Therapeutic concepts in upper airway obstruction.

In children, congenital or acquired upper airway obstruction can present as an acute, potentially life-threatening condition or a chronic process. The latter may be progressive and lead to chronic respiratory failure or episodes of acute airway obstruction. Therapeutic options have been greatly expanded recently, and the single approach of tracheotomy has been replaced by a complex and invidualised approach in many cases. Conservative treatment ranges from topical application or local injection to systemic administration of pharmacological substances such as steroids, adrenalin and antibiotics. Interventions available for children, even for the very young, include non-invasive or invasive ventilation, endoscopic or open surgical interventions. Such interventions can carry considerable risks and have to be performed cautiously by experienced personnel but offer great promise for the individual patient. Non-invasive approaches will not always be inherently safer than timely surgery.