Medical Treatments in Upper Airway Obstruction
Nebulized adrenaline- This can be used to treat laryngeal oedema in patients with partial UAO who remain conscious and self-ventilating (low grade evidence).
- A typical dose is 1 mL of a 1:1000 solution diluted with saline to 5 mL.
- It is not a substitute for IM adrenaline in anaphylaxis.
Corticosteroids- Widely used in adults, despite sparse evidence (even in the setting of anaphylaxis). Some studies suggest a reduction in post-extubation laryngeal oedema with prophylactic use.
- Typically used doses are hydrocortisone 100–200 mg IV or dexamethasone 10 mg IV or IM.
Heliox- This is a mixture of at least 70% helium in oxygen, which reduces the work of breathing by diminishing turbulent flow in the partially obstructed airway.
- Its use may be limited by concomitant lung disease requiring a higher fraction of inspired oxygen. Most research has involved patients with obstructive lung disease, rather than UAO.
- It is only a temporizing measure and does nothing to correct the underlying pathology.
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