RT Book, Section
A1 Aujla, Shean J.
A2 Rudolph, Colin D.
A2 Rudolph, Abraham M.
A2 Lister, George E.
A2 First, Lewis R.
A2 Gershon, Anne A.
SR Print(0)
ID 7051081
T1 Chapter 510. Disorders Causing Airway Obstruction
T2 Rudolph's Pediatrics, 22e
YR 2011
FD 2011
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-149723-7
LK accesspediatrics.mhmedical.com/content.aspx?aid=7051081
RD 2024/04/24
AB It  is  important  to  recognize  the  differences  between  the  pediatric  and  adult  upper  airway  to  fully  understand  why  even  a  relatively  minor  obstruction  can  cause  significant  airway  compromise  in  children  (Fig.  510-1).  The  pediatric  airway  is  shorter  and  narrower  and  the  larynx  is  placed  more  anterior  than  in  adults.1  The  narrowest  portion  of  the  pediatric  airway  is  the  subglottis,  which  is  below  the  vocal  cords.  Therefore,  mild  edema  in  this  region  can  result  in  a  large  reduction  in  the  cross-sectional  area  of  the  airway.  The  resistance  is  inversely  proportional  to  the  fourth  power  of  the  radius  of  the  airway  (see  Chapter  503).  Therefore,  even  a  small  decrease  in  airway  diameter  leads  to  a  much  larger  increase  in  resistance.  Young  children,  and  infants  especially,  have  a  large  tongue  in  relation  to  the  small  oropharynx.1  They  also  have  a  larger  epiglottis.1  Signs  of  partial  inspiratory  obstruction  include  stridor  (a  high-pitched  sound  heard  on  inhalation),  hoarseness,  and  increased  work  of  breathing  (suprasternal  and  intercostal  retractions).2  Stridor  can  be  inspiratory  or  expiratory,  depending  on  whether  the  obstruction  is  supraglottic  or  subglottic  respectively.  If  the  obstruction  is  severe  or  near-complete,  worsening  agitation,  cyanosis,  and  respiratory  failure  will  likely  occur.  Although  acute  stridor  is  usually  infectious  in  etiology,  other  disorders  may  be  present,  especially  when  symptoms  are  severe  or  persistent.  This  chapter  discusses  inspiratory  airway  obstruction  of  infectious  or  noninfectious  origin.