Acute epiglottitis in adults

Baxter, Fred; Dunn, G. L.

doi:10.1007/bf03010869

Cited by 42 publications

(31 citation statements)

References 75 publications

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“…For example, the efficacy of corticosteroids in the management of croup has been documented in a randomized clinical trial [29]. In AS, the evidence supporting the use of steroids is limited [30]. A prospective randomized trial evaluating the benefits of steroids in this disease would certainly help elucidate the role of this pharmacologic intervention.…”

Section: Airway Managementmentioning

confidence: 99%

Diagnosis and management of supraglottitis (Epiglottitis)

Glynn¹,

Fenton

2008

Curr Infect Dis Rep

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Acute supraglottitis is a serious, potentially fatal infection in both adults and children. Haemophilus influenzae type b (Hib) is the most common cause in children, even in this era of the Hib vaccine. Most cases of acute supraglottitis in adults are thought to be caused by other bacterial organisms, viral or combined viral-bacterial infections, and noninfectious etiologies. Early visualization of the larynx is essential, as is establishment of a secure airway in selected cases. Most cases will respond to intravenous antibiotic therapy and will not require an artificial airway. Admission to an area of high-intensity nursing is essential. Daily laryngoscopy is necessary to monitor response to treatment. Although the incidence of acute supraglottitis in children has decreased, isolated cases will be encountered and demand high vigilance.

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Section: Airway Managementmentioning

confidence: 99%

Diagnosis and management of supraglottitis (Epiglottitis)

Glynn¹,

Fenton

2008

Curr Infect Dis Rep

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“…A third method to assess readiness for extubation is to test for an air leak around the tube or the patient's ability to breathe with the tube plugged for a few brief moments and the balloon deflated for these maneuvers [39,41]. It is important to understand the limitations of this latter method.…”

Section: Diagnosismentioning

confidence: 99%

“…The initial drug of choice at this time is a second-generation or third-generation cephalosporin, which will cover ampicillin-resistant Z7. influenzae, as well as the following other possible pathogens in adults: Staphylococcus aureus, Streptococcus pneumoniae, and other Streptococcus species [2,7,41]. Ampicillin with chloramphenicol has also been used, primarily in children where the overwhelmingly predominant organism is H. influenzae [11,39].…”

Section: Diagnosismentioning

confidence: 99%

Upper Respiratory Tract Infections in the Critically I11

Jacobs

Irwin

Raptopoulos

1990

J Intensive Care Med

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that present in the critically ill (supraglottitis [epiglottitis], deep neck infections, and sinusitis) is presented with attention to pathogenesis, pathophysiology, diagnosis, differential diagnosis, and treatment. Supraglottitis is increasingly diagnosed in adults and, as with children, early recognition is crucial to limit mortality. To aid in diagnosis and treatment, a management algorithm is used. Deep cervical infections, usually extensions of upper airway infections, can spread along fascial planes with fatal results. Knowledge of the interconnections between anatomical spaces is a prerequisite to diagnosis and treatment. Sinusitis will present in the critically ill as orbital or intracranial complications or as a nosocomial infection. Discussions of acute and chronic community-acquired sinusitis in general, nosocomial sinusitis, and sphenoid sinusitis as a separate entity highlight differences in clinical presentation and bacteriology that are important to diagnosis and treatment.The upper respiratory tract consists of the nose, mouth, nasopharynx and oropharynx, hypopharynx. and the paranasal sinuses. While minor infections in these areas are common outpatient entities, they may infrequently become severe and life threatening. It is this class of disease that requires intensive observation and aggressive treatment, and is the focus of this review. Supraglottitis (Epiglottitis). Acute supraglottitis is an uncommon infection of the epiglottis and other supralaryngeal structures, which may progress to abrupt and fatal airway obstruction. The condition is well recognized in children, in whom the presentation and course are usually fulminant. In pediatric age groups, increased awareness and prophylactic airway control have reduced the overall mortality to less than 1% [1]. In adults, however, the course is often more indolent and the mortality approximates 7%, largely due to misdiagnosis and unexpected airway obstruction [2]. Pathogenesis and Pathophysiology. Supraglottitis, the term more recently preferred, since it is more anatomically correct, is an acute, usually bacterial inflammation of the supraglottic structures including the epiglottis, aryepiglottic folds, and arytenoids. The true vocal cords are seldom involved in the process. Since the lingual aspect of the epiglottis in children has a more loose mucosa than in adults, providing an easy space for edema to collect [3], swelling in this area tends to curl the epiglottis posteriorly and inferiorly, accentuating the juvenile &dquo;omega&dquo; shape characteristically seen in children. This swelling reduces the airway aperture [4]. The obstruction increases and respiratory distress occurs when edema spreads and involves the aryepiglottic folds [5]. Inspiration draws these swollen structures downward, thus exacerbating the obstruction and producing stridor [6]. Since the larynx is larger and the epiglottis is shaped less like an omega and more like a &dquo;spatula&dquo; in adults [7], these

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“…He developed a mild dysphagia and after review by speech pathology was morbidity and the shorter hospital stay that is associated with it [8]. However, all laryngoscopy should be performed in a safe environment with all airway options considered, particularly if there is a need for an emergency tracheostomy [9].…”

Section: Case Studymentioning

confidence: 99%

Epiglottic abscess and the management of a ‘precious airway’: A case study

Smith¹,

Loizou²,

Smith³

2017

Otorhinolaryngol Head Neck Sur

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An epiglottic abscess is a rare, life-threatening cause of acute airway obstruction with a mortality of 30%, requiring immediate management with a multidisciplinary specialist team. Since HiB immunisation was introduced epiglottitis and epiglottic abscess incidence has dramatically reduced, though it has risen again in recent times due to other pathogens.We present a case of a 45-year-old gentleman who presented with odynophagia, throat pain and reduced oral intake. He was diagnosed using CT imaging with contrast and flexible nasolaryngoscopy and commenced on IV antibiotics and steroids. Definitive management of the airway was achieved with an awake fibreoptic intubation (AFOI) with tracheostomy set on standby. He underwent a second washout in theatres day 6 and was extubated day 7. Prior to discharge, he experienced postextubation dysphagia that fully recovered prior to his discharge day 13. This paper explores the need for prompt securing of the airway, the advantages of AFOI and the post-operative course of epiglottic abscesses.

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Acute epiglottitis in adults

Cited by 42 publications

References 75 publications

Diagnosis and management of supraglottitis (Epiglottitis)

Diagnosis and management of supraglottitis (Epiglottitis)

Upper Respiratory Tract Infections in the Critically I11

Epiglottic abscess and the management of a ‘precious airway’: A case study

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