Acute epiglottitis—25 years experience with nasotracheal intubation, current management policy and future trends

Abstract

During a 25-year period 168 adults and 111 children in Copenhagen County were treated for acute epiglottitis. Four patients, two children and two adults died, of these the two children and one adult had a cardiac arrest on arriving at the hospital. Most children were treated by nasotracheal intubation while only some adults required nasotracheal intubation in order to secure the airway. Our data indicate that intubation of adults with epiglottitis is technically more difficult than in children. The fibrelaryngoscope, a new diagnostic tool, is advocated, and was in this study used to establish the diagnosis in 12 unclear cases of acute epiglottitis. The incidence of acute epiglottitis in children was calculated at 3.2/100,000 with a minor annual variation. As vaccination against Haemophilus influenzae type b becomes more common, the incidence will probably be markedly reduced, maybe even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b.

Acute epiglottitis in adults — a recent review in an Indian hospital

“…Patients with milder symptoms, and mild to moderate edema, require admission for close airway monitoring and commencement of intravenous antibiotics and steroids. Delayed airway obstruction occurring several days after admission, has been reported, highlighting the need for regular examination of larynx to rule out signs of progressive airway obstruction [4,13,14]. Moreover, certain factors have been suggested as signs of impending airway obstruction.…”

Acute epiglottitis in adults: a recent experience with 10 cases

“…Delayed airway obstruction, occurring several days after admission, has been reported, highlighting the need for regular examination of the larynx to rule out signs of progressive airway obstruction. 6,17,18 Moreover, certain factors have been suggested as predictors of impending airway obstruction. These include dyspnoea, drooling, history of diabetes mellitus, rapid onset of symptoms and epiglottic abscess.…”

Epiglottis cyst infection presenting with acute epiglottitis

“…Erişkin hastalarda muayene ile hava yolu darlığının arttığını gösteren hiçbir çalışma yoktur, bu yüzden ciddi boğaz ağrısı ve yutma güçlüğü olan erişkin hastalar mutlaka endoskopik olarak muayene edilmelidir. [5,12,15,16] Epiglot apsesini epiglottitten ayırmada boyun BT'nin önemini vurgulayan yayınlar olmasına karşın, [17] kistin apseleşmesi ile epiglottit komplikasyonu olarak apse gelişiminin görüntüleme yöntemi ile ayırt edilmesinin neredeyse mümkün olmadığı söylenebilir. [18] Epiglottit tanısı olan erişkin hastayı sadece gözlemlemek tehlikeli olabilir.…”

“…[18] Epiglottit tanısı olan erişkin hastayı sadece gözlemlemek tehlikeli olabilir. [15] Yüksek ateşi olan ve lökositozu olan hastalar çok daha yakından takip edilmelidir. Belirgin ağır nefes darlığı olan hastalar erken entübasyondan fayda görebilir.…”