Obstruction Of Upper Respiratory Tract Research Articles

Respiratory emergencies in adult horses

SummaryAlthough respiratory distress is encountered infrequently in equine practice, it can be serious and potentially fatal, requiring immediate and decisive intervention. History and physical examination can often give sufficient clues to identify the cause of respiratory distress and initiate emergency treatment. Ultrasonography can also be invaluable when assessing distress caused by lower respiratory tract issues. Upper respiratory tract obstruction, tension pneumothorax and occasionally pulmonary oedema can be rapidly fatal and require immediate intervention by emergency tracheotomy, thoracocentesis and evacuation of pleural air or administration of furosemide and oxygen, if available. Acute severe asthma and substantial pleural effusion are often not an immediate threat to life but nonetheless require fast intervention including administration of bronchodilators and corticosteroids or pleurocentesis, respectively.

The correlation between dento-maxillary anomalies and breathing in adults. Literary review.

One of the causes of dentomaxillary anomalies (MADs) in the development of the dentomaxillary apparatus in adulthood is oral respiration with or without nasal breathing. Adults with untreated MAD complain of nasal breathing disorders such as hypopnea (snoring) or sleep apnea (loud snoring). The purpose of the study was to review the literature on the relationship between dentomaxillary anomalies and breathing in adult patients. In this respect, an electronic search in PubMed (MedLine) and Google Scholar was performed. The studies until 20.01.2023 have been analyzed. Thus, 221 sources have been identified of which 21 have been included in the literature review. The mean age of patients in the examined articles constituted 35 years ±9.5 years. The link between MAD and breathing process has been described in 17 articles. The low transverse dimension of the upper jaw leads to nasal cavity obstruction, which can lead to the impairment of the air flow to the lungs. Patients with undiagnosed MAD and upper respiratory tract obstruction may develop OSAS later in life, in those with pre-existing OSAS the condition worsens after the age of 65. The literature describes a direct relationship between hypopnea or obstructive sleep apnea syndrome (OSAS) and hypodevelopment of the lower jaw in the sagittal plane and/or the upper jaw in the transverse plane.

Epstein-Barr virus - uzroci, posledice, dijagnostika i lečenje Epstein-Barr virusa kod ljudi

The Epstein-Barr virus (EBV) belongs to the family of herpesviruses, subfamily Gammaherpesvirinae, and genus Lymphocryptovirus. Despite this classification, there are two serotypes of the Epstein-Barr virus, namely type A and type B. Both types play significant roles in the development of viremia. Additionally, EBV infection can lead to lymphadenopathy, upper respiratory tract obstruction, spleen rupture, thrombocytopenia, and recently, there has been increased emphasis on the connection between this virus and certain malignant neoplasms. Diagnosing this virus can be challenging if clinicians rely solely on serological confirmation. In some cases, it is necessary to perform more specific methods, in addition to considering the clinical picture and history, to prove the presence of the virus in blood, nasopharyngeal swabs, and other tissue samples. The aim of this paper is to present the severity and consequences caused by the Epstein-Barr virus and to emphasize the importance of preventive measures in preventing the virus from coming into contact with susceptible individuals. Prevention plays a crucial role in reducing contact with the virus. Since the infection spreads via droplets, wearing masks in healthcare facilities and regular hand washing are hygiene priorities to prevent infection and further transmission.

Unilateral and bilateral compression of the epiglottis during poll flexion in harness racehorses

SummaryBackgroundHorses exercised ‘onto the bit’ with periods of induced poll flexion can demonstrate a unique array of upper respiratory tract (URT) disorders.ObjectivesTo describe a previously unreported exercise‐related disorder of the epiglottis associated with poll flexion in harness racehorses.Study designRetrospective observational study.MethodsMedical records of all harness racehorses that presented for exercising URT endoscopy between 2005 and 2022 were reviewed. These horses were exercised on a high‐speed treadmill using a previously standardised protocol with alternating 1‐min phases of free head carriage (no rein tension on the bit) and poll flexion (driven onto the bit with long reins) until they could no longer maintain the trotting gait.ResultsSeven Standardbreds and 11 Norwegian‐Swedish Coldblooded trotters were diagnosed with unilateral or bilateral compression of the epiglottis during exercise in poll flexion. These horses demonstrated progression of this disorder during the phases of induced poll flexion and showed no signs of epiglottic compression during phases exercised with free head carriage.Main limitationsRetrospective nature of study and limited sample size due to low prevalence.ConclusionsExercise‐related compression of the base of the epiglottis is a URT disorder only evident videoendoscopically when horses are driven onto the bit leading to poll flexion. It is most often seen in association with dynamic laryngeal collapse but can also be witnessed as a solitary disorder. Videoendoscopically, it appears that the compression is initiated by the rostral advancement of the larynx and hyoid apparatus within a progressively narrowing intermandibular space during poll flexion. Visually, this leads to local inward compression of the lateral nasopharyngeal walls and base of the epiglottis. Further studies are ongoing to confirm this hypothesis and to objectively quantify the degree of URT obstruction caused by this conformational narrowing of the epiglottis during poll flexion.

Mechanical ventilation in dogs and cats with tick paralysis.

Respiratory failure from tick paralysis (TP) is an important cause of mortality in cats and dogs in Australia, occurring from a combination of respiratory muscle paralysis, upper respiratory tract obstruction and pulmonary disease. Patients may require positive-pressure ventilation in management of any combination of hypoxemia, hypoventilation or respiratory fatigue, but may also require airway management due to laryngeal paralysis. No single ventilation strategy is recommended due to the heterogenous disease presentations. Lung protective ventilation should be used in patients with pulmonary disease. Due to local and systemic effects of TP, patients are at higher risk of complications such as aspiration pneumonia and corneal ulceration and may have additional intravenous fluid and nutritional considerations. Treatment with hyperimmune serum is associated with improved outcomes. Prognosis is considered good with documented survival to discharge (STD) of 52.6-77% for animals with TP ventilated with lung disease and 90.5% for animals without lung disease. Median reported duration of ventilation for TP ranges from 23 to 48 h (range 3 h-10 days). The severity of individual neuromuscular signs and the presence of associated conditions such as aspiration pneumonia and laryngeal paralysis may necessitate longer periods of mechanical ventilation. This review aims to summarize the current recommendations regarding indications, management and prognosis of cats and dogs undergoing MV for TP and to identify areas for future research.

Association between obstructive sleep apnea and cardiovascular diseases.

Obstructive sleep apnea (OSA) is a common respiratory disorder characterized by partial obstruction of upper respiratory tract and repetitive cessation of breathing during sleep. The etiology behind OSA is associated with the occurrence of intermittent hypoxemia, recurrent arousals and intrathoracic pressure swings. These contributing factors may turn on various signaling mechanisms including elevated sympathetic tone, oxidative stress, inflammation, endothelial dysfunction, cardiovascular variability, abnormal coagulation and metabolic defect ( e.g., insulin resistance, leptin resistance and altered hepatic metabolism). Given its close tie with major cardiovascular risk factors, OSA is commonly linked to the pathogenesis of a wide array of cardiovascular diseases (CVDs) including hypertension, heart failure, arrhythmias, coronary artery disease, stroke, cerebrovascular disease and pulmonary hypertension (PH). The current standard treatment for OSA using adequate nasal continuous positive airway pressure (CPAP) confers a significant reduction in cardiovascular morbidity. Nonetheless, despite the availability of effective therapy, patients with CVDs are still deemed highly vulnerable to OSA and related adverse clinical outcomes. A better understanding of the etiology of OSA along with early diagnosis should be essential for this undertreated disorder in the clinical setting.

Mouth breathing habit as an etiological factor of malocclusion: literature review

Mouth breathing is one of the bad habits in the oral cavity that deviates from the normal state. The main cause of mouth breathing habit is the presence of upper respiratory tract obstruction, such as adenoid hypertrophy and allergic rhinitis. In this article, dis-cussed about the mouth breathing habit as an etiologic factor for malocclusion. By reviewing the literature, information is col-lected in accordance with the topic of the study and then synthetic. From 8 scientific articles, it is known that mouth breathing habit is an etiological factor for malocclusion, with the most common malocclusions being Class 2 malocclusion, anterior open bite, maxillary anterior teeth protrusion, and posterior crossbite. It is concluded that mouth breathing habit is one of the etiolo-gical factors for malocclusion.

Medical and surgical outcome of retropharyngeal abscess and its prognosis

Although retropharyngeal abscess is not a common condition, it can impact the quality of life of the affected patients, and can even be life-threatening. Asphyxia, upper respiratory tract obstruction, and respiratory distress might then develop secondary to this abscess which continues to grow even larger increasing the seriousness of the complications. Surgical incisions and long-course medical and antibiotic therapies have been described in the literature for the management of retropharyngeal abscess. In this study, the literature review discusses the surgical and medical treatment of retropharyngeal abscesses and the predicted prognosis of the disease after treatment based on evidence obtained from studies in the literature. Early presentation and management are important in achieving better outcomes and enhancing the prognosis. Therefore, patients should be aware enough of the symptoms that might suggest the presence of a retropharyngeal abscess. Using intravenous antibiotics can achieve favorable outcomes. However, some adverse events might be associated and the treatment might not be completed as a result of reduced patient compliance. Surgical management is also efficacious and can be done by different approaches as discussed earlier. Nevertheless, it can also be associated with some complications. Therefore, providing optimal care for these patients should be considered in all scenarios to enhance the prognosis.

Outcomes after cervical vertebral interbody fusion using an interbody fusion device and polyaxial pedicle screw and rod construct in 10 horses (2015-2019).

Further development of surgical techniques for equine cervical stabilisation is necessary to make the procedure less technically demanding, reduce complications and improve outcomes. To describe clinical outcomes and owner reports in horses undergoing placement of an interbody fusion device and polyaxial pedicle screw and rod construct for cervical vertebral fusion in horses with cervical vertebral compressive myelopathy. Retrospective case series. Data were retrieved from medical records of 10 horses undergoing cervical vertebral fusion (2015-2019). Records were evaluated for signalment, duration of clinical signs, number and location of compression sites, grade of ataxia, duration of hospitalisation and complications. Long-term follow-up was obtained through clinical re-evaluation, postoperative radiographs and owner contact. Breeds were mixed. Median age was 24 (range 12-168) months. There were 2/10 mares, 4/10 geldings and 4/10 stallions. Preoperative grade of ataxia ranged from 1-3/5. Fusion was performed at one (n=3) or two (n=7) sites. Two horses were euthanised within the first year. In 6 of 8 horses with ≥1-year follow-up, ataxia improved by 1-3 grades, with an average improvement of 1.25 grades. In four horses, ataxia improved to grade 0-1. In two horses the gait was unaffected, but neck comfort improved. Complications included seroma formation (n=9), pain (n=5), fever (n=4), upper respiratory tract obstruction (n=2), azotemia (n=2), screw breakage (n=2), progression of neurological signs (n=1), Horner's Syndrome (n=1), dysphagia (n=1), hives (n=1), implant infection (n=1) and nondisplaced fracture (n=1). Small case series, heterogeneous patient population. This technique resulted in ≥1 grade gait improvement in 6/10 cases operated and 6/8 cases for which ≥1-year follow-up was available, similar to other methods. Fatal complications related to implant placement did not occur. This technique may represent a safer alternative to current techniques of ventral interbody fusion with similar outcomes.

Lingual Thyroid- A Review

Lingual thyroid as the name suggests it is an ectopic positioning of thyroid gland which is a rare developmentalanomaly. Thyroid gland is usually located in the same level as that of cricoids cartilage in human body.Ectopic occurrence of thyroid gland can be seen anywhere from tongue to diaphragm though in ninetypercent of reported cases it is generally seen in base of tongue. Lingual thyroid mainly seen as a result ofthe inability of thyroid gland to descend to its normal anatomical position during embryogenesis. Generallyit takes its origin from the epithelial tissues of non-obliterated thyroglossal duct. From infancy to adulthoodmostly faced problems by the patients are dysphagia, dysphonia, upper respiratory tract obstruction. Sothis review is entirely about the pathophysiology, clinical manifestation and diagnostic criteria along withtreatment modalities for a better understanding of the dental professionals.

[Analysis on clinical characteristics, diagnosis and treatment of 13 cases of infant hairy polyp].

Objective: To explore and analyze the clinical characteristics, diagnosis and treatment of infant hairy polyp. Methods: A retrospective analysis was made on 13 cases of hairy polyp confirmed by pathology, who were admitted to the Children's Hospital of Hebei Province from January 2010 to September 2019, including 4 males and 9 females, with a male-female ratio of 1∶2.25. The age ranged from 3 hours to 1 year, and the median age was 1 month. Twelve of the 13 children were found to have difficulty breathing or feeding. All the children received coblation resection under general anesthesia. The root pedicle of the mass was found in the lateral nasopharyngeal wall in 8 cases, in the junction of palatine and palatopharyngeal arch of tonsil and the tongue and esophageal entrance in 1 case, respectively. Nasal septum was found in 2 cases, including 1 case located between two incisors. The wound at the root pedicle was ablated and the bleeding was stopped completely. Results: Postoperative follow-up lasted from 3 months to 2 years, and there was no recurrence in 12 cases. Fibrolaryngoscope showed a mass of the right eustachian tube and pharyngeal mouth in 1 case 2 years after the surgery, which was considered recurrence of hairy polyps and lost after that. Conclusion: Hairy polyps in infants is a rare clinical disease, and its main symptom is upper respiratory tract obstruction. Early diagnosis and radical surgery are the key to the treatment of the disease.

Obstrukcinės miego apnėjos klinikinis atvejis

Tyrimo tikslas. Obstrukcinės miego apnėjos (OMA) diagnostika ir gydymas yra aktuali problema. OMA dažniau serga vyrai ir vyresnio amžiaus žmonės. Remiantis apnėjų/hipopnėjų indeksu (AHI), skirstoma į lengvą, vidutinio sunkumo ir sunkią. Simptomai pasireiškia knarkimu, dusuliu miego metu, mieguistumu dieną. Klinikinėje praktikoje, vertinant viršutinių kvėpavimo takų obstrukciją, naudojama Friedmano stadijų sistema. OMA diagnozuojama atlikus respiracinę poligrafiją arba polisomnografiją. Yra parengti specifiniai atrankos klausimynai: Epworth, Berlino, STOP-Bang, STOP.Nakties oksimetrijos tyrimas tinka vidutinės arba sunkios OMA atrankai.

The effects of nasal septum deviation on eye posterior segment finding

Aim: Deviation of the nasal septum, which can cause upper respiratory tract obstruction and systemic hypoxia, may also affect the eye. The aim of this study was to detect changes in posterior segment parameters of the eye in patients with nasal septal deviation. Material and Methods: The study included 50 patients with nasal septal deviation, and a control group of 30 healthy subjects with no nasal septal deviation. Choroidal thickness, central macular thickness and retinal nerve fiber layer thickness were measured with Optical Coherence Tomography.Results: Choroidal thickness was significantly lower in patients with severe nasal septal deviation compared to the control group. (p=0.001) There is no statistically significant change in other measurements.Conclusion: The study results suggest that marked nasal septal deviation may lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.

Complete upper airway collapse and apnoea during tethered swimming in horses.

There is limited knowledge of the breathing strategy and impact on the patency of the upper respiratory tract (URT) in swimming horses. To describe the respiratory responses and endoscopic appearance of the URT during tethered swimming in horses. Prospective descriptive study. Ten race-fit horses, with no history of URT obstruction, were examined during tethered swimming. Endoscopic examination, heart rate, sound recordings and above and below water video recordings were obtained. Plasma lactate concentration was measured before and 5min after swimming and tracheal endoscopy was performed 30min after exercise to assess for presence of blood or mucus. Four horses also underwent endoscopy during exercise on the track. Mean (±s.d.) breathing frequency was 28±5breaths/min during swimming, with a brief inspiration (mean±s.d. TI =0.51±0.08s), followed by a period of apnoea (1.59±0.53s) and then a short, forced expiration (TE =0.42±0.5s). During apnoea all horses exhibited complete collapse of the URT including closure of the external nares, nasopharynx and rima glottidis (with bilateral adduction of the arytenoid cartilages and vocal folds) and, in two horses, epiglottic retroversion. No horses had URT collapse during overground exercise. Locomotor-respiratory coupling was not observed during swimming. Median (IQR) plasma lactate post swim was 4.71mmol/L (2.08-8.09mmol/L) vs 0.68mmol/L (0.65-0.71mmol/L) preswim. Post swim endoscopy revealed grade 1 exercise-induced pulmonary haemorrhage (EIPH) in 2 horses. Median mucus grade was 1 (range 0-3). Overground endoscopy was not performed in all horses. Horses experienced complete URT collapse associated with post inspiratory apnoea when swimming. The reason for this is unknown but may be to aid buoyancy or associated with the mammalian dive response - a survival reflex to preserve oxygen stores and prevent water entering the lungs.

[Clinical characteristics of 46 pediatric diffuse large B-cell lymphoma and treatment outcome].

Objective: To summarize the clinical data of diffuse large B-cell lymphoma (DLBCL) in children and to evaluate the efficacy of Beijing Children's Hospital B cell lymphoma protocol in the treatment of pediatric DLBCL. Methods: The data (clinical, pathology, lab and image data) of 46 pediatric DLBCL admitted to the treatment group of Beijing Children's Hospital from January 2005 to June 2017 were collected and analyzed retrospectively. According to the risk factors of staging, existence of poor prognosis genes and giant tumors, stratified treatment was carried out according to the international standard modified LMB89 regimen with high dose and short course. The Kaplan-Meier method was used to calculate the event free survival (EFS) and the overall survival (OS). Results: (1) Among the 46 cases, there were 33 males and 13 females. The median age was 8.0 years. The time from the initial symptom onset to the diagnosis was more than 15 days in 45 children. Fourteen cases had B group symptoms (fever, night sweat, and weight lost), 25 cases had extranodal disease, 39 cases were stage Ⅲ and Ⅳ, 12 cases had bone marrow involvement, 3 cases had jawbone involvement. Thirty cases were group B and 16 cases were group C in the treatment group. (2) Initial symptoms: 6 cases had cervical mass, 20 cases had abdominal mass, 10 had abdominal pain with acute abdomen, 8 cases had fever, 2 cases had snore or upper respiratory tract obstruction. (3) Pathology result: 40 cases were germinal center B cell DLBCL, 6 cases were non germinal center B cell DLBCL, no case had the MYC gene rupture, double hit lymphoma and triple hit lymphoma. (4) Complication and evaluation: the tumor lysis syndrome was seen in 3 cases initially, severe infection and delayed treatment was seen in 1 case, no treatment related death. The first evaluation showed all cases were sensitive to chemotherapy (shrink>25%), the second evaluation showed 1 case had residual disease, the others were complete remission. (5) Treatment and outcome: the 5 year-EFS was the same with 5 year-OS, both were (97.8±2.2) %. Two cases relapsed after treatment off, early relapse was seen in 1 case, and died because of abandoning treatment. Late relapse was seen in 1 case and got a complete remission after Rituximab+group C protocol treatment. Conclusions: Pediatric DLBCL was common in school aged boys, most cases were at middle and late stage at the time of diagnosis. DLBCL had a good prognosis after the treatment with Beijing Children's Hospital's B cell lymphoma protocol, but late relapse could be seen.

[Application value of color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns complicated with upper respiratory tract obstruction].

Objective: To explore the application value of color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns complicated with upper respiratory tract obstruction. Methods: From July 2013 to June 2018, 17 patients with head and neck burns complicated with upper respiratory tract obstruction, including 15 males and 2 females, aged 19-63 years, were hospitalized in our unit and treated with color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps. Before operation, the trachea was examined by color Doppler ultrasonography to specify condition of trachea and peribronchial tissues and organs for comprehensive assessment, so as to confirm optimal incision site of puncture and pathways as well as specify distance from anterior cervical skin to intima of anterior tracheal wall. Then, under real-time guidance of color Doppler ultrasound, percutaneous dilational tracheostomy with dilatation forceps was performed. The position, shape, inner diameter, and intraluminal abnormalities of trachea of patients before operation, abnormal location of peribronchial vessels and thyroid, distance from anterior cervical skin to intima of anterior tracheal wall, success rate of puncture, surgical time (from skin disinfection to successful catheterization), success rate of catheterization, intraoperative blood loss, heart rate, blood pressure, respiration, percutaneous oxygen saturation, and presence or absence of complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative hemorrhea, wound infection after operation were observed and detected. Results: (1)Preoperative color Doppler ultrasonography showed that the trachea of one patient deviated from the anterior median line of neck 13 mm to the right; 17 patients had edema of different degrees in the cervical soft tissue and more secretions in the trachea; 3 patients had the trachea changed from round to oval with reduced anteroposterior diameter; 1 patient had a small artery obstruction at the conventional puncture point; 2 patients had the trachea covered by the congestive and swollen isthmus of the thyroid between the first and the third tracheal cartilage rings; 16 patients had a distance from anterior cervical skin to anterior tracheal wall intima of 17-33 mm, and 1 patient had a distance from anterior cervical skin to anterior tracheal wall intima of 47 mm. (2) Puncture for 17 patients was successful at one time, and success rate of puncture was 100%. The operation time was 5-11 min, with an average of 7 min, and the success rate of catheterization was 100%. (3) Intraoperative blood loss of patients was less, all not exceeding 8 mL. Intraoperative percutaneous oxygen saturation was maintained between 0.90 and 0.99. The heart rate, blood pressure, and respiration were stable. (4) No complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative massive hemorrhage, or wound infection occurred in any patient. Conclusions: Applying color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns combined with upper respiratory tract obstruction can not only open up the airway quickly and effectively, but also reduce the complications related to the operation. It is expected to improve the success rate of rescue and improve the prognosis, making it of good application value.

Mouth Breathing, Head Posture, and Prevalence of Adenoid Facies in Patients with Upper Respiratory Tract Obstruction

Frequent upper respiratory tract infections and allergic reactions may cause upper respiratory tract obstruction (OURT). Mouth breathing (MB) occurs in individuals with nasal breathing problems. A person with MB will raise his head higher; thus, MB is a risk factor for head posture ( HP) deviation. Children with MB during growth and development may exhibit dentocraniofacial (DCF) deviation. Objective: To evaluate the prevalence of MB, HP, and DCF deviation in OURT patients to know risk factors of HP deviation, morphological aberrations of DCF and DCF deviation growth and development. Methods: This cross-sectional study included 285 OURT subjects aged 9–15 years. Data obtained from cephalometric analysis, physical examination, and questionnaires were analyzed. Results: Of 285 OURT subjects, 80.4% showed MB, 44.2% HP deviation, and 66.7% DCF deviation. As risk factors for DCF deviation, MB and HP showed odds ratios of 20.45 and 8.11 and population attributable risks of 87.5% and 59.7%, respectively. Conclusion: The prevalence of MB and DCF deviation in OURT patients is high, but that of HP deviation is generally comparable. MB and deviated HP are risk factors for DCF deviation growth and development.

Assessment of dynamic upper respiratory tract function in the equine athlete

SummaryDynamic upper respiratory tract (URT) obstructions occur commonly in the equine athlete. During the past 25 years, veterinary diagnostic capabilities have improved greatly with the ability to perform endoscopy during exercise and thus to visualise upper airway function during various types of exercise. After correctly reproducing and diagnosing an URT obstruction, the veterinary surgeon must consider the functional significance of the endoscopic findings for that individual athlete. This is the third paper in this series and focuses on the diagnosis of URT obstructions, their relationship to the exercise test and their functional significance.

Evaluation of Overground Endoscopy Findings in Sport and Pleasure Horses

Any factors that increase negative pressure in the upper respiratory tract (URT) can influence its mechanics. The aim of this report was to describe the results of URT diagnostic evaluation with overground endoscopy in sport and pleasure horses. The URT and plasma lactate levels were evaluated during rest and during overground endoscopic examination in 19 cases. Horses performed their normal training session. When history and clinical examination suggested a lower airway obstruction, we performed bronchoalveolar lavage. Dorsal displacement of the soft palate (DDSP) was diagnosed in 8 of 19 horses, which might have developed secondary to URT or lower respiratory tract inflammation or obstruction. DDSP was also detected at rest in four cases. Laryngeal hemiplegia (LHP) was diagnosed in 15 of 19 horses, 11 of which were complex cases with other types of URT obstructions. Severe pharyngeal collapse (PHC), suspected already at rest, was visible in two cases during exercise. In contrast, PHC diagnosed with nasal occlusion at rest in two cases was fully compensated under the rider. Plasma lactate levels significantly decreased during exercise. All DDSP cases were suspected to be of inflammatory or obstructive origin, which is different from findings in racehorses, where extrinsic causes are more common. Resting endoscopic examinations were sensitive in cases of obstructive origin. LHP and PHC could not be predicted on the basis of findings at rest, and increased neuromuscular activity during exercise could compensate for the problem in less severe cases. Decreased levels of lactate could be explained by the increased clearance during exercise.

THE AIRWAY OBSTRUCTION — IMPORTANT ABRUPT CONDITION FOR PEDIATRICS

The ability of fast response in case of increasing health problems of a child which lead directly to life-threatening situations is a necessary condition for creating opportunity of child’s survival until it will be transported to intensive care unit, where it will be provided with care by a specialist. In case of healthy children the most common cause of acute respiratory failure is obstruction of upper respiratory tract. There is an enormous variety of causes of upper airway obstruction, but the most important are the result of congenital defects, acute inflammation, anaphylactic reactions, foreign body aspiration and injuries. Consequence of the hypoventilation resulting from significant impediment of airflow through the obstructed airways is impaired gas exchange in the lungs. This leads to the increasing hypoxemia (PaO 2 45 mmHg). This condition is called the total respiratory failure. The persistence of hypoventilation leads to hypoxia of vital organs (heart muscle, brain), increased anaerobic metabolism, acidosis, and inevitably to cardiac arrest as a result of homeostasis disorders. Respiratory failure is defined as acute when developing suddenly and is potentially reversible. We can find such a situation in the fast-increasing stenosis of the larynx. Symptoms of severe dyspnoea occur in a short time, but can be interrupted by an effective airway patency. Acute respiratory failure is a state of direct threat to life, which is why it is crucial to give a prompt aid to the sick child. The aim of this paper is to discuss the signs and symptoms, knowledge of which is essential for rapid identification and initial differentiation of the causes of acute upper airway obstruction in children. The principles of first-aid for children with acute respiratory failure and above all the description of life-saving procedures will be presented.