Helium, being a less dense gas than nitrogen, reduces turbulent flow through the airways. Use of inhaled Heliox (70% helium, 30% oxygen) the effect is almost instantaneous.Use of dexamethasone ( Decadron) 4–8 mg IV q 8 - 12 h in cases where airway edema may be the cause of the stridor note that some time (in the range of hours) may be needed for dexamethasone to work fully.(Nebulized Codeine in a dose not exceeding 3 mg/kg may also be used, but not together with racemic adrenaline. Use of nebulized racemic adrenaline epinephrine (0.5 to 0.75 ml of 2.25% racemic epinephrine added to 2.5 to 3 ml of normal saline) in cases where airway edema may be the cause of the stridor.Expectant management with full monitoring, oxygen by face mask, and positioning the head on the bed for optimum conditions (e.g., 45 - 90 degrees).If intubation can be delayed for a period, a number of other potential options can be considered, depending on the severity of the situation and other clinical details. Some patients will need immediate tracheal intubation. A reduction in oxygen saturation is considered a late sign of airway obstruction, particularly in a child with healthy lungs and normal gas exchange. The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy is immediately necessary. Stridor is mainly diagnosed on the basis of history and physical examination, with a view to revealing the underlying problem or condition.Ĭhest and neck x-rays, bronchoscopy, CT-scans, and/or MRIs may reveal structural pathology.įlexible fiberoptic bronchoscopy can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection. ALL (T-cell ALL can present with mediastinal mass that compresses the trachea and causes inspiratory stridor).tumor (e.g., laryngeal papillomatosis, squamous cell carcinoma of larynx, trachea or esophagus).pediatrics), cuff over inflation, and prolonged intubation times.) Laryngeal edema is a common cause of stridor post extubation (occurring from pressure of the endotracheal tube on the mucosa as a result of endotracheal tube that is too large (e.g.congenital anomalies of the airway are present in 87% of all cases of stridor in infants and children. tracheomalacia or tracheobronchomalacia (e.g., collapsed trachea). thyroiditis such as Riedel's thyroiditis.vascular rings compressing the trachea.laryngospasm (from aspiration, GERD, or complication of anesthesia).airway edema (e.g., following instrumentation of the airway, tracheal intubation, drug side effect, allergic reaction).subglottic stenosis (e.g., following prolonged intubation or congenital).infections (e.g., epiglottitis, retropharyngeal abscess, croup).
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