Upper airway obstruction happens when there is an anatomic narrowing or occlusion that results in a reduced ability to exchange gas in and out of the lungs. The obstruction can lead to respiratory failure, arrhythmias, cardiac arrest or death within minutes. Therefore, healthcare professionals must be aware of signs and symptoms, possible causes and management in order to intervene promptly and minimise morbidity and mortality.
The upper airway includes four compartments: the nose and mouth, the pharynx, the larynx, and the trachea.1 Obstruction can occur in any of these compartments. The onset can be acute or may evolve chronically.1,2 Chronic airway obstruction can also develop into an acute episode with further narrowing of the airway.
Upper airway obstruction is also classified as partial or complete depending on the degree of occlusion.2 Partial obstruction allows for some gas exchange, whilst complete obstruction does not allow any.
Patients presenting with acute upper airway obstruction may be unable to give history and are often in distress. Accessory muscles of respiration may be used (neck and shoulder muscles), and there may be intercostal and subcostal recession and a tracheal tug.3 When obstruction is complete, patients may be unconscious or in cardiopulmonary arrest.
The Resuscitation Council UK (2015, 2017) recommends assessing a possible airway obstruction by the look, listen and feel approach. 3,4
This approach will help identify whether an obstruction is present, and if it is a partial of complete obstruction. In complete obstructions, there are often no sounds and there may be paradoxical chest and abdominal movements, described as ‘see-saw breathing’ as the patient tries to ventilate.3
In partial airway obstruction, air entry is reduced and usually noisy:3
There are several possible causes of upper airway obstruction:
When a patient presents with upper airway obstruction, the immediate goal is relieving the obstruction, so air exchange can occur. In acute obstructions, the condition can worsen rapidly if left untreated. Even though the focus is in correcting the underlying cause, in acute cases, it may be required to correct the obstruction first before identifying the pathology.
Main considerations in upper airway obstruction intervention include the following:3,4
Upper airway obstruction can be acute or chronic and lead to respiratory failure, arrhythmias, cardiac arrest or death within minutes. Healthcare professionals must be aware of signs and symptoms, possible causes and management described above in order to intervene promptly and minimise morbidity and mortality.
My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management.
This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.
The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger.
1. Gautam George; Michael Lippmann (2017) Disorders of the Central Airways and Upper Airway Obstruction. Pulmonology Advisor. Available at https://www.pulmonologyadvisor.com/home/decision-support-in-medicine/pulmonary-medicine/disorders-of-the-central-airways-and-upper-airway-obstruction/
2. Mark F. Brady; Bracken Burns (2019) Airway Obstruction. Available at https://www.ncbi.nlm.nih.gov/books/NBK470562/
3. Resus (2017) Airway Management and Ventilation. Available at https://lms.resus.org.uk/modules/m65-non-technical-skills/resources/chapter_7.pdf
4. Resus (2015) The ABCDE Approach. Available at https://www.resus.org.uk/library/2015-resuscitation-guidelines/abcde-approach
5. Finucane BT, Santora AH. Airway Management. 3th ed. New York, NY: Springer; 2003: 81.