pulmonary disorders
Stridor
Treatment of Stridor
Definitive treatment of stridor involves treating the underlying disorder. As a temporizing measure in patients with severe distress, a mixture of helium and oxygen (heliox) improves airflow and reduces stridor in disorders of the large airways, such as postextubation laryngeal edema, croup, and laryngeal tumors. The mechanism of action is thought to be reduced flow turbulence as a result of lower density of helium compared with oxygen and nitrogen. Nebulized racemicepinephrine(0.5 to 0.75 mL of 2.25% racemicepinephrineadded to 2.5 to 3 mL of normal saline) anddexamethasone(10 mg IV, then 4 mg IV every 6 hours) may be helpful in patients in whom airway edema is the cause. Tracheal Intubation should be used to secure the airway in patients with advanced respiratory distress, impending loss of airway, or decreased level of consciousness; if possible, this should be done in the operating room. When significant edema is present, endotracheal intubation can be difficult, and emergency surgical airway measures (eg, cricothyrotomy, tracheostomy) may be required. In patients with advanced respiratory distress and stridor (including in children with suspected epiglottitis), perform endotracheal intubation in the operating room whenever possible. 