Case Of Upper Airway Obstruction Research Articles

Therapeutic effects of endoscopic posterior cordotomy for bilateral vocal cord paralysis

Objective: To evaluate the efficacy of the endoscopic bilateral posterior transverse partial cordotomy in patients with upper airway obstruction due to bilateral vocal fold paralysis. Methods: A retrospective analysis of 48 cases of upper airway obstruction due to bilateral vocal fold paralysis, who were admitted to Department of Otolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital from July 2009 to July 2019, was performed, including 13 males and 35 females. Patients' ages ranged from 27 to 83 years old. All patients underwent bilateral vocal fold posterior resection. Results: Among the 48 patients, 1 patient was lost to follow-up, and the remaining 47 patients were followed up for 5 months to 10 years . None of the 47 patients had a recurrence or severe complications. 89.58% (43/48) patients reconstructed a reliable and effective airway and 88.89% (40/45) patients were decannulated in 1-3 months postoperatively, with the median decannulation time of 1 month. Recovery rate of swallowing function and satisfactory pronunciation were 97.92% (47/48) and 95.35% (41/43) respectively. Conclusions: Endoscopic bilateral posterior transverse partial cordotomy can establish a reliable and effective airway and maximize the protection of swallowing and voice functions. At the same time, it is a safe, reliable, simple and minimally invasive treatment option.

Postobstructive pulmonary edema: A fatal complication in suicidal near-hanging

Postobstructive pulmonary edema is a life-threatening complication that occurs after the removal of severe upper airway obstruction. Development of postobstructive pulmonary edema has been described after several cases of upper airway obstruction. However, postobstructive pulmonary edema developing after non-lethal hanging has not been reported widely in the literature. Herein, we describe a fatal case of postobstructive pulmonary edema in a 10-year-old girl, which was brought to the hospital with history of attempted suicide by hanging. At presentation, the girl was breathing laboriously. The oxygen saturation was of 82% and pulmonary auscultation revealed bilateral and diffuse crepitations. The chest computed tomographic scan showed bilateral diffuse infiltrates consistent with pulmonary edema. After 3 days of hospitalization, the respiratory state of the girl worsened leading to death despite intensive care. An autopsy was conducted and confirmed the diffuse pulmonary edema. Hence, this case confirms that delayed death in near hanging may occur. Pulmonary edema which develops subsequently in such patients is an uncommon mechanism of death that physicians should consider in emergency room.

ACUTE AIRWAY OBSTRUCTION DUE TO CERVICAL GOITER IN A POST-OPERATIVE PATIENT

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Benign cervical goiter, though very common, is a rare cause of upper airway obstruction. In most cases there is a significant retrosternal extension of the goiter that leads to chronic respiratory failure. Here we present a case of upper airway obstruction due to a cervical goiter causing acute respiratory failure in a post-operative patient. CASE PRESENTATION: A 67-year-old woman with a past medical history of diabetes, hypertension, coronary artery disease and hypothyroidism presented to our facility with palpitations and shortness of breath. She underwent extensive evaluation including cardiac catheterization, which showed triple vessel disease. She was subsequently referred for coronary artery bypass grafting. On the second postoperative day, the patient developed sudden onset of shortness of breath and complained of feeling like her throat was closing. She was intubated for acute respiratory failure and placed on mechanical ventilation. Extubation was attempted twice in the post-operative period, but on both occasions, she relapsed into hypercarbic respiratory failure shortly after withdrawal of the endotracheal tube. After a prolonged period of intubation, she was referred for tracheostomy. She eventually required a subtotal thyroid resection before the trachea could be accessed. She was discharged with the tracheostomy in place DISCUSSION: Our patient had multiple comorbid conditions, underwent a major surgical procedure and received analgesic medications with sedative properties. These elements taxed her physiological reserve. She was therefore unable to maintain the same respiratory effort and could no longer overcome the resistance caused by airway narrowing due to the goiter. After prolonged intubation and failed attempts at extubation, tracheostomy was felt necessary. Benign goiters are very common, but do not often lead to upper airway obstruction. However, in critically ill or in post-operative patients, they can have significant influence on the prognosis. The presence of a large cervical goiter should be viewed as a risk factor for upper airway obstruction during the post-operative period. CONCLUSIONS: Acute respiratory failure due to benign cervical goiter is uncommon. However, in post-operative or critically ill patients, it should be factored as a potential cause of respiratory failure and considered during the pre-operative assessment. Reference #1: Bayhan Z, Zeren S, Ucar BI, et al. Emergency thyroidectomy: Due to acute respiratory failure. Int J Surg Case Rep. 2014;5(12):1251-3. Reference #2: White ML, Doherty GM, Gauger PG. Evidence-based surgical management of substernal goiter. World J Surg. 2008;32(7):1285-300. Reference #3: Ito T, Shingu K, Maeda C, et al. Acute airway obstruction due to benign asymptomatic nodular goiter in the cervical region: A case report. Oncol Lett. 2015;10(3):1453-1455. DISCLOSURES: No relevant relationships by Israel Acosta Sanchez, source=Web Response no disclosure on file for Ali Ashraf; No relevant relationships by Anthony Chahin, source=Web Response No relevant relationships by Jovan Gayle, source=Web Response No relevant relationships by Relin Yang, source=Web Response

Retropharyngeal Hematoma Secondary to Minor Blunt Trauma Neck: A Rare Case Report

Introduction
 Traumatic retropharyngeal hematoma is rare, but can be lethal, if not identified and managed promptly. It isclinically important because of the close proximity of the retropharyngeal space to the upper airway.
 Case report
 A case of upper airway obstruction in a 75 year old man due to a large retropharyngeal hematoma following minor injury to neckis presented.Progressive dysphagia, hoarseness and dyspnoea developed over time. Emergency tracheostomy and subsequent surgical drainage was performed.
 Conclusion
 Retropharyngeal hematoma is a rare but potentially lethal problem that can be faced in an emergency department. Clinicians should be alert to the potential occurrence of this cause of acute or delayed airway collapse. Thus, an awareness of the possibility of airway obstruction secondary to massive hematoma formation after an asymptomatic interval is needed.

ABSTRACT 463

Background and aims: Paediatric extubation failure, defined as need for re-intubation within 24–72 hours is multifactorial and factors helpful for predicting extubation failure in adults generally are not useful. Aims: We undertook the study with the aim to see factors associated with this and thereby to facilitate prediction of extubation failure. Methods: After ethics committee approval, all consecutive newborns, infants and children <12 years of age, admitted to PICU and NICU remained on ventilator for >12 hours, were included and prospectively followed up till they were extubated. Cases of upper airway obstruction, neuromuscular disorders, anatomic malformations, accidental extubation, tracheostomy or death before extubation were excluded. Results: Data collected for 92 ventilated patients, 64 were extubated following application of 30 minutes spontaneous breathing trial (SBT) using PEEP and pressure support delivered through the ventilator. 16 (25%) patients failed extubation. Extubation following SBT has sensitivity 72%, and PPV 75% over extubation following clinical decision (p=0.4237). 7 patients failed SBT and subsequently failed extubation. Extubation following successful SBT has sensitivity 87%, specificity 100%, PPV 100%, positive likelihood ratio of 49 over extubation following failed SBT (p=0.0001) in predicting successful extubation.Table: No title available.Conclusions: 30 minutes SBT is a simple and reliable predictor of extubation success in paediatric and neonatal intensive care unit.

頭頸部外傷後の咽頭後間隙血腫により上気道狭窄を来した2例

頭頸部外傷後の咽頭後間隙血腫により上気道狭窄を来した2例

Temporary Tracheostomy

Upper airway obstruction can be due to a variety of causes in small animal patients and is often life threatening if left untreated. Placement of a temporary tracheostomy tube may be necessary in the most severe cases of upper airway obstruction until definitive therapy can be implemented. This paper discusses the indications, technique for placement, maintenance, and complications associated with temporary tracheostomy in dogs and cats.

頸椎後方固定術後に上気道閉塞をきたした3症例

頸椎後方固定術後に上気道閉塞をきたした3症例

A case of upper airway obstruction caused by retropharyngeal hematoma afrer central spinal cord injury

A case of upper airway obstruction caused by retropharyngeal hematoma afrer central spinal cord injury

Nasopharyngeal Tuberculosis in a Patient Presenting With Upper Airway Obstruction

Objective: &nbsp;To report a rare case of upper airway obstruction from multiple pharyngeal masses due to nasopharyngeal tuberculosis in a 22-year-old male. Methods: Design:&nbsp; Case Report Setting:&nbsp; Tertiary Government Hospital Patient: &nbsp;One &nbsp; Result: A 22-year-old Filipino male with upper airway obstruction from multiple pharyngeal masses was diagnosed to have nasopharyngeal tuberculosis by histopathology. He improved after six months of anti-tuberculosis medications. Conclusion: Tuberculosis should not be overlooked in the differential diagnoses of nasopharyngeal masses because of the difference in its management, and swift and adequate cure, compared to other nasopharyngeal pathologies. Keywords:&nbsp; tuberculosis, nasopharynx, mycobacteria, hypopharyngeal mass, upper airway obstruction

Nasopharyngeal Tuberculosis in a Patient Presenting With Upper Airway Obstruction

Objective: To report a rare case of upper airway obstruction from multiple pharyngeal masses due to nasopharyngeal tuberculosis in a 22-year-old male.&#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Hospital&#x0D; Patient: One&#x0D; &#x0D; Result: A 22-year-old Filipino male with upper airway obstruction from multiple pharyngeal masses was diagnosed to have nasopharyngeal tuberculosis by histopathology. He improved after six months of anti-tuberculosis medications.&#x0D; Conclusion: Tuberculosis should not be overlooked in the differential diagnoses of nasopharyngeal masses because of the difference in its management, and swift and adequate cure, compared to other nasopharyngeal pathologies.&#x0D; Keywords: tuberculosis, nasopharynx, mycobacteria, hypopharyngeal mass, upper airway obstruction

Upper Airway Compromise by Extravasated Fluid: A Rare Complication After Arthroscopic Repair of Atrophic Cuff Tear

During arthroscopic procedures, leakage of irrigation fluid into surrounding tissue planes is a frequently noticed phenomenon usually clinically asymptomatic and resolving within 12 hours postoperatively. Although rare, this fluid may produce life-threatening complications such as airway compromise. This article describes a case of upper airway obstruction in a 60-year-old man undergoing arthroscopic repair for an atrophic rotator cuff tear. The patient presented with a 6-month history of pain and weakness in the left shoulder. Magnetic resonance imaging studies revealed a massive rotator cuff tear with significant retraction and fatty degeneration of cuff musculature. Perioperatively, all vital cardiorespiratory parameters were within normal limits. Postoperatively, immediately on extubation, he was dyspneic, and examination revealed a diffuse swelling extending from the left shoulder up to the neck and face. He was reintubated and sent to the recovery room, where he recovered 12 hours later. This article highlights the possibility of respiratory compromise due to the extravasation of irrigation fluid into the neck and chest during arthroscopic repair of massive and atrophied cuff tears, even with shorter surgical time as is this case. The widened suprascapular space will offer less resistance to the spread of fluid into the neck and chest from the shoulder. We advocate monitoring the patient continuously to prevent this serious complication from becoming life-threatening.

Laringocele: uma causa de obstrução de vias aéreas superiores

Laringoceles são dilatações anormais do sáculo do ventrículo de Morgani da laringe, localizando-se entre a falsa prega vocal e a face interna da cartilagem tireóide. Relevância clínica é rara, sendo o achado de laringoceles assintomáticas em necropsia muito alto. Algumas vezes, pode se apresentar já como uma grande massa cervical, levando à obstrução de vias aéreas e necessitando de intervenção de urgência. Neste trabalho, os autores relatam um caso de laringocele levando à obstrução de vias aéreas superiores, necessitando de traqueostomia de urgência e fazem uma revisão da literatura sobre o tema. Complicações de laringocele incluem infecção (formação de piocele), aspiração de patógenos e subseqüente bronquite e pneumonia, infecção do espaço lateral da faringe (depois de ruptura) e obstrução de vias aéreas superiores, como no caso apresentado. A laringocele, apesar de ser uma doença benigna, é uma causa potencial de obstrução respiratória que pode ameaçar a vida do paciente. O correto diagnóstico e manejo adequado precoce podem evitar que situações de emergência, como a do paciente do caso relatado, levem à morte.

Needle cricothyroidotomy

Needle cricothyroidotomy

High-pressure water jet injury to the pharynx, requiring intubation

We report a case of upper airway obstruction following high-pressure water jet injury to the pharynx incurred from a car wash jet. Injuries from high-pressure water jets are relatively rare and, to the best of our knowledge, airway obstruction as a result has not been reported. Since this unusual injury may be associated with life-threatening complications, it must be promptly recognized and treated.

Risk factors for extubation failure in mechanically ventilated pediatric patients

To describe the incidence of extubation failure and its associated risk factors among mechanically ventilated children. Prospective cohort study. Children who were mechanically ventilated for longer than 12 hrs were followed up to 48 hrs after extubation. Cases of upper airway obstruction, accidental extubation, tracheostomy, or death before extubation were excluded. Extubation failure was defined as reintubation within 48 hrs after extubation. Student's t -test, Mann-Whitney, and chi-squared tests, odds ratio with 95% confidence interval, and multivariate analysis were used for data analysis. Extubation failure rate was 10.5% (13 of 124 patients). Variables associated with extubation failure were age between 1 and 3 mos (odds ratio [OR] = 5.68; 95% confidence interval [CI] = 1.58-20.42), mechanical ventilation >15 days (OR = 6.36; 95% CI = 1.32-30.61), mean oxygenation index (OI) >5 (OR = 4.08; 95% CI = 1.25-13.30), mean airway pressure 24 hrs before extubation lower than 5 cm H(2)O (OR = 6.03; 95% CI = 1.48-24.60), continuous positive airway pressure (CPAP) (OR = 4.71; 95% CI = 1.34-16.58), dopamine and dobutamine use (OR = 3.71; 95% CI = 1.08-12.78), intravenous sedation >10 days (OR = 6.60; 95% CI = 1.62-26.90), tachypnea and subcostal retractions (relative risk [RR] = 3.68; 95% CI = 1.14-11.93), and inspired fraction of oxygen (Fio(2)) > 0.4 after extubation (RR = 3.63; 95% CI = 1.21-10.88). After multiple logistic regression analysis, age between 1 and 3 mos, mean OI > 5, CPAP and mechanical ventilation >15 days remained associated with extubation failure. Extubation failure was more frequent among young infants who received prolonged ventilatory support and intravenous sedation, used CPAP, had impaired lung oxygenation, and required inotropic therapy.

Dynamic bilateral arytenoid and vocal fold collapse associated with head flexion in 5 Norwegian Coldblooded Trotter racehorses

Dynamic obstruction of the upper airway is a common cause of poor performance in racehorses, often associated with abnormal respiratory noise during exercise (Morris and Seeherman 1991; Kannegieter and Dore 1995). Welldocumented upper respiratory tract disorders diagnosed using traditional resting upper airway endoscopy include left laryngeal hemiplegia (LLH), dorsal displacement of the soft palate (DDSP), epiglottic entrapment, subepiglottic cyst, epiglottic hypoplasia, pharyngeal lymphoid hyperplasia, arytenoid chondritis and rostral displacement of the palatopharyngeal arch. High-speed treadmill (HST) videoendoscopy has improved our ability to appreciate previously unrecognised forms of dynamic airway obstruction (King et al. 2001). Recently described forms of upper airway obstruction diagnosed using HST videoendoscopy are dynamic collapse of the roof of the nasopharynx (Strand and Staempfli 1993), epiglottic retroversion (Holcombe et al. 1997; Parente et al. 1998), intermittent epiglottic entrapment (Weishaupt et al. 1998) and axial deviation of the aryepiglottic folds (King et al. 2001). This report describes 5 cases of upper airway obstruction due to dynamic bilateral collapse of the vocal folds and arytenoid cartilages in Norwegian Coldblooded Trotter (NCT) racehorses, diagnosed by use of slowmotion playback of HST videoendoscopic recordings.

UPPER AIRWAY OBSTRUCTION IN A YOUNG ADULT

SUMMARYAcute 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.

Obstrução de vias aéreas superiores após drenagem de abscesso periamigdaliano: relato de caso

Peritonsillar abscess is an unusual complication, but predisposes to severe upper airway complications. This report aimed at presenting a case of upper airway obstruction after surgical drainage of a peritonsillar abscess in a healthy young female patient.Young female patient, 26 years old, with severe peritonsillar abscess and submitted to general anesthesia for drainage. After extubation, she presented a severe respiratory failure requiring reintubation and controlled ventilation for 24 hours.The anesthetic strategy and the adequate surgical indication are fundamental in preventing complications during ENT surgeries.

A case of upper airway obstruction in an infant due to congenital hypothyroidism

This report describes a newborn with congenital hypothyroidism who presented with thyroidomegaly and upper airway obstruction. Technetium scintigraphy and an esophagram were performed. A review of the disease process with emphasis of the imaging diagnosis is provided.