exudates and Airway-Obstruction

The use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. The patient was therefore referred for an emergency tracheostomy. This case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. This imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.

Topics: Airway Management; Airway Obstruction; Cricoid Cartilage; Emergencies; Hoarseness; Humans; Laryngeal Neoplasms; Larynx; Malaysia; Male; Middle Aged; Point-of-Care Systems; Preoperative Period; Respiratory Sounds; Thyroid Cartilage; Tracheostomy; Ultrasonography

Teratomas arising from the palate or pharynx may cause immediate life-threatening airway obstruction to the newborn. Early diagnosis via antenatal ultrasound enables the treating team to perform an ex utero intrapartum treatment (EXIT) procedure to secure an airway and perform subsequent tumour resection. We present the first EXIT procedure done in Malaysia. A 34 year old , gravida 4, para 3, her unborn child diagnosed at 24 weeks of gestation to have a large oropharyngeal mass. Upper airway obstruction was anticipated. Orchestration of multiple specialities was executed to properly plan and perform the EXIT procedure. The fetus was delivered at 33 weeks of gestation and managed to be intubated. The extraoral portion of the multilobular mass originating from the palate was resected. Complete resection of the intraoral teratoma was successfully done at day 22 of life.

Topics: Airway Obstruction; Humans; Malaysia; Teratoma

We aimed to evaluate the severity of upper airway obstruction at the retropalatal and retroglossal regions in obstructive sleep apnea (OSA) patients.. This is a descriptive cross-sectional study at the Sleep Clinic, Department of Otorhinolaryngology-Head and Neck Surgery. Flexible nasopharyngolaryngoscopy was performed in seated erect and supine position. Retropalatal and retroglossal regions were continuously recorded during quiet breathing and Mueller's maneuver in both positions. Captured images were measured using Scion Image software and narrowing rate was calculated. Level of each site was classified based on Fujita classification and severity of obstruction using Sher scoring system for Mueller's maneuver.. A total of 59 patients participated in this study. Twenty-nine (49.2%) participants had type 1 (retropalatal) obstruction, 23 (38.9%) had type 2 (retropalatal and retroglossal), and seven (11.9%) in type 3 (retroglossal) obstruction. Fifty (84.7%) of the patients have severe obstruction at the retropalatal region in supine position (SRP) followed by 35 (59.3%) at retropalatal region in erect position (ERP), 27 (45.8%) at retroglossal region in supine position (SRG) and eight (13.5%) at retroglossal region in erect position (ERG). The average oxygen saturation showed significant association in ERP (P = 0.012) and SRP (P < 0.001), but not significant in ERG and SRG.. Videoendoscopy utilizing flexible nasopharyngolaryngoscopy and Scion Image software is reliable, minimally invasive, and useful as an office procedure in evaluating the multilevel obstruction of upper airway in OSA patients. The retropalatal region has more severe obstruction compared with retroglossal region either in erect or supine position.

Topics: Adult; Airway Obstruction; Endoscopes; Equipment Design; Female; Humans; Image Interpretation, Computer-Assisted; Malaysia; Male; Middle Aged; Oxygen; Reference Values; Sleep Apnea, Obstructive; Video Recording; Young Adult

We describe a child who presented with intermittent respiratory obstruction especially in supine position. Examination revealed a fleshy post nasal mass extending up to the oropharynx. The mass was removed surgically and histopathology revealed an antrochonal polyp. Patient was relieved of his symptoms and has been well ever since.

Topics: Airway Obstruction; Child; Humans; Malaysia; Male; Nasal Polyps; Treatment Outcome

Topics: Airway Obstruction; Education, Continuing; Humans; Malaysia; Sleep Apnea Syndromes

Indication for pediatric tracheostomy has changed. Upper airway obstruction secondary to infectious disorders is no longer the commonest indication. The aim of this study was to establish data on indications, outcome and complications of pediatric tracheostomy. A retrospective analysis of pediatric tracheostomies carried out between March 2002 to March 2004 was done. Eighteen patients were identified. The commonest indication was prolonged ventilation (94.5%) followed by pulmonary toilet (5.5%). None was performed for upper airway obstruction. Postoperative complications were encountered in six patients (33.3%), the commonest being accidental decannulation notably in children less than six years of age. Twelve patients (66.6%) were successfully decannulated. The mortality rate was 16.6%. All death were non tracheostomy related. The commonest indication for tracheostomy was prolonged ventilation and tracheostomy in children is relatively safe despite complications.

Topics: Adolescent; Adult; Airway Obstruction; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Infant, Newborn; Malaysia; Male; Retrospective Studies; Tracheostomy

Extragonadal teratomas and germ cell tumours are uncommon. Most teratomas of the head and neck present in the paediatric age group. Occurrence of such tumours in an adult is extremely rare and, to date, less than 40 cases have been reported in the literature. We report a case of a young man presenting with impending airway obstruction secondary to a malignant teratoma of the neck.

Topics: Adult; Airway Obstruction; Biopsy, Needle; Chemotherapy, Adjuvant; Combined Modality Therapy; Follow-Up Studies; Head and Neck Neoplasms; Humans; Immunohistochemistry; Malaysia; Male; Risk Assessment; Teratoma; Tomography, X-Ray Computed; Treatment Outcome

To determine the risk factors associated with severe viral croup in hospitalised Malaysian children.. The medical records of children aged less than five years admitted with a diagnosis of viral croup between 1994 and 1999 were reviewed. Severe viral croup was diagnosed in children who had stridor at rest with marked recession associated with central cyanosis or altered level of consciousness. Multivariate logistic regression analysis was performed to identify risk factors associated with severe viral croup.. Eighteen (14.7%) of 122 children with viral croup were severe. These children were older (mean age 16.8 +/- 7.2 vs 12.6 +/- 6.6 months, p = 0.01) and had a shorter duration of illness prior to admission (1.7 +/- 0.7 days vs 2.3 +/- 1.4 days, p = 0.03). Age between 12 and 24 months (OR 3.8 95% Cl 1.3, 12.7, p = 0.02) and fever (OR 5.7 95% Cl 2.9, 15.6, p = 0.02) were the only risk factors associated with severe viral croup after multivariate logistic regression analysis. Only three children or 2.5 per 100 children admitted with viral croup required ventilation.. Only a small number of children admitted particularly those between 12 to 24 months with fever developed severe viral croup. Recognition of these risk factors provides a guide in selecting children who will most likely benefit from steroid therapy. The overall outcome was nonetheless favourable.

Topics: Airway Obstruction; Child, Preschool; Female; Hospitalization; Humans; Infant; Malaysia; Male; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome; Virus Diseases

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.. 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.. 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.. 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.

Topics: Airway Obstruction; Critical Illness; Female; Humans; Infant; Intensive Care Units, Pediatric; Malaysia; Male; Respiration, Artificial; Severity of Illness Index; Survival Rate; Treatment Outcome; Tropical Climate

The objective of this study was to determine the relationship between asthma symptoms and the degree of airway obstruction as measured by the forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) in a group of 64 asthmatic patients with clinically stable disease attending a university-based urban asthma clinic. Asthma symptoms did not correlate with the degree of airway obstruction as measured by prebronchodilator PEFR (total asthma symptom score vs PEFR: r = -0.214, p = 0.104, n = 59) and only correlated poorly with prebronchodilator FEV1 (total asthma symptom score vs FEV1: r = -0.256, p = 0.041, n = 64). These results lend support to the recommendation that airway obstruction should be measured objectively when assessing patients with chronic persistent asthma.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Aged, 80 and over; Airway Obstruction; Asthma; Bronchodilator Agents; Female; Forced Expiratory Volume; Humans; Malaysia; Male; Middle Aged; Peak Expiratory Flow Rate; Predictive Value of Tests; Severity of Illness Index; Spirometry; Surveys and Questionnaires

Six children who survived severe acute bronchiolitis in infancy and early childhood continued to have persistent symptoms of breathlessness, cough and wheeze resistant to bronchodilator therapy. Hyperinflation of the chest, widespread crepitations and rhonchi were persistent clinical features. Failure to thrive was a problem in most. At presentation clinical measles was diagnosed in one child and adenovirus titres were raised in another; the aetiological agents in the others were not known. Lung biopsy from the child with measles showed features of severe bronchiolitis. The clinical and radiological features and course of the illness were consistent with those of bronchiolitis obliterans. Although illness was prolonged the long term prognosis was satisfactory with the majority of children showing improved chest signs, growth and general health after four to eight years of follow up.

Topics: Acute Disease; Adrenal Cortex Hormones; Airway Obstruction; Bronchiolitis Obliterans; Child; Child, Preschool; Humans; Malaysia; Male; Oxygen Inhalation Therapy; Prognosis