:1940-1949

Airway diseases
Paediatric respiratory diseases
Respiratory critical care
Endoscopy and interventional pulmonology
General respiratory patient care

Digest Author(s): Stylianos Loukides, e-Learning Director / 17 November, 2019

Acute upper airway obstruction is a life-threatening clinical condition and requires immediate assessment and intervention. Before treating acute upper airway obstruction in the clinical setting, a detailed and comprehensive diagnostic approach is needed. There are multiple causes (infectious, inflammatory, traumatic, mechanical, and iatrogenic), for the upper airway obstruction. According to subsite we can divide the upper airway obstruction in three groups. The supraglottic, the glottic and the subglottic or tracheal part. The management of an upper airway obstruction needs a multidisciplinary approach.

In the glottic part the main underlying causes are iatrogenic, tumour and foreign body. For the supraglottic part the predominant causes are the presence of croup and the manifestations of angioedema. Finally in the subglottic or trachea part we can consider as underlying causes the presence of tumor, the foreign body and the subglottic stenosis.
The traditional algorithm for management consists of high-flow oxygen, medical interventions that may affect edema or trying to control infections and some other protective measures like the mask ventilation or even the intubation with mechanical ventilation. Finally a surgical intervention for opening the airways is provided for specific cases.

Comment

The management of acute upper airway obstruction in the clinical setting is not so simple since it requires a multidisciplinary approach where many specialities are implicated. The critical point is the early clarification of the specific underlying cause through the potential multiple causes of the disease. After defining the cause, the next critical step is to secure the airway and to reverse the cause of the disease.