Upper airway obstruction happens when there is an anatomic narrowing or occlusion that results in a reduced ability to exchange gas in and out of the lungs. The obstruction can lead to respiratory failure, arrhythmias, cardiac arrest or death within minutes. Therefore, healthcare professionals must be aware of signs and symptoms, possible causes and management in order to intervene promptly and minimise morbidity and mortality.
The upper airway includes four compartments: the nose and mouth, the pharynx, the larynx, and the trachea.1 Obstruction can occur in any of these compartments. The onset can be acute or may evolve chronically.1,2 Chronic airway obstruction can also develop into an acute episode with further narrowing of the airway. Upper airway obstruction is also classified as partial or complete depending on the degree of occlusion.2 Partial obstruction allows for some gas exchange, whilst complete obstruction does not allow any.
Patients presenting with acute upper airway obstruction may be unable to give history and are often in distress. Accessory muscles of respiration may be used (neck and shoulder muscles), and there may be intercostal and subcostal recession and a tracheal tug.3 When obstruction is complete, patients may be unconscious or in cardiopulmonary arrest. The Resuscitation Council UK (2015, 2017) recommends assessing a possible airway obstruction by the look, listen and feel approach. 3,4
This approach will help identify whether an obstruction is present, and if it is a partial of complete obstruction. In complete obstructions, there are often no sounds and there may be paradoxical chest and abdominal movements, described as ‘see-saw breathing’ as the patient tries to ventilate.3
In partial airway obstruction, air entry is reduced and usually noisy:3
There are several possible causes of upper airway obstruction:
When a patient presents with upper airway obstruction, the immediate goal is relieving the obstruction, so air exchange can occur. In acute obstructions, the condition can worsen rapidly if left untreated. Even though the focus is in correcting the underlying cause, in acute cases, it may be required to correct the obstruction first before identifying the pathology. Main considerations in upper airway obstruction intervention include the following:3,4
Upper airway obstruction can be acute or chronic and lead to respiratory failure, arrhythmias, cardiac arrest or death within minutes. Healthcare professionals must be aware of signs and symptoms, possible causes and management described above in order to intervene promptly and minimise morbidity and mortality.
My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management. This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.
The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger. Medically Reviewed by Dan Brennan, MD on October 25, 2021 An airway obstruction happens when you can't move air in or out of your lungs. It could be because you inhaled something that's blocking your airway. Or it could be caused by disease, allergic reaction, or trauma. Airway obstructions may block part of your airway or the whole thing. Airway obstructions can happen anywhere along your airway, including your: Upper respiratory tract. The upper airway consists of the following parts: Lower respiratory tract. The lower airway includes: Foreign objects. Inhaling an object that blocks the airway is the fourth leading cause of unintentional death. This is more likely to happen in children, who have smaller airways, and people who have problems with their nerves and muscles. The objects most likely to cause choking deaths in children include:
In adults, the objects most likely to cause choking deaths include:
Anaphylaxis. Allergies can lead to a severe, life-threatening reaction. It's almost always unexpected and can lead to death. Anaphylaxis causes the airways to swell and stop you from breathing if not treated right away. The most common causes of anaphylaxis include:
Burns. When the air temperature gets hot enough, such as in a fire, it can injure your upper airway. These injuries cause swelling to your epiglottis, which is a flap of cartilage at the root of the tongue, and the mucous membranes around the larynx. This swelling can block your airway. Infections. The most common cause of infectious airway obstruction in children is croup, which is caused by a virus. Infections caused by bacteria can also lead to airway obstruction, though it's not as common. These include: Lower airway obstructions can be caused by a variety of different conditions. Some of the most common include: Asthma. Asthma is a lifelong disease that affects airflow. Symptoms include airway swelling, hyperreactivity, and making more mucus. They can cause coughing, wheezing, shortness of breath, and tightness in your chest. Asthma can be triggered by many different factors, including: Bronchiolitis. Bronchiolitis most often affects young children and is usually caused by a virus. It makes your airways swell, blocking airflow. Symptoms of bronchiolitis can include: Chronic obstructive pulmonary disease (COPD). That’s an inflammatory lung disease that blocks the airflow into the lungs. COPD can cause inflammation of the lining of the tubes that carry air to the sacs in the lungs. This is called chronic bronchitis. Emphysema also contributes to COPD by destroying the air sacs at the end of the smallest air passages. Symptoms of COPD include: Symptoms of an airway obstruction can vary depending on how severe the blockage is, including: The treatment for an airway obstruction depends on the cause and severity. An inhaled object is a medical emergency and needs treatment right away. If an inhaled object causes choking, you should call 911 and perform first aid. The five-and-five method recommended by the American Red Cross consists of five black blows followed by five abdominal thrusts, which is the Heimlich maneuver. Alternate between the two until the object is coughed up. Other treatment options may include: |
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