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Severe upper airway obstruction in the tropics requiring intensive care
1Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia. patrick@medicine.med.um.edu.my
Insights
Severe pediatric upper airway obstruction in the tropics is diverse, with viral croup most common. While most cases have favorable outcomes, bacterial tracheitis and mediastinal malignancy present significant risks.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Respiratory Medicine
Background:
- Severe upper airway obstruction is a critical pediatric emergency.
- Limited data exists on its clinical profile in tropical developing nations.
Purpose of the Study:
- To document the clinical characteristics, causes, and outcomes of severe upper airway obstruction in children.
- To analyze factors influencing severity and mortality in this population.
Main Methods:
- Retrospective review of 63 episodes in 56 children admitted to a Pediatric Intensive Care Unit (PICU) from 1994-1999.
- Assessment of diagnostic categories, illness severity using Pediatric Risk of Mortality (PRISM) II score, and outcomes including ventilation, mortality, and complications.
Main Results:
- Viral croup was the most frequent diagnosis (29%), followed by mediastinal malignancy (13%) and bacterial tracheitis (11%).
- Nearly half of the cases (48%) required mechanical ventilation, with bacterial tracheitis and subglottic stenosis posing the highest need.
- Overall mortality was 11%, with higher PRISM II scores and diagnoses of bacterial tracheitis or mediastinal malignancy associated with increased mortality.
Conclusions:
- Severe upper airway obstruction in the tropics presents with varied etiologies, predominantly viral croup.
- While many cases resolve favorably, bacterial tracheitis and mediastinal malignancy are associated with poorer outcomes and increased ventilation requirements.
Background:
The clinical profile of severe upper airway obstruction, a challenging acute pediatric emergency, has not been extensively documented in the developing nations of the tropics.
Methods:
The diagnostic categories, severity of illness and outcome from 63 episodes of severe upper airway obstruction in 56 children admitted to the Pediatric Intensive Care Unit between January 1994 and December 1999 were reviewed. Outcome variables studied included requirement for ventilation, mortality and complications. Severity of illness was determined with the Pediatric Risk of Mortality (PRISM) II score.
Results:
Viral croup (29%) was the most common diagnosis, followed by mediastinal malignancy (13%), bacterial tracheitis (11%) and Pierre Robin syndrome (11%). There were no admissions for acute epiglottitis. Thirty episodes (48%) required ventilation for a median duration of 4.0 days. Bacterial tracheitis (100%) and subglottic stenosis (100%) were the most likely diagnoses requiring ventilation. Difficulty in intubation was encountered in 13 episodes (43%) involving, in particular, patients with bacterial tracheitis (83%; P = 0.006). Only two patients required a tracheostomy. The overall mortality was 11%. The PRISM score for all categories was generally low (mean 10.3 +/- 1.0; median 9.0). Non-survivors had a significantly higher PRISM II score than survivors (27.4 +/- 9.7 vs 8.1 +/- 4.9, respectively; P = 0.002) and were more likely to include children with bacterial tracheitis and mediastinal malignancy.
Conclusions:
There is marked heterogeneity in the causes of upper airway obstruction in the tropics with viral croup remaining the most common. A significant proportion required ventilation, but outcome is generally favorable, except in those with bacterial tracheitis and mediastinal malignancy.