Subglottic Cysts: A Complication of Neonatal Endotracheal Intubation?

A 67-year-old man presented with cervical myelopathy for which a C3/4 discectomy and anterior fusion was performed. Recurrent episodes of acute upper airway obstruction necessitated laryngoscopy and endotracheal intubation. Drainage of a prevertebral collection of CSF and surgical repair of a dural tear corrected the obstructive symptoms. Management of the difficult airway is discussed.

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A predictive formula for difficult endotracheal intubation in the emergency department

10.21203/rs.3.rs-49018/v1 ◽

2020 ◽

Author(s):

En-Chih Liao ◽

Wen-Han Chang ◽

Ching-Hsiang Yu ◽

Cheng-Ying Shen ◽

Fang-Ju Sun ◽

...

Keyword(s):

Emergency Department ◽

Airway Obstruction ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Intubation ◽

Upper Airway ◽

High Body Mass Index ◽

Upper Airway Obstruction ◽

Binary Logistic Regression Model ◽

Difficult Endotracheal Intubation

Abstract Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula. Methods This was a 17-month prospective observational study. For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variable. Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p < 0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938). Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.

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Pneumothorax and Pneumomediastinum during Colonoscopy

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600313 ◽

1998 ◽

Vol 26 (3) ◽

pp. 302-304 ◽

Cited By ~ 21

Author(s):

T. Webb

Keyword(s):

Airway Obstruction ◽

Endotracheal Intubation ◽

Subcutaneous Emphysema ◽

Bowel Perforation ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Diagnostic Colonoscopy ◽

Sudden Appearance

A case of bowel perforation during diagnostic colonoscopy is reported. This resulted in the sudden appearance of massive subcutaneous emphysema of the neck, causing acute upper airway obstruction which necessitated urgent endotracheal intubation. Large bilateral pneumothoraces and pneumomediastinum were also present.

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Comparison between an upper airway obstruction score and airway endoscopy to detect airway injury associated with endotracheal intubation in children

Jornal de Pediatria ◽

10.2223/jped.1116 ◽

2003 ◽

Vol 79 (6) ◽

pp. 543-9

Author(s):

Andréa M. G. Cordeiro ◽

Daniela C. Souza ◽

Regina H. Quinzani ◽

Eduardo J. Troster

Keyword(s):

Airway Obstruction ◽

Endotracheal Intubation ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Airway Injury

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The Aerodigestive Clinic: Multidisciplinary Management of Pediatric Dysphagia

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd17.3.101 ◽

2008 ◽

Vol 17 (3) ◽

pp. 101-109 ◽

Cited By ~ 1

Author(s):

Laura Haibeck ◽

David L. Mandell

Keyword(s):

Young Children ◽

Airway Obstruction ◽

Multidisciplinary Approach ◽

Laryngopharyngeal Reflux ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Pediatric Airway ◽

Common Causes ◽

The Individual ◽

The Relationship

Abstract The purposes of this article are (a) to explore the relationship between pediatric upper airway obstruction and dysphagia and (b) to highlight the benefits of using a multidisciplinary approach when assessing infants and children with upper respiratory and swallowing disorders. The functions of breathing and swallowing are tightly coordinated in infants and young children, and pediatric upper airway disorders can often adversely affect the swallowing mechanism and may even predispose the individual to aspiration. Some of the more common causes of pediatric airway obstruction seen in this setting are laryngomalacia, vocal fold paralysis, laryngeal cleft, and Pierre Robin's sequence. In the setting of all of these disorders, associations may also exist with gastroesophageal reflux (GER) and laryngopharyngeal reflux, and this topic is also reviewed. In the multidisciplinary assessment of young children with aerodigestive disorders, fiberoptic flexible endoscopic evaluation of swallowing has gained traction as a useful test for simultaneous evaluation of pediatric upper airway obstruction and dysphagia and has provided complimentary information to the more traditional pediatric videofluoroscopic swallowing evaluation. A representative case study is provided that illustrates the relationship between pediatric upper airway obstruction and dysphagia and demonstrates the effectiveness of a multidisciplinary approach.

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Endotracheal intubation-induced upper airway obstruction

Heart & Lung ◽

10.1016/s0147-9563(96)80015-x ◽

1996 ◽

Vol 25 (1) ◽

pp. 69-71 ◽

Cited By ~ 4

Author(s):

Martin E. Warshawsky ◽

Harvey M. Shanies ◽

Madhu Dharawat ◽

Sabina Grochowski

Keyword(s):

Airway Obstruction ◽

Endotracheal Intubation ◽

Upper Airway ◽

Upper Airway Obstruction

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The relationship between partial upper-airway obstruction and inter-breath transition period during sleep

Respiratory Physiology & Neurobiology ◽

10.1016/j.resp.2017.06.006 ◽

2017 ◽

Vol 244 ◽

pp. 32-40

Author(s):

Dwayne L. Mann ◽

Bradley A. Edwards ◽

Simon A. Joosten ◽

Garun S. Hamilton ◽

Shane Landry ◽

...

Keyword(s):

Airway Obstruction ◽

Transition Period ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Partial Upper Airway Obstruction ◽

The Relationship

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Management of upper airway obstruction in Pierre Robin sequence

The Journal of Laryngology & Otology ◽

10.1017/s0022215100139581 ◽

1997 ◽

Vol 111 (12) ◽

pp. 1155-1156 ◽

Cited By ~ 40

Author(s):

A. P. Bath ◽

P. D. Bull

Keyword(s):

Airway Obstruction ◽

Surgical Intervention ◽

Neonatal Period ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Pierre Robin Sequence ◽

Severe Respiratory Distress ◽

Feeding Difficulties ◽

Robin Sequence ◽

Pierre Robin

AbstractPierre Robin sequence (PRS) presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress. This is potentially fatal and surgical intervention in these cases is necessary. We present our series of cases with severe PRS requiring surgical relief of their airway obstruction, and the reasons for preferring tracheostomy over glossopexy.

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Predictors of diﬃcult endotracheal intubation in the emergency department: a single-center pilot study

10.22514/sv.2020.16.0118 ◽

2020 ◽

Keyword(s):

Emergency Department ◽

Tracheal Intubation ◽

Airway Obstruction ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Upper Airway ◽

Difficult Tracheal Intubation ◽

Upper Airway Obstruction ◽

Cutoff Score ◽

Difficult Endotracheal Intubation

Background: Identifying patients who are at risk of difficult endotracheal intubation is crucial in the emergency department. Therefore, this study evaluated the incidence and predictive factors of difficult tracheal intubation in the emergency department. Methods: This was a 17-month prospective observational study. A difficult airway was defined as Cormack & Lehane classification grades III and IV at the first attempt of intubation. Patients who visited the emergency department, underwent traditional endotracheal intubation from participating physicians, and provided informed consent by themselves or via their delegates were enrolled in this study. Univariate associations between patient characteristics and difficult endotracheal intubation were identified, and statistically significant factors were included in a multivariate binary logistic regression model. A generalized association plot was used to show the relationships between variables. Results: A total of 110 patients were enrolled in the study. The incidence of difficult intubation was 35.5% (39/110). In the difficult airway group, significantly higher body mass index (BMI), and incidence of double chin, thick short neck, Mallampati difficulty, small interincisor distance, small thyromental distance, and upper airway obstruction were noted on univariate analysis. A predictive formula for difficult tracheal intubation was successfully established by the combination of four independent predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cutoff score of four maximized Youden’s index, providing sensitivity (79.5%) and specificity (81.7%) (95% CI: 0.794 to 0.938). Conclusions: We used four predictors of difficult tracheal intubation, namely, BMI, thyromental distance, upper airway obstruction, and Mallampati difficulty, to create a predictive formula. This formula could help emergency physicians to quickly identify and carefully manage patients with difficult endotracheal intubation and consult experts early if necessary.

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A Predictive Formula for Difficult Endotracheal Intubation in the Emergency Department

10.21203/rs.3.rs-47509/v1 ◽

2020 ◽

Author(s):

En-Chih Liao ◽

Wen-Han Chang ◽

Ching-Hsiang Yu ◽

Cheng-Ying Shen ◽

Fang-Ju Sun ◽

...

Keyword(s):

Emergency Department ◽

Airway Obstruction ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Intubation ◽

Upper Airway ◽

High Body Mass Index ◽

Upper Airway Obstruction ◽

Binary Logistic Regression Model ◽

Difficult Endotracheal Intubation

Abstract Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula.Methods For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variables.Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p<0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR]=1.270), thyromental distance (OR=0.614), upper airway obstruction (OR=4.038), and Mallampati difficulty (OR=5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938).Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.Trial registration This 17-month (2011/11/1-2013/3/31) prospective observational study was approved by the Institutional Review Board of MacKay Memorial Hospital (11MMHISO64).

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