Acute upper airway obstruction

Acute airway closure may occur upon extubation as the result of airway edema, laryngospasm, or failure of vocal cord adduction. If no air leak can be detected on deflation of the endotracheal tube cuff or the patient has sustained airway or neck trauma during or before intubation, this may be seen. Intraoperative injury to the recurrent laryngeal nerve or mechanical compression from a cervical hematoma may also be responsible.

Nebulized racemic epinephrine (adrenaline) induces vasoconstriction and decreases mucosal edema, and is useful for non-operative obstruction. Corticosteroids also may reduce laryngeal edema, although there is no role for the routine use of steroids to prevent postextubation laryngeal edema.

A helium-oxygen mixture can be used as a temporizing measure in the management of upper airway obstruction. A mixture of 80 per cent helium and 20 per cent oxygen has a density one-third that of air. The reduced density decreases airway resistance and flow resistive work, providing time for definitive therapy. In cases of rapid respiratory failure, surgical control of the airway is required. Cricothyroidotomy may be performed under emergent conditions; it is quicker than a tracheostomy, can be carried out by non-surgical personnel, and has a lower general complication rate than emergent tracheostomy.

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