Management of severe upper airway obstruction not due to a foreign body in children^*

ICU: intensive care unit; LMA: laryngeal mask airway; OR: operating room; RSI: rapid sequence intubation.

* The following findings suggest upper airway obstruction:

• Inspiratory stridor, wheezing, or stertor
• Suprasternal or supraclavicular retractions
• Prolonged inspiratory phase
• Drooling
• Dysphagia

Positions of comfort to help maintain airway patency in patients with severe obstruction:

• "Sniffing" position (neck is mildly flexed and head is mildly extended)
• Tripod position (leaning forward while bracing on the arms with neck hyperextended and chin thrust forward)

¶ Refer to UpToDate topics on evaluation of upper airway obstruction in children.

Δ Needle cricothyroidotomy may be performed on patients of any age but is used instead of surgical cricothyroidotomy in infants and children up to 10 to 12 years of age because it is anatomically easier to perform with less potential damage to the larynx and surrounding structures. For description of the technique and performance of cricothyrotomy and transtracheal ventilation, refer to UpToDate topics on needle and surgical cricothyrotomy.