Acute epiglottitis in children: experiences with tracheotomy and intubation

Abstract

Acute epiglottitis is one of the most serious and potentially fatal conditions dealt with in paediatric laryngology. The infectious agent is mostly Haemophilus influenzae. An active and planned treatment to secure the airway is necessary to reduce the morbidity and mortality. The ‘watch and wait’ attitude should be abandoned. Tracheotomy or intubation should be performed. Mostly literature today is in favour of intubation. However, both tracheotomy and intubation can be used, and if properly managed the complication rate with both methods is low. This series comprised 102 children of whom 79 were tracheotomized and 23 were intubated. No differences could be found between intubation or tracheotomy time (2.3 and 2.9 days respectively) or in hospital stay (6.7 and 6 days). The complication rate was low in both groups except for subcutaneous and mediastinal emphysema in the tracheotomy group but these did not cause any serious problems.

Failure of intubation in acute inflammatory airway obstruction in childhood

“…Forfar and Arneil (1978) report a comparable complication rate in groups managed by both methods. In neither group was there any serious long-term complication, and Kinnefors,and Olofsson (1983) found no significant difference in the length of hospital stay in a series of 141 patients treated for epiglottitis by either tracheotomy or intubation. Bjure et al (1981) proposed that, while the overall stay in hospital may be longer in the tracheotomized group, the time spent in the ICU was much shorter than in the intubated group.…”