Management of Upper Airway Obstruction | Croup in the PICU
Apr 13, 2025
Join the experts as they tackle upper airway obstruction in children, starting with a compelling case of a 12-month-old girl with stridor and fever. Key insights include the crucial role of calming the child and positioning for optimal treatment. They explain the significance of dexamethasone and racemic epinephrine in managing croup, while also discussing serious infections like epiglottitis. The hosts highlight essential diagnostic signs and emphasize the importance of timely interventions, making it a must-listen for healthcare professionals!
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insights INSIGHT
Airway Radius Drastically Impacts Resistance
Airway resistance dramatically increases with even a tiny decrease in airway radius due to the fourth power relationship.
This explains why small children with airway narrowing can deteriorate rapidly and require urgent management.
insights INSIGHT
Stridor Indicates Significant Obstruction
Stridor is a high-pitched inspiratory sound indicating more than 65% upper airway obstruction.
Its timing and intensity help localize the obstruction site in the airway.
insights INSIGHT
Foreign Body Aspiration in Toddlers
Foreign body aspiration is common in children under three due to developmental factors.
Most lodge in bronchi; symptoms begin with choking and coughing, then may become subtle over time.
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In today’s episode, Dr. Rahul Damania and Dr. Pradip Kamat welcome their new co-host, Dr. Monica Gray. They’ll dive into the topic of upper airway obstruction in children and explore a case involving a 12-month-old girl who presents with stridor and fever. Throughout the discussion, they delve into the underlying causes, possible diagnoses, and management strategies. Key takeaways include the significance of keeping the child calm, ensuring proper positioning, and utilizing treatments such as dexamethasone and Racemic epinephrine. They’ll also touch on advanced therapies and serious infections like epiglottitis. The episode highlights the importance of recognizing stridor, knowing when to consider PICU admission, and the effectiveness of low-dose dexamethasone. Tune in to learn more!
Show Highlights:
Overview of upper airway obstruction in pediatric patients
Case presentation of a 12-month-old girl with stridor and fever
Discussion on the pathophysiology of stridor and its clinical significance
Differential diagnoses for stridor, including croup, epiglottitis, and foreign body aspiration
Management strategies for upper airway obstruction, including stabilization and medication
Importance of calming the child and optimal positioning during treatment
Use of dexamethasone and racemic epinephrine in managing croup
Advanced therapies, such as Helios, for specific cases
Indicators for pediatric intensive care unit (PICU) admission
Key clinical points and takeaways for healthcare professionals managing airway emergencies
References:
Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 47 Otteson T, Richardson C, Shah J: Diseases of the upper Airway. Pages 524-535
Rogers Textbook of Pediatric Intensive Care: Chapter 25; Ong May Soo Jacqueline, Tijssen J, Bruins BB and Nishisaki A: Airway management. Pages 341-365
Reference: Aregbesola A, Tam CM, Kothari A, Le ML, Ragheb M, Klassen TP. Glucocorticoids for croup in children. Cochrane Database Syst Rev. 2023 Jan 10;1(1):CD001955. doi: 10.1002/14651858.CD001955.pub5. PMID: 36626194; PMCID: PMC9831289.
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