Life-threatening airway obstruction secondary to mass in children-a preventable event?

Objectives: To investigate the management of children with life-threatening airway obstruction from large mediastinal masses.
Methods: Review of the medical records of children with mediastinal masses and severe airway obstruction who were admitted to a multidisciplinary pediatric intensive care unit.
Results: Eight patients with 12 life-threatening events were identified. Five events (in 4 patients) occurred before hospital admission, and 3 patients had more than 1 choking episode. Five patients underwent cardiorespiratory resuscitation (2 before admission), and 2 underwent emergency endotracheal intubation because of severe airway obstruction; the eighth patient could not be weaned off the ventilator until the mediastinal mass was resected. Median time from appearance of the initial symptoms to diagnosis was 8.5 days, and median time from the onset of alarming signs to admission was 2 days.
Conclusions: Severe airway obstruction in children with an anterior mediastinal mass is not rare and can lead to complete obstruction, requiring cardiorespiratory resuscitation. Physician awareness and preparedness for respiratory complications are essential for proper management of children with mediastinal masses.