Specific Diseases of the Respiratory System: Upper Airway

• Diseases leading to compromise of the airway are the most frequent cause of cardiac arrest in pediatric patients. A small reduction in the caliber of the child’s airway may lead to a life-threatening reduction of airflow. • Laryngomalacia is the most common congenital anomaly of the larynx. Infants tend to outgrow this problem during the first year of life; however, the condition may be of sufficient severity in some infants that activities such as feeding are compromised. • The trachea may be compressed by the presence of an abnormal vascular structure. Children affected by this problem may have such diverse symptoms as stridor, wheezing, lobar atelectasis, or recurrent pulmonary infections. • The practice of treating laryngotracheobronchitis with corticosteroids is standard of care, especially for hospitalized patients. A meta-analysis in which the efficacy of corticosteroids was evaluated suggests that corticosteroids may reduce the need for endotracheal intubation and hasten improvement when given in the first 24 hours of illness. • Epiglottitis, a bacterial infection of the supraglottic tissues historically caused by Haemophilus influenzae type B, is now most frequently caused by group A β-hemolytic streptococcus. • Patients with bacterial tracheitis usually do not respond to inhaled racemic epinephrine, have a high fever, and appear very ill.