II. Definitions
- Subglottic Stenosis
- Congenital or acquired narrowing of the airway immediately below the level of the Larynx (cricoid cartilage level)
III. Pathophysiology
- Subglottic airway (between Vocal Cords and trachea) is the narrowest portion of the upper airway
- Most common cause is prior Premature Infants with history of prolonged intubation (scar forms in subglottis)
- Typically present 3 to 6 weeks after Extubation
IV. Epidemiology
- Rare aside from Premature Infants who underwent prolonged intubation
V. Causes
- Congenital Anomaly
- Acquired
- Airway Trauma
- Prolonged neonatal Endotracheal Intubation (postintubation stenosis)
- Gastroesophageal Reflux disease
- Infectious
- Airway Trauma
VI. Symptoms
VII. Diagnostics
-
Pulmonary Function Tests
- Typically demonstrates a fixed upper airway obstruction
VIII. Management
- Non-Emergent Presentation
- Otolaryngology Consultation in all suspected cases
- Endoscopic dilation or surgical repair
-
Emergency Airway Management (respiratory distress)
- Early emergent Consultation with ENT for surgical Tracheostomy
- Temporize airway
- Nebulized racemic epinephrine (preferred)
- Systemic Corticosteroids
- Noninvasive Positive Pressure Ventilation (NIPPV)
- High Flow Nasal Cannula (HHNFC)
- Calm Patient
- Other measures
- Tracheal Jet Ventilation
- Heliox
- References
- Guest and Friedman in Herbert (2020) EM Rap 20(12): 1-2
IX. References
- Dahan, Campbell and Melville (2020) Crit Dec Emerg Med 34(11): 3-10