Thread by @dastrainees

#JanuAIRWAY Day 21. Airway Obstruction – Infraglottic (extrathoracic). Presents a unique set of challenges. Let’s dive in … Here's a #OnePager
#JanuAIRWAY 1/6

Physiology
- Theory=fixed lesion unaffected by respiratory cycle / anaesthesia induction (most have dynamic element)
- Extrathoracic lesions usually better in expiration +ve pressure splints airway open
- Lets’ revisit flow-volume loops as they can be helpful
#JanuAIRWAY 2/6

Issues:
- Laryngoscopy likely to be uneffected. However, major concern = inability to pass ETT atraumatically beyond the level of obstruction
- Nasendoscopy can be useful to view lesion
- AFOI/FOI may cause ‘cork in bottle’ effect depending on lesion size/location
#JanuAIRWAY 3/6

How would you manage Infraglottic (extrathoracic) Airway Obstruction?
•MLT – depending on size of obstruction/stenosis
•Tubeless technique – eg intermittent O2 (HFNO)
•Jet ventilation +/- rigid bronchoscope
•ATI
•Other (eg tracheostomy - leave a comment)
#JanuAIRWAY 4/6

Here are some papers / links that you might find interesting:
🔗ncbi.nlm.nih.gov/pmc/articles/P…
🔗…-publications.onlinelibrary.wiley.com/doi/10.1002/an…
🔗bjanaesthesia.org.uk/article/S0007-… 🔗…-publications.onlinelibrary.wiley.com/doi/abs/10.111…
🔗ajol.info/index.php/saja…
🔗ispub.com/IJA/15/2/11535
🔗tandfonline.com/doi/abs/10.108…
#JanuAIRWAY 5/6

Hope that helps. Tomorrow, continuing with obstructed airways –Infraglottic (intrathoracic) Obstruction. See you then! #JanuAIRWAY 6/6

*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement