Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure

Sleep disordered breathing (SDB) may occur in a variety of ways. While obstructive sleep apnea is the most common of these, this chapter reviews the most common types of SDB that occur independently of upper airway obstruction. In many cases, there is concurrent upper airway obstruction and neurological respiratory dysregulation. Thus, along with attempts to correct the underlying etiologies (when present), stabilization of the upper airway is most often combined with flow generators (noninvasive positive pressure ventilation devices) that modulate the inadequate ventilatory pattern. Among these devices, when continuous positive airway pressure (CPAP) alone does not allow correction of SDB, adaptive servo-ventilation (ASV) is increasingly used for non-hypercapnic types of central sleep apnea (CSA), while bilevel PAP in spontaneous-timed mode (BPAP-ST) is more often reserved for hypercapnic CSA/alveolar hypoventilation syndromes. Coordination of care among neurologists, cardiologists, and sleep specialists will often benefit such patients.

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Pulmonary Edema following Relief of Acute Upper Airway Obstruction

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948008900206 ◽

1980 ◽

Vol 89 (2) ◽

pp. 124-128 ◽

Cited By ~ 45

Author(s):

Antonio G. Galvis ◽

Sylvan E. Stool ◽

Charles D. Bluestone

Keyword(s):

Airway Obstruction ◽

Pulmonary Edema ◽

Venous Return ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Acute Pulmonary Edema ◽

Positive Pressure ◽

Sudden Increase ◽

Artificial Airway ◽

Continuous Positive Pressure

Five children, aged one to five years, with severe upper airway obstruction, three of whom had epiglottitis and two of whom had laryngotracheobronchitis, developed acute pulmonary edema after the obstruction had been relieved by placement of an artificial airway. Although major physiologic changes, such as hypoxemia and massive sympathetic discharge, play a significant role in the development of acute pulmonary edema, we have postulated a possible etiological cause for the development of pulmonary edema in these children which involves a series of physiologic events. The generation of very high transpulmonary pressure gradients during inspiration is opposed by a decreased venous return due to the obstruction during exhalation. Airway pressures then fall abruptly with the insertion of the artificial airway, resulting in a sudden increase in venous return to the central circulation and marked increase in the intravascular hydrostatic pressures. The final result of this series of events is the development of pulmonary hyperemia and edema. The prevention of this situation must begin the moment the airway is inserted and involves the application of moderate amounts of continuous positive pressure to the airway, thus allowing time for circulatory adaption to take place.

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Airway management

Emergencies in Respiratory Medicine ◽

10.1093/med/9780199202447.003.0042 ◽

2007 ◽

pp. 259-266

Keyword(s):

Tracheal Intubation ◽

Respiratory Tract ◽

Airway Management ◽

Airway Obstruction ◽

Failure Rate ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Positive Pressure ◽

High Failure Rate ◽

Advanced Airway

Aims of airway management 260 Upper airway obstruction 260 Airway manoeuvres 261 Ventilation 266 • To relieve upper airway obstruction. • To facilitate positive pressure ventilation. • To protect respiratory tract from aspiration of gastric contents. Upper airway obstruction is a commonly encountered emergency and is often relieved by simple basic airway manoeuvres. Although many patients will go on to require more advanced management (e.g. tracheal intubation), such procedures carry a high failure rate and should not be performed by inexperienced practitioners. However, it is still useful to have a good knowledge about advanced airway manoeuvres as it enables the non-anaesthetist to prepare some of the equipment needed and to assist during the procedure once expert help has arrived....

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