Management of upper airway obstruction in the intensive care unit

Three patients under observation in ICUs developed mechanical upper airway obstruction requiring surgical intervention for airway control. One patient was treated by tracheotomy placed through a vertical midline incision and 2 patients were treated by cricothyroidotomy followed by elective tracheostomy and closure of the cricothyroidotomy. The literature of acute upper airway obstruction is reviewed and recommendations made for rapid assessment and management of these patients. The importance of rapid cricothyroidotomy through a small incision in patients unresponsive to less invasive measures is emphasized. The use of a small pediatric endotracheal tube placed through the cricothyroidotomy incision is suggested as a method to increase the speed and safety of the procedure and avoid the potential long-term complication of laryngeal stricture.