References | Management of Airway Obstruction and Stridor in Pediatric Patients

<< Management of Airway Obstruction and Stridor in Pediatric Patients (Pharmacology CME)


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study is included in bold type following the references, where available. The most informative references cited in this paper, as determined by the author, are noted by an asterisk (*) next to the number of the reference.

  1. Rafei K, Lichenstein R. Airway infectious disease emergencies. Pediatr Clin North Am. 2006;53(2):215-242. (Review article)
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  3. Boudewyns A, Claes J, Van de Heyning P. Clinical practice: an approach to stridor in infants and children. Eur J Pediatr. 2010;169(2):135-141. (Review article)
  4. Daniel M, Cheng A. Neonatal stridor. Int J Pediatr. 2012;2012:859104. (Review article)
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  7. Ida JB, Thompson DM. Pediatric stridor. Otolaryngol Clin North Am. 2014;47(5):795-819. (Review article)
  8. Mandal A, Kabra SK, Lodha R. Upper airway obstruction in children. Indian J Pediatr. 2015;82(8):737-744. (Review article)
  9. Dalal PG, Murray D, Messner AH, et al. Pediatric laryngeal dimensions: an age-based analysis. Anesth Analg. 2009;108(5):1475-1479. (Epidemiology study; 128 patients)
  10. Wani TM, Bissonnette B, Rafiq Malik M, et al. Age-based analysis of pediatric upper airway dimensions using computed tomography imaging. Pediatr Pulmonol. 2016;51(3):267-271. (Retrospective review; 220 patients)
  11. Litman RS, Weissend EE, Shibata D, et al. Developmental changes of laryngeal dimensions in unparalyzed, sedated children. Anesthesiology. 2003;98(1):41-45. (Epidemiology study; 99 patients)
  12. Darras KE, Roston AT, Yewchuk LK. Imaging acute airway obstruction in infants and children. Radiographics. 2015;35(7):2064-2079. (Review article)
  13. Bew S. Acute and chronic airway obstruction. Anaesth Inten Care Med. 2006;7(5):164-168. (Review article)
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  15. Primhak R. Evaluation and management of upper airway obstruction. Paediatr Child Health. 2013;23(7):301-306. (Review article)
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  18. * Petrocheilou A, Tanou K, Kalampouka E, et al. Viral croup: diagnosis and a treatment algorithm. Pediatr Pulmonol. 2014;49(5):421-429. (Systematic review)
  19. Jenkins IA, Saunders M. Infections of the airway. Paediatr Anaesth. 2009;19 Suppl 1:118-130. (Review article)
  20. Loftis L. Acute infectious upper airway obstructions in children. Semin Pediatr Infect Dis. 2006;17(1):5-10. (Review article)
  21. Shah RK, Roberson DW, Jones DT. Epiglottitis in the Hemophilus influenzae type B vaccine era: changing trends. Laryngoscope. 2004;114(3):557-560. (Retrospective chart review; 19 patients)
  22. Acevedo JL, Lander L, Choi S, et al. Airway management in pediatric epiglottitis: a national perspective. Otolaryngol Head Neck Surg. 2009;140(4):548-551. (Case series; 342 patients)
  23. * Hopkins A, Lahiri T, Salerno R, et al. Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics. 2006;118(4):1418-1421. (Retrospective case series; 107 patients)
  24. Digoy GP, Burge SD. Laryngomalacia in the older child: clinical presentations and management. Curr Opin Otolaryngol Head Neck Surg. 2014;22(6):501-505. (Review article)
  25. Sharma BS, Shekhawat DS, Sharma P, et al. Acute respiratory distress in children: croup and acute asthma. Indian J Pediatr. 2015;82(7):629-636. (Review article)
  26. Choi J, Lee GL. Common pediatric respiratory emergencies. Emerg Med Clin North Am. 2012;30(2):529-563. (Review article)
  27. Pfleger A, Eber E. Management of acute severe upper airway obstruction in children. Paediatr Respir Rev. 2013;14(2):70-77. (Review article)
  28. Al-Mutairi B, Kirk V. Bacterial tracheitis in children: approach to diagnosis and treatment. Paediatr Child Health. 2004;9(1):25-30. (Review article)
  29. Bedwell J, Zalzal G. Laryngomalacia. Semin Pediatr Surg. 2016;25(3):119-122. (Review article)
  30. Richards AM. Pediatric respiratory emergencies. Emerg Med Clin North Am. 2016;34(1):77-96. (Review article)
  31. Lee SS, Schwartz RH, Bahadori RS. Retropharyngeal abscess: epiglottitis of the new millennium. J Pediatr. 2001;138(3):435-437. (Retrospective chart review; 26 patients)
  32. Leboulanger N, Garabedian EN. Airway management in pediatric head and neck infections. Infect Disord Drug Targets. 2012;12(4):256-260. (Review article)
  33. Kawaguchi A, Joffe A. Evidence for clinicians: nebulized epinephrine for croup in children. Paediatr Child Health. 2015;20(1):19-20. (Systematic review; 8 studies, 225 patients)
  34. Rotta AT, Wiryawan B. Respiratory emergencies in children. Respir Care. 2003;48(3):248-258. (Review article)
  35. Sobol SE, Zapata S. Epiglottitis and croup. Otolaryngol Clin North Am. 2008;41(3):551-566. (Review article)
  36. Al-Gazi M, Quinn K. Case 1: a toddler with stridor. Paediatr Child Health. 2012;17(6):307-308. (Case report)
  37. Mauro RD, Poole SR, Lockhart CH. Differentiation of epiglottitis from laryngotracheitis in the child with stridor. Am J Dis Child. 1988;142(6):679-682. (Retrospective chart review; 155 patients)
  38. Stoner MJ, Dulaurier M. Pediatric ENT emergencies. Emerg Med Clin North Am. 2013;31(3):795-808. (Review article)
  39. Ibrahimov M, Yollu U, Akil F, et al. Laryngeal foreign body mimicking croup. J Craniofac Surg. 2013;24(1):e7-e8. (Case report)
  40. Cirilli AR. Emergency evaluation and management of the sore throat. Emerg Med Clin North Am. 2013;31(2):501-515. (Review article)
  41. Tanizaki S. Assessing inhalation injury in the emergency room. Open Access Emerg Med. 2015;7:31-37. (Review article)
  42. Berg E, Naseri I, Sobol SE. The role of airway fluoroscopy in the evaluation of children with stridor. Arch Otolaryngol Head Neck Surg. 2008;134(4):415-418. (Retrospective chart review; 39 patients)
  43. Kulendra K, Mullineux J, McDermott AL, et al. Are contrast swallows a relevant investigation for paediatric stridor? Eur Arch Otorhinolaryngol. 2013;270(3):969-973. (Retrospective audit study; 117 cases)
  44. * Cohen S, Avital A, Godfrey S, et al. Suspected foreign body inhalation in children: what are the indications for bronchoscopy? J Pediatr. 2009;155(2):276-280. (Prospective cohort study; 142 patients)
  45. Najada AS, Dahabreh MM. Bronchoscopy findings in children with recurrent and chronic stridor. J Bronchology Interv Pulmonol. 2011;18(1):42-47. (Retrospective chart review; 64 patients)
  46. Fraga JC, Jennings RW, Kim PC. Pediatric tracheomalacia. Semin Pediatr Surg. 2016;25(3):156-164. (Review article)
  47. Javia L, Harris MA, Fuller S. Rings, slings, and other tracheal disorders in the neonate. Semin Fetal Neonatal Med. 2016;21(4):277-284. (Review article)
  48. Dobbie AM, White DR. Laryngomalacia. Pediatr Clin North Am. 2013;60(4):893-902. (Review article)
  49. Cheng J, Smith LP. Endoscopic surgical management of inspiratory stridor in newborns and infants. Am J Otolaryngol. 2015;36(5):697-700. (Consecutive case series with chart review; 30 patients)
  50. Ayari S, Aubertin G, Girschig H, et al. Management of laryngomalacia. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(1):15-21. (Update article)
  51. * Parkes WJ, Propst EJ. Advances in the diagnosis, management, and treatment of neonates with laryngeal disorders. Semin Fetal Neonatal Med. 2016;21(4):270-276. (Review article)
  52. Midyat L, Cakir E, Kut A. Upper airway abnormalities detected in children using flexible bronchoscopy. Int J Pediatr Otorhinolaryngol. 2012;76(4):560-563. (Retrospective chart review; 1076 patients)
  53. Rankin I, Wang SM, Waters A, et al. The management of recurrent croup in children. J Laryngol Otol. 2013;127(5):494-500. (Retrospective chart review; 90 patients)
  54. Kwong K, Hoa M, Coticchia JM. Recurrent croup presentation, diagnosis, and management. Am J Otolaryngol. 2007;28(6):401-407. (Retrospective chart review; 17 patients)
  55. Arslan Z, Cipe FE, Ozmen S, et al. Evaluation of allergic sensitization and gastroesophageal reflux disease in children with recurrent croup. Pediatr Int. 2009;51(5):661-665. (Prospective observational study; 57 patients)
  56. D’Agostino J. Pediatric airway nightmares. Emerg Med Clin North Am. 2010;28(1):119-126. (Review article)
  57. Diep J, Kam D, Kuenzler KA, et al. Emergent airway management of an uncooperative child with a large retropharyngeal and posterior mediastinal abscess. A A Case Rep. 2016;6(3):61-64. (Case report)
  58. Shah S, Sharieff GQ. Pediatric respiratory infections. Emerg Med Clin North Am. 2007;25(4):961-979. (Review article)
  59. Johnson DW. Croup. BMJ Clin Evid. 2014 Sep 29;2014. pii: 0321. (Systematic review)
  60. * Fitzgerald DA. The assessment and management of croup. Paediatr Respir Rev. 2006;7(1):73-81. (Review article)
  61. Russell KF, Liang Y, O’Gorman K, et al. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011(1):CD001955. (Cochrane review; 38 studies)
  62. * Amir L, Hubermann H, Halevi A, et al. Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial. Pediatr Emerg Care. 2006;22(8):541-544. (Prospective randomized trial; 52 patients)
  63. Rittichier KK, Ledwith CA. Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing. Pediatrics. 2000;106(6):1344-1348. (Single-blind prospective study; 277 patients)
  64. Geelhoed GC. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. Pediatr Emerg Care. 2005;21(6):359-362. (Randomized controlled trial; 72 patients)
  65. Geelhoed GC, Macdonald WB. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol. 1995;20(6):362-368. (2 sequential double-blind randomized trials; 60 children in each group)
  66. Chub-Uppakarn S, Sangsupawanich P. A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup. Int J Pediatr Otorhinolaryngol. 2007;71(3):473-477. (Randomized comparison study; 41 patients)
  67. Moraa I, Sturman N, McGuire T, et al. Heliox for croup in children. Cochrane Database Syst Rev. 2013(12):CD006822. (Cochrane review; 3 randomized controlled trials, 91 patients)
  68. Myers TR. Use of heliox in children. Respir Care. 2006;51(6):619-631. (Review article)
  69. * Kline-Krammes S, Reed C, Giuliano JS Jr, et al. Heliox in children with croup: a strategy to hasten improvement. Air Med J. 2012;31(3):131-137. (Retrospective chart review; 35 patients)
  70. * Bjornson C, Russell K, Vandermeer B, et al. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev. 2013(10):CD006619. (Cochrane review; 8 studies, 225 patients)
  71. Eghbali A, Sabbagh A, Bagheri B, et al. Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study. Fundam Clin Pharmacol. 2016;30(1):70-75. (Randomized double-blind clinical trial; 174 patients)
  72. Moore M, Little P. Humidified air inhalation for treating croup: a systematic review and meta-analysis. Fam Pract. 2007;24(4):295-301. (Systematic review and meta-analysis; 3 studies, 135 patients)
  73. Cherry JD. Clinical practice. Croup. N Engl J Med. 2008;358(4):384-391. (Clinical practice)
  74. Cooper T, Kuruvilla G, Persad R, et al. Atypical croup: association with airway lesions, atopy, and esophagitis. Otolaryngol Head Neck Surg. 2012;147(2):209-214. (Case series with chart review; 88 patients)
  75. Tibballs J, Watson T. Symptoms and signs differentiating croup and epiglottitis. J Paediatr Child Health. 2011;47(3):77-82. (Prospective observational study; 203 patients)
  76. Kavanagh KR, Batti JS. Traumatic epiglottitis after foreign body ingestion. Int J Pediatr Otorhinolaryngol. 2008;72(6):901-903. (Case report)
  77. Orenstein JB, Thomsen JR, Baker SB. Pneumococcal bacterial tracheitis. Am J Emerg Med. 1991;9(3):243-245. (Case report)
  78. Chan PW, Goh A, Lum L. Severe upper airway obstruction in the tropics requiring intensive care. Pediatr Int. 2001;43(1):53-57. (Retrospective chart review; 56 patients aged < 12 years)
  79. Nagler J, Ruebner RL. Suppurative complications and upper airway obstruction in infectious mononucleosis. J Hosp Med. 2007;2(4):280-282. (Case report)
  80. Glynn FJ, Mackle T, Kinsella J. Upper airway obstruction in infectious mononucleosis. Eur J Emerg Med. 2007;14(1):41-42. (Case report)
  81. Jain V, Singhi S, Desai RV. Infectious mononucleosis presenting as upper airway obstruction. Indian J Chest Dis Allied Sci. 2003;45(2):135-137. (Case report)
  82. Chan SC, Dawes PJ. The management of severe infectious mononucleosis tonsillitis and upper airway obstruction. J Laryngol Otol. 2001;115(12):973-977. (Retrospective chart review; 36 patients)
  83. Chen TH, Tseng YH, Yang SN. A child with severe stridor. Emerg Med J. 2013;30(7):603. (Case report)
  84. Lin HW, O’Neill A, Cunningham MJ. Ludwig’s angina in the pediatric population. Clin Pediatr (Phila). 2009;48(6):583-587. (Review article)
  85. Shubha AM, Das K. Tracheobronchial foreign bodies in infants. Int J Pediatr Otorhinolaryngol. 2009;73(10):1385-1389. (Retrospective chart review; 102 patients)
  86. Sittel C. Pathologies of the larynx and trachea in childhood. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc09. (Review article)
  87. Mandal S, Ghosh A, Saha S, et al. Dilemma in diagnosis between acute laryngotracheobronchitis and airway foreign body. Journal of Case Reports. 2015;5(1):33-36. (Case report)
  88. Linscott MS, Horton WC. Management of upper airway obstruction. Otolaryngol Clin North Am. 1979;12(2):351-373. (Review article)
  89. Rudders SA, Banerji A, Clark S, et al. Age-related differences in the clinical presentation of food-induced anaphylaxis. J Pediatr. 2011;158(2):326-328. (Retrospective chart review, 605 patients)
  90. Kim H, Dinakar C, McInnis P, et al. Inadequacy of current pediatric epinephrine autoinjector needle length for use in infants and toddlers. Ann Allergy Asthma Immunol. 2017;118(6):719-725. (Prospective observational study; 53 patients)
  91. * Simons FE, Sampson HA. Anaphylaxis: unique aspects of clinical diagnosis and management in infants (birth to age 2 years). J Allergy Clin Immunol. 2015;135(5):1125-1131. (Review article)
  92. Chipps B. Update in pediatric anaphylaxis: a systematic review. Clin Pediatr. 2013;52(5):451-461. (Systematic review)
  93. Einhorn A, Horton L, Altieri M, et al. Serious respiratory consequences of detergent ingestions in children. Pediatrics. 1989;84(3):472-474. (Case reports)
  94. Riffat F, Cheng A. Pediatric caustic ingestion: 50 consecutive cases and a review of the literature. Dis Esophagus. 2009;22(1):89-94. (Retrospective chart review; 50 patients)
  95. Madnani DD, Steele NP, de Vries E. Factors that predict the need for intubation in patients with smoke inhalation injury. Ear Nose Throat J. 2006;85(4):278-280. (Retrospective chart review; 41 patients)
  96. Dorsey DP, Bowman SM, Klein MB, et al. Perioperative use of cuffed endotracheal tubes is advantageous in young pediatric burn patients. Burns. 2010;36(6):856-860. (Retrospective chart review, 327 patients)
  97. Chen EY, Inglis AF Jr. Bilateral vocal cord paralysis in children. Otolaryngol Clin North Am. 2008;41(5):889-901. (Review article)
  98. Kothur K, Singh M, Dayal D, et al. Bilateral idiopathic vocal cord palsy. Pediatr Emerg Care. 2007;23(3):171-172. (Case report)
  99. Rosin DF, Handler SD, Potsic WP, et al. Vocal cord paralysis in children. Laryngoscope. 1990;100(11):1174-1179. (Retrospective chart review; 51 patients)
  100. Gimenez LM, Zafra H. Vocal cord dysfunction: an update. Ann Allergy Asthma Immunol. 2011;106(4):267-274. (Review article)
  101. Vats A, Worley GA, de Bruyn R, et al. Laryngeal ultrasound to assess vocal fold paralysis in children. J Laryngol Otol. 2004;118(6):429-431. (Case series; 55 patients)
  102. Lyons M, Vlastarakos PV, Nikolopoulos TP. Congenital and acquired developmental problems of the upper airway in newborns and infants. Early Hum Dev. 2012;88(12):951-955. (Review article)
  103. Setlur J, Hartnick CJ. Management of unilateral true vocal cord paralysis in children. Curr Opin Otolaryngol Head Neck Surg. 2012;20(6):497-501. (Review article)
  104. Tilles SA, Ayars AG, Picciano JF, et al. Exercise-induced vocal cord dysfunction and exercise-induced laryngomalacia in children and adolescents: the same clinical syndrome? Ann Allergy Asthma Immunol. 2013;111(5):342-346. (Retrospective chart review; 143 patients)
  105. Daniel SJ. The upper airway: congenital malformations. Paediatr Respir Rev. 2006;7 Suppl 1:S260-S263. (Review article)
  106. Faria J, Behar P. Medical and surgical management of congenital laryngomalacia: a case-control study. Otolaryngol Head Neck Surg. 2014;151(5):845-851. (Case-control study; 51 patients)
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  108. Bitar MA, Al Barazi R, Barakeh R. Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis. Braz J Otorhinolaryngol. 2017;83(3):299-312. (Retrospective review; 25 patients)
  109. Avelino MG, Fernandes EJ. Balloon laryngoplasty for subglottic stenosis caused by orotracheal intubation at a tertiary care pediatric hospital. Int Arch Otorhinolaryngol. 2014;18(1):39-42. (Prospective cohort study; 9 patients)
  110. Aubin A, Lescanne E, Pondaven S, et al. Stridor and lingual thyroglossal duct cyst in a newborn. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(6):321-323. (Case report)
  111. Busino RS, Quraishi HA, Cohen IT. Stridor secondary to a bronchogenic cyst in a neonate. Ear Nose Throat J. 2011;90(11):E8-E10. (Case report)
  112. Cheng J. Isolated subglottic hemangiomas: a potential diagnostic challenge in the absence of a cutaneous clue. Am J Otolaryngol. 2015;36(3):399-401. (Consecutive case series with chart review; 2 patients)
  113. Meier JD, Grimmer JF. Evaluation and management of neck masses in children. Am Fam Physician. 2014;89(5):353-358. (Review article)
  114. Licari A, Manca E, Rispoli GA, et al. Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol. 2015;50(5):511-524. (Review article)
  115. Tola H, Ozturk E, Yildiz O, et al. Assessment of children with vascular ring. Pediatr Int. 2017;59(2):134-140. (Retrospective chart review; 21 patients)
  116. Leibowitz JM, Smith LP, Cohen MA, et al. Diagnosis and treatment of pediatric vallecular cysts and pseudocysts. Int J Pediatr Otorhinolaryngol. 2011;75(7):899-904. (Retrospective chart review; 11 patients)
  117. Burns SC, Leonard P. Recurrent respiratory papillomatosis presenting to an emergency department. Eur J Emerg Med. 2010;17(2):116-118. (Case report)
  118. Elluru RG, Friess MR, Richter GT, et al. Multicenter evaluation of the effectiveness of systemic propranolol in the treatment of airway hemangiomas. Otolaryngol Head Neck Surg. 2015;153(3):452-460. (Case series with chart review; 27 patients)
  119. Vivas-Colmenares GV, Fernandez-Pineda I, Lopez-Gutierrez JC, et al. Analysis of the therapeutic evolution in the management of airway infantile hemangioma. World J Clin Pediatr. 2016;5(1):95-101. (Retrospective chart review; 23 patient)
  120. Hamilton J, Yaneza MM, Clement WA, et al. The prevalence of airway problems in children with Down’s syndrome. Int J Pediatr Otorhinolaryngol. 2016;81:1-4. (Retrospective chart review; 239 patients)
  121. * Rudinsky SL, Sharieff GQ, Law W, et al. Inpatient treatment after multi-dose racemic epinephrine for croup in the emergency department. J Emerg Med. 2015;49(4):408-414. (Retrospective chart review; 200 patients)
  122. Narayanan S, Funkhouser E. Inpatient hospitalizations for croup. Hosp Pediatr. 2014;4(2):88-92. (Retrospective chart review; 327 patients)
  123. Alqurashi W, Stiell I, Chan K, et al. Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis. Ann Allergy Asthma Immunol. 2015;115(3):217-223. (Chart review; 484 patients)
  124. Lee JM, Greenes DS. Biphasic anaphylactic reactions in pediatrics. Pediatrics. 2000;106(4):762-766. (Retrospective chart review; 108 patients)
  125. Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005;95(3):217-226. (Review article)
  126. Manuyakorn W, Benjaponpitak S, Kamchaisatian W, et al. Pediatric anaphylaxis: triggers, clinical features, and treatment in a tertiary-care hospital. Asian Pac J Allergy Immunol. 2015;33(4):281-288. (Retrospective chart review; 160 patients)
  127. Greifer M, Santiago MT, Tsirilakis K, et al. Pediatric patients with chronic cough and recurrent croup: the case for a multidisciplinary approach. Int J Pediatr Otorhinolaryngol. 2015;79(5):749-752. (Retrospective chart review; 40 patients)
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Ashley Marchese, MD; Melissa L. Langhan, MD, MHS

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November 2, 2017

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