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White JJ, Cambron JD, Gottlieb M, Long B. Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting. J Emerg Med 2023; 64:145-155. [PMID: 36806432 DOI: 10.1016/j.jemermed.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department. OBJECTIVE This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician. DISCUSSION Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered. CONCLUSIONS An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.
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Affiliation(s)
- Joshua J White
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - John D Cambron
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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2
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Ali Akbari Ghavimi S, Gehret PM, Aronson MR, Schipani R, Smith KW, Borek RC, Germiller JA, Jacobs IN, Zur KB, Gottardi R. Drug delivery to the pediatric upper airway. Adv Drug Deliv Rev 2021; 174:168-189. [PMID: 33845038 DOI: 10.1016/j.addr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
Pediatric upper airway disorders are frequently life-threatening and require precise assessment and intervention. Targeting these pathologies remains a challenge for clinicians due to the high complexity of pediatric upper airway anatomy and numerous potential etiologies; the most common treatments include systemic delivery of high dose steroids and antibiotics or complex and invasive surgeries. Furthermore, the majority of innovative airway management technologies are only designed and tested for adults, limiting their widespread implementation in the pediatric population. Here, we provide a comprehensive review of the most recent challenges of managing common pediatric upper airway disorders, describe the limitations of current clinical treatments, and elaborate on how to circumvent those limitations via local controlled drug delivery. Furthermore, we propose future advancements in the field of drug-eluting technologies to improve pediatric upper airway management outcomes.
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3
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Wen SH, Lin L, Yu G, Xu CF, Zhang HL, Zheng YM. Pseudomembranous laryngotracheobronchitis due to coinfection with human bocavirus 1 and Mycoplasma pneumoniae: a case report. Transl Pediatr 2021; 10:673-678. [PMID: 33880337 PMCID: PMC8041609 DOI: 10.21037/tp-20-278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pseudomembranous laryngotracheobronchitis is rarely reported yet potentially life-threatening infectious cause of airway obstruction in children. The causative organisms of this condition are often considered to promote bacterial superinfection following viral infection. We report a case of pseudomembranous laryngotracheobronchitis in a patient caused by human bocavirus 1 and Mycoplasma pneumoniae (M. pneumoniae). A 2-year-old child was admitted to our hospital presenting with cough, hoarseness, and labored breathing. Computed tomography of the chest revealed atelectasis of the right middle lobe of the lung with bronchostenosis and occlusion. Laryngeal edema, pseudomembrane formation and ulceration of the trachea were found during bronchoscopy. Chronic inflammation of the mucosa and local cellulose exudation with acute and chronic inflammatory cell infiltration were confirmed by hematoxylin-eosin staining. Human bocavirus 1 and M. pneumoniae were detected in the bronchoalveolar lavage fluid by next-generation sequencing. The patient tested positive for IgM antibodies against M. pneumoniae. Bronchoscopy was performed three times to clear the secretions in the airway, and azithromycin, ceftriaxone, methylprednisolone, budesonide inhalation, and ambroxol were administered as treatment. The patient's condition improved and she was discharged 21 days after admission. Clinicians should be aware of the potential involvement of human bocavirus 1 and M. pneumoniae in pseudomembranous laryngotracheobronchitis for accurate diagnosis and timely antibiotic administration, and to lower mortality and morbidity rates.
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Affiliation(s)
- Shun-Hang Wen
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Li Lin
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Gang Yu
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chang-Fu Xu
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hai-Lin Zhang
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yang-Ming Zheng
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134700. [PMID: 32629891 PMCID: PMC7369691 DOI: 10.3390/ijerph17134700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022]
Abstract
(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: “foreign body aspiration,” “infant choking, 1.5 to 3 years,” “food and foreign body aspiration,” “common household,” “prevention of foreign body aspiration,” “guidelines,” “recommendations,” “training of caregivers (parents, educators),” “resuscitation,” “Heimlich maneuver,” and “disengagement of the upper airways.” We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications.
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5
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Abstract
Shortness of breath and wheezing are common presenting signs for children in the emergency department. In adolescence, it is often due to asthma or lower respiratory tract infections. We present a rare pediatric case of an adolescent with biphasic stridor and progressive exercise-induced shortness of breath who was found to have severe idiopathic subglottic stenosis.
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6
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Wu X, Wu L, Chen Z, Zhou Y. Fatal choking in infants and children treated in a pediatric intensive care unit: A 7- year experience. Int J Pediatr Otorhinolaryngol 2018; 110:67-69. [PMID: 29859591 DOI: 10.1016/j.ijporl.2018.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Foreign bodies aspiration can lead to significant morbidity, few have examined in detail the deaths resulting from foreign bodies aspiration. METHODS We conducted a review of children who presented to the pediatric intensive care unit of a university hospital due to fatal foreign bodies aspiration during the period of 2010-2017. RESULT Of the 28 patients, 17 (61%) patients were male and 11 (39%) were female. The range of age was 1-63 months, with mean of 15.2 months. The common foreign bodies included milk, nuts and fruits. Majority of them had round shapes. All the patients died due to asphyxia or serious complications after foreign bodies aspiration. CONCLUSIONS Prevention and early recognition remains a critical factor to reduce the mortality of foreign bodies aspiration.
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Affiliation(s)
- Xiling Wu
- Department of Pulmonology, Child's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
| | - Lei Wu
- Department of Pulmonology, Child's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
| | - Zhimin Chen
- Department of Pulmonology, Child's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
| | - Yunlian Zhou
- Department of Pulmonology, Child's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
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Elliott AC, Williamson GR. A Systematic Review and Comprehensive Critical Analysis Examining the Use of Prednisolone for the Treatment of Mild to Moderate Croup. Open Nurs J 2018; 11:241-261. [PMID: 29290883 PMCID: PMC5738747 DOI: 10.2174/1874434601711010241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/25/2017] [Accepted: 11/10/2017] [Indexed: 12/04/2022] Open
Abstract
Background: Many randomised control trials and systematic reviews have examined the benefits of glucocorticoids for the treatment of croup in children, but they have reported mainly on dexamethasone as an oral treatment for croup. No systematic reviews have examined prednisolone alone. Aim: To determine in a systematic review of the literature whether a single dose of oral prednisolone is as effective as a single dose of dexamethasone for reducing croup symptoms in children. Search Strategy: A detailed search was conducted on the following databases: CINAHL, MEDLINE EBSCO, MEDLINE, OVID, PubMed, The Cochrane Library, ProQuest, EMBASE, JBI, Sum search, and OpenGrey. Study authors were contacted. Selection Criteria: Randomised Controlled Trials, clinical trials or chart reviews which examined children with croup who were treated with prednisolone alone, or when prednisolone was compared to a dexamethasone treatment and the effectiveness of the intervention was objectively measured using croup scores and re-attendance as primary outcomes. Data Collection and Analysis: Following PRISMA guidelines for systematic reviews, relevant studies were identified. Scores were graded agreed by two independent reviewers using QualSyst. Main Results: Four studies met the inclusion criteria, but were too heterogeneous to combine in statistical meta-analysis. The result suggests that although prednisolone appears as effective as dexamethasone when first given, it is less so for preventing re-presentation. Trial sample sizes were small, making firm conclusions difficult, however, a second dose of prednisolone the following day may be useful. More research including cost-benefit analysis is needed to examine the efficacy of prednisolone compared to dexamethasone.
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Affiliation(s)
- Anna Catherine Elliott
- Meneage Street Surgery, 100 Meneage Street, Helston, Cornwall TR17, 8RF, UK, 01326 555288
| | - Graham R Williamson
- Adult Nursing, School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth, PL4 8AA. UK, 07976761858
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8
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Cronjé L. Bardet–Biedl syndrome: expect the unexpected, suspect the unsuspected. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1379719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Larissa Cronjé
- Perioperative Research Group, Department of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, King Edward VIII Hospital, Durban, South Africa
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9
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Kens OV, Gnateyko OZ, Lukyanenko NS, Vishtak NV, Bergtravm VI. Analysis of molecular genetic study on the polymorphic C-159T locus of the CD14 gene in children with increased risk of recurrent episodes of acute obstructive bronchitis. CYTOL GENET+ 2017. [DOI: 10.3103/s0095452717050036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Stenosierende Laryngitis im Kindesalter. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Gencpinar P, Duman M. Importance of back blow maneuvers in a 6 month old patient with sudden upper airway obstruction. Turk J Emerg Med 2016; 15:177-8. [PMID: 27239623 PMCID: PMC4882197 DOI: 10.1016/j.tjem.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 07/15/2013] [Accepted: 07/07/2014] [Indexed: 12/01/2022] Open
Abstract
Foreign body aspiration in children under four years old is one of the most frequently observed reasons for accident related deaths. It is more common in this age group due to inadequate swallowing functions and exploration of objects with the mouth. The most frequently encountered foreign bodies are food and toy parts. Life threatening complete laryngeal obstruction is rarely observed. Dyspnea, hypersalivation, cough and cyanosis can be seen. The basic and life-saving treatment approach is complete removal of foreign body maneuvers in the sudden onset of total obstruction. Here we report a six-month old male, who ingested a foreign body and was treated with back blow maneuvers successfully. In this case we emphasized the importance of back blow maneuvers.
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Affiliation(s)
- Pinar Gencpinar
- Akdeniz University, Department of Pediatric Neurology, Antalya, Turkey
| | - Murat Duman
- Dokuz Eylul University, Department of Pediatric Emergency Care, Izmir, Turkey
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12
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Abstract
Stridor is a variably pitched respiratory sound, caused by abnormal air passage during breathing and often is the most prominent sign of upper airway obstruction. It is usually heard on inspiration (typically resulting from supraglottic or glottic obstruction) but also can occur on expiration (originating from obstruction at or below glottic level and/or severe upper airway obstruction). Stridor due to congenital anomalies may exist from birth or may develop within days, weeks or months. Various congenital and acquired disorders prevail in neonates, infants, children, and adolescents, and have to be distinguished. History, age of the child and physical examination together often allow a presumptive diagnosis. Further investigations may be necessary to establish a definite diagnosis, and flexible airway endoscopy is the diagnostic procedure of choice in most circumstances ("stridor is visible").
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Affiliation(s)
- Andreas Pfleger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria.
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13
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Bu R, Price H, Mitran S, Zdanski C, Oldenburg AL. Swept-Source Anatomic Optical Coherence Elastography of Porcine Trachea. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9689:968923. [PMID: 27746580 PMCID: PMC5061295 DOI: 10.1117/12.2213186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Quantitative endoscopic imaging is at the vanguard of novel techniques in the assessment upper airway obstruction. Anatomic optical coherence tomography (aOCT) has the potential to provide the geometry of the airway lumen with high-resolution and in 4 dimensions. By coupling aOCT with measurements of pressure, optical coherence elastography (OCE) can be performed to characterize airway wall stiffness. This can aid in identifying regions of dynamic collapse as well as informing computational fluid dynamics modeling to aid in surgical decision-making. Toward this end, here we report on an anatomic optical coherence tomography (aOCT) system powered by a wavelength-swept laser source. The system employs a fiber-optic catheter with outer diameter of 0.82 mm deployed via the bore of a commercial, flexible bronchoscope. Helical scans are performed to measure the airway geometry and to quantify the cross-sectional-area (CSA) of the airway. We report on a preliminary validation of aOCT for elastography, in which aOCT-derived CSA was obtained as a function of pressure to estimate airway wall compliance. Experiments performed on a Latex rubber tube resulted in a compliance measurement of 0.68±0.02 mm2/cmH2O, with R2=0.98 over the pressure range from 10 to 40 cmH2O. Next, ex vivo porcine trachea was studied, resulting in a measured compliance from 1.06±0.12 to 3.34±0.44 mm2/cmH2O, (R2>0.81). The linearity of the data confirms the elastic nature of the airway. The compliance values are within the same order-of-magnitude as previous measurements of human upper airways, suggesting that this system is capable of assessing airway wall compliance in future human studies.
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Affiliation(s)
- Ruofei Bu
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina, USA, 27599
| | - Hillel Price
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, North Carolina, USA, 27599
| | - Sorin Mitran
- Department of Mathematics, University of North Carolina at Chapel Hill, North Carolina, USA, 27599
| | - Carlton Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA, 27599
| | - Amy L Oldenburg
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina, USA, 27599; Department of Physics and Astronomy, University of North Carolina at Chapel Hill, North Carolina, USA, 27599; Biomedical Research Imaging Center; University of North Carolina at Chapel Hill, North Carolina, USA, 27599
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14
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Hyland EJ, Harvey JG, Martin AJP, Holland AJA. Airway compromise in children with anterior neck burns: Beware the scalded child. J Paediatr Child Health 2015; 51:976-81. [PMID: 25939573 DOI: 10.1111/jpc.12912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of the study was to describe characteristics of children with anterior neck burns admitted to our Paediatric Intensive Care Unit (PICU) and to highlight potential airway complications associated with these injuries, especially in children with scalds. METHODS Retrospective review of children with anterior neck burns requiring admission to PICU January 2004-December 2013. RESULTS Fifty-two children with anterior neck burns were admitted; average age 6.6 years. Thirty sustained flame/explosion injuries; 22 scalds. Seventy-nine per cent were male. Mean total body surface area (TBSA) burn 21%. Forty-seven were intubated. Some primary reasons for intubation included unconsciousness, inhalational/ingestion/direct airway injury and large TBSA. Majority, however, required intubation for airway complications secondary to subcutaneous/soft tissue anterior neck oedema not associated with airway injury/ingestion/inhalational burns. The scalds subgroup mean age was 2.3 years. Eighty-two per cent were male. Mean TBSA 18%. There were no inhalational/ingestion/airway injuries. Nineteen children were intubated; average 9.3 h post-injury. Majority (63%) were intubated post-arrival in the Burn Unit, compared with flame/explosion group (32%). Primary reasons for intubation included large burns, although majority (74%) required intubation for airway complications secondary to subcutaneous and soft tissue anterior neck oedema. For the flame/explosion group this was the case in only 46%, with other primary reasons such as unconsciousness or inhalational injury being the immediate precedent. CONCLUSION These results demonstrate that subcutaneous and soft tissue oedema secondary to anterior neck burns may contribute to airway narrowing and compromise requiring intubation. When assessing children's airways, evolving oedema should be recognised and higher observation or early intubation considered regardless of the mechanism of injury.
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Affiliation(s)
- Ela J Hyland
- The Children's Hospital's Burns Research Institute and the Department of Anaesthesia, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - John G Harvey
- The Children's Hospital's Burns Research Institute and the Department of Anaesthesia, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J P Martin
- The Children's Hospital's Burns Research Institute and the Department of Anaesthesia, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- The Children's Hospital's Burns Research Institute and the Department of Anaesthesia, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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15
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Pfleger A, Eber E. [Infectious upper airway obstruction]. ACTA ACUST UNITED AC 2015; 50:53-56. [PMID: 32287398 PMCID: PMC7101730 DOI: 10.1007/s00608-015-0240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infektiöse Erkrankungen der oberen Luftwege können besonders beim Säugling und Kleinkind zum Notfall mit partieller bis kompletter Luftwegsobstruktion und respiratorischer Insuffizienz führen. Sie erfordern ein besonnenes, ruhiges Vorgehen, manchmal aber auch ein rasches Eingreifen des erstversorgenden Mediziners. Fragen nach dem Symptombeginn, begleitender Rhinitis und Fieber sowie eine orientierende Anamnese zu möglicherweise bereits bekannten Atemwegsproblemen seit der Geburt oder in den ersten Wochen danach (z. B. kongenitale Malformationen von Larynx oder Trachea) und eine sorgfältige Beobachtung zur Einschätzung des Ausmaßes der Atemnot und Zuordnung des Atemgeräuschs zu den Atemphasen stehen am Beginn jeder Untersuchung. Die systemische Applikation von Steroiden und Inhalation von Epinephrin (Adrenalin) sind Standard bei der viralen Laryngotracheobronchitis, der häufigsten infektiösen Luftwegserkrankung mit oberer Luftwegsobstruktion. Seltene Differenzialdiagnosen wie die bakterielle Tracheitis, der Retro- und Parapharyngealabszess oder die Epiglottitis erfordern ein spezielles Management.
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Affiliation(s)
- A Pfleger
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - E Eber
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
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16
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Abstract
On the basis of research evidence, (1)(2) numerous diseases and conditions can impair gas exchange, resulting in failure to meet the body's metabolic demands and leading to respiratory failure. On the basis of consensus, (1)(2)(7)(8)(9)(10) the clinical presentations of respiratory failure depend on the underlying cause and the level of hypoxemia and hypercapnia. Early diagnosis, close monitoring, and timely intervention are of utmost importance. On the basis of research evidence, (5)(14)(25) interventions range from noninvasive methods, such as close monitoring and supplemental oxygen, to full respiratory support with mechanical ventilation and in extreme cases even the use of extracorporeal membrane oxygenation.
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Affiliation(s)
- Phuong Vo
- Division of Pediatric Pulmonary and Allergy, Boston Medical Center, Boston, MA
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17
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Mieritz HB, Kühne JP. Complete airway obstruction in an infant caused by a toy balloon. Emerg Med Australas 2014; 26:310-1. [DOI: 10.1111/1742-6723.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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