Although all airway obstructions are medical emergencies, blockages caused by a foreign body can be resolved relatively quickly. Once the blockage is removed, the airway opens up, resolving the situation. But a foreign body is not the only cause of airway obstructions. For example, malignancy, trauma, or an infectious process can block the airway, potentially leading to delayed recovery or hypoxic brain damage.

What is Upper Airway Obstruction?

Upper airway obstruction is an anatomic narrowing or occlusion of the airways leading to compromised ventilation. Obstructions can be chronic or acute, acquired or congenital, partial or complete. A complete acute obstruction - a total inability to get air to and from the lungs - can be fatal within minutes without an emergency medical intervention. 

In such a scenario, time is of the essence; therefore, doctors must act quickly, evaluate the patient, and be prepared to intervene immediately. Chronic airway obstructions are different in that they lead to damage over time, for instance, cardiopulmonary compromise morbidity and even death.

What are the Causes of Upper Airway Obstructions?

Pathologies that compromise airflow to and from the lungs cause upper airway obstruction. The blockage can be either in the nasopharynx or the oropharynx. The most common causes are: 

• foreign body in the airway
• deviated septum 
• tracheal webs (a thin layer of tissue that narrows the tracheal lumen)
• macroglossia (a disorder in which the tongue is larger than normal)
• tracheal atresia (a rare birth defect in which the trachea fails to develop)
• retropharyngeal abscess
• peritonsillar abscess
• enlarged tonsils
• rhinitis
• lipoma of the neck
• nasopharyngeal and oropharyngeal cancers
• edema from epiglottitis (profound swelling of the upper airways)
• anaphylaxis
• blunt or penetrating trauma
• turbinate hypertrophy (an enlargement of the turbinates)
• chemical or thermal burns

Basic Airway Management Techniques

Although various airway management techniques can be used to open an obstructed airway, the correct method depends on the cause of the obstruction. For instance, the Heimlich maneuver should be performed if choking is suspected and no medical help is available. 

If the cause of the obstruction is inhaled foreign body, and the patient is in respiratory distress and unstable, direct micro laryngoscopy or bronchoscopy may be needed to remove the foreign body.

Acute Upper Airway Obstruction Management

Airway Medications

Allergic anaphylaxis can send a patient into a crisis, making breathing impossible and obstructing the airway. If the patient presents with an obstructed airway due to allergic anaphylaxis, epinephrine and other similar drugs can reduce swelling and inflammation. Keep in mind, however, that some people experience a secondary anaphylactic reaction. Therefore, it is critical to monitor their airways even after epinephrine administration.

Intubation

If the blockage is in the oral cavity (oropharynx), securing an airway is critical and may necessitate an awake fibreoptic intubation. Intubation is an invasive procedure with the possibility of complications if not done correctly. The risk of complications sharply rises if doctors need more than two tries to intubate patients successfully. 

Passing the scope through the level of the vocal cords and the endotracheal tube down past the cords is particularly risky, especially when performing the procedure on a patient with a difficult airway. QuickSteer™ allows physicians to reduce variation in time to intubate because, with the tool, the time to place the tip of the intubation aid through the vocal cords is faster.

Tracheostomy

Tracheostomy is a surgical procedure used to create a hole through the front of the neck and into the windpipe (trachea). Once the hole is made, a tracheostomy tube is placed to keep it open and provide an air passage to help the patient breathe. Tracheostomy is generally reserved for cases when upper airway obstruction cannot be solved with intubation and should be performed in the OR.

Cricothyroidotomy

Like tracheostomy, cricothyroidotomy is also reserved for true emergencies, where intubation is not possible or anticipated to be very difficult. Although cricothyroidotomy is a rapid procedure, it is invasive, involving a vertical incision between the thyroid and cricoid cartilage. 

Manage Obstructed Airways with Confidence

As you can see, the best method to open an obstructed airway depends on various factors, such as the cause of the blockage, its location (oropharynx or nasopharynx), acute or chronic nature, the patient's airway anatomy, medical history, and more. Nonetheless, having the right tools, equipment, training, and skillset can save lives. 

Seek out innovative technologies to get better results with lifesaving procedures. For example, QuickSteer™ was designed to help improve overall intubation time and patient safety by reducing the potential for injury and trauma in even the most complex airway cases. 

Want to learn more? Watch this video to see QuickSteer™ in action. 

Want to learn more? Connect with a specialist by calling 763.330.2162 or emailing info@accessairways.com.

---

‍

References: 

https://www.ncbi.nlm.nih.gov/books/NBK470562/

https://www.ncbi.nlm.nih.gov/books/NBK441873/

https://www.ncbi.nlm.nih.gov/books/NBK564399/

‍