Upper airway obstruction

Upper airway obstruction is an uncommon but obviously serious management issue that will present to the Emergency Department from time to time. This article covers upper airway obstruction in the adult patient and concentrates on the acute and subacute presentations.     

Heliox in upper airway obstruction

The use of a helium-oxygen (heliox) mixture in patients with airway obstruction was used as early as the 1930s. Although heliox does not resolve airway obstruction, it decreases airway resistance providing time to allow other treatments to become therapeutic, and thus, possibly preventing the need for intubation and mechanical ventilation. Despite new and advanced treatment options in airway obstruction, heliox continues to be a choice for treatment. It is important for critical care nurses to understand the rationale for the use of heliox, the mechanism of action and administration of heliox. Through a case study, the authors discuss the physical properties of helium and its use in airway obstruction. Nursing management of patients receiving heliox is also reviewed.     

Proteases involved in airway inflammation of COPD

Chronic obstructive pulmonary disease(COPD) is one of major cause of morbidity and mortality worldwide. Cigarette smoking is the main risk factor for the development of COPD and causes airway inflammation and parenchymal destruction. In the pathogenesis of COPD, protease-antiprotease imbalance is considered to be one of the important processes through the study of alpha 1-antitrypsin deficiency. At present, not only neutrophil elastase but also cathepsin and matrix metalloproteinases produced by inflammatory cells are demonstrated to be important in the pathogenesis of COPD, In this review, the roles of various kinds of proteases in the airway inflammation are summarized.     

Acute upper airway obstruction

Methods for controlling the airway in a variety of clinical situations are comprehensively reviewed. Use of mechanical ventilatory support should be considered when spontaneous respiration is inadequate, but the modality chosen must be adapted to the individual patient.     

The challenge of upper airway obstruction in pediatric intensive care

Over a 5-year period, 75 patients were admitted to a pediatric intensive care unit because of acute upper airway obstruction (AUAO). Congenital abnormalities were demonstrated in 25 children; 9 of them died secondary to severe combined malformations or major central nervous system dysfunction. Acquired AUAOs were seen in 50 patients; 1 died in brain death secondary to anoxia. Obstructions were observed at all levels of the airways from the nose to the carina. In 28% of the patients, AUAO had remained undiagnosed until admission for complications such as acute respiratory failure, cardiac arrest, coma, seizures. With early diagnosis and prompt release of the obstruction the prognosis is good unless severe congenital abnormalities or major central nervous system damage are associated.     

慢性阻塞性肺疾病患者吸入氦氧混合气后肺功能改善的机制探讨

目的探讨氦氧混合气治疗慢性阻塞性肺疾病(ChronicObstructivePulmonaryDisease,COPD)的机制.方法让COPD患者测定呼吸氦氧混合气前后的最大呼气流速-容积曲线,并设对照组进行比较.结果所有受检者呼吸氦氧混合气后肺功能各数据都有不同程度的增加,但两组比较仅△FVC有显著差异(P<0.05).结论氦氧混合气可改善通气和CO2潴留,尚可能改善肺的弹性,使肺回缩,从而改善COPD患者的通气/血流失衡及弥散功能.     

Causes of airway obstruction during cuffed oropharyngeal airway use

This study investigated the cause for needing airway maneuvers to maintain a patent airway during the use of cuffed oropharyngeal airway (COPA). Twenty adult patients (29.4+/-6.8 years-old, ASA 1-2) scheduled for minor gynecological surgery who required brief manipulations of the airway despite COPA use following the manufacture's guidelines, were enrolled in this study. To obtain airway patency, 15 patients required only the head-tilt maneuver. In eight of the 15 patients, the laryngeal inlet was opened partially (n=4) or completely (n=4). Despite lifting the epiglottis, the laryngeal inlet was incomplete at the level of pharyngeal view. The patency of the laryngeal inlet was decided by the extent of the distance between the posterior pharyngeal wall and the lateral glossoepiglottic fold, which was made by hyoid bone. In the other seven patients, the head-tilt maneuver elevated the epiglottis and completely opened the laryngeal inlet. Five patients required both the jaw-thrust and head-tilt maneuver. Of these patients lifting the epiglottis was incomplete in three and the laryngeal inlet was partially collapsed in one even after the airway manipulations. The airways in these three patients, however, became patent after manipulations despite the persisting partial obstruction.     

RapidRhino herniation causing airway obstruction

Epistaxis is commonly managed with RapidRhino in emergency departments. We report a case of RapidRhino herniation during air inflation in a 99-year-old female, leading to significant airway obstruction. Upon re-inflation of the RapidRhino for persistent epistaxis, our patient suddenly developed acute respiratory distress. Throat examination revealed a large clot-like circular mass occluding the oropharynx. Initially mistaken as a massive blood clot, the mass was identified as the distal end of the RapidRhino. Immediate deflation of the RapidRhino results in spontaneous resolution of the respiratory distress. We hypothesise that the RapidRhino has herniated posteriorly into the oropharynx through excessive air inflation, potentially compounded by a product defect. Our case highlights a fatal consequence of RapidRhino application where emergency physicians should be cautious of, especially among inexperienced users.     

Managing upper airway obstruction.

A complete respiratory obstruction can lead to death in 3 minutes. The first and constant duty of the nurse aider is to check that the person is breathing by looking, listening and feeling. Partial obstruction is no less serious than complete obstruction. The nurse aider, in any situation, should assess the problem and attempt to overcome the airway obstruction using the measures described.     

人工气道阻塞的护理干预

人工气道的阻塞问题已成为当今呼吸治疗和危重症治疗中的一个重要课题,近年来国内外护理同行在此方面进行了大量的研究,以往文献对人工气道的阻塞问题报道很多,但大多仅侧重于某一方面的探讨,缺少对人工气道阻塞的原因、人工气道效能的评估和人工气道阻塞干预进行一个完整的、综合的论述。本文拟通过对当今各种文献所报道的解决人工气道内阻塞方案进行简单、综合的评述,现综述如下。造成呼吸道内阻塞的原因1.呼吸道生理功能的丧失。在自然呼吸状态时上呼吸道和额窦对吸入气体有湿化、加温的作用。所以,吸入气体在到达气管时已被水蒸气所饱和…     

Upper airway obstruction in infectious mononucleosis.

Patients with infectious mononucleosis caused by the Epstein-Barr virus frequently present to the accident and emergency department. The most common presenting symptoms are fever, fatigue, odynophagia and malaise. Although significant airway compromise is rare and occurs in an estimated 1-3.5% of cases, it may present as a potentially life-threatening situation demanding immediate intervention. We present two such cases and discuss their management.     

Upper airway obstruction in a young adult

Acute epiglottitis is a potentially rapidly fatal illness. Although commonly thought of as a disease affecting children, it is increasingly being diagnosed in adults. We report a case of upper airway obstruction due to epiglottitis in a 37-year-old female. The need for early diagnosis because of the risk of a fatal outcome is highlighted.