title: Work of breathing as a tool to diagnose severe fixed upper airway obstruction.
abstract: A 4-year-old girl with bilateral vocal fold palsy was successfully decannulated from tracheotomy after seven laryngeal procedures. But an important stridor and dyspnea recurred 13 months after decannulation. Nocturnal gas exchange was normal but her daytime work of breathing was increased by fourfold, without any beneficial effect of nasal noninvasive continuous positive airway pressure ventilation (CPAP), reflecting a severe fixed airway obstruction. Endoscopic examination confirmed the work of breathing findings showing glottic and supraglottic stenosis. This upper airway obstruction was successfully treated with a recannulation. In conclusion, the major message of this case report is that measurement of the work of breathing was able to document the "fixed" nature of the airway obstruction, by showing no improvement even with highest tolerated levels of nasal CPAP. As such, the work of breathing may be proposed as a screening tool to quantify and assess the reversibility of severe upper airway obstruction in children.
authors: S2A Santé, Ivry-sur-Seine, France; AP-HP, Hôpital Armand Trousseau, Pediatric Pulmonary Department, Paris, France.
authors: S
authors: S
authors: Khirani
authors: S
authors: S
authors: Pierrot
authors: N
authors: N
authors: Leboulanger
authors: A
authors: A
authors: Ramirez
authors: D
authors: D
authors: Breton
authors: V
authors: V
authors: Couloigner
authors: B
authors: B
authors: Fauroux
mesh_terms: D000402:Airway Obstruction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002675:Child, Preschool; D045422:Continuous Positive Airway Pressure; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D007829:Laryngostenosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D012135:Respiratory Sounds / Q000209:etiology; D014140:Tracheotomy; D014826:Vocal Cord Paralysis / Q000150:complications / Q000601:surgery*; D014939:Work of Breathing / Q000502:physiology*
keywords: CPAP; tracheotomy; vocal fold paralysis; work of breathing