ACUTE EPIGLOTTITIS IN CHILDREN: Review of 27 patients

Abstract

Of 27 children treated for acute epiglottitis, 26 survived. Eighteen patients treated by nasotracheal intubation were devoid of sequelae, whereas of six patients in whom tracheotomy was performed, one developed an ugly scar and two had slight tracheal stenosis at the tracheostomy site. In 22 of the 27 children the diagnosis of the referring physician was wrong, causing serious delay in securing the airway. We conclude that short-term nasotracheal intubation and antibiotic prophylaxis is the optimal treatment for acute epiglottitis in children. However, such patients are often in a critical condition, and it is essential that a well-planned procedure for examination and treatment is established in each hospital.

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

“…One patient, the 29-year-old man who died, was treated in the beginning of our study period, and this case highlighted the need for and precipitated the implementation of our present protocol. AE can have fatal consequences both in adults and children (Breivik and Klaastad, 1978;Hugosson etai, 1991), but the need for intubation in adults appears more likely to be initially misjudged and the fact that obstruction can occur suddenly and unexpectedly as in the children, may explain why we had to perform two emergency tracheostomies in our observed adults. This would suggest that more adults should be primarily intubated.…”

“…Acute epiglottitis, originally thought to be primarily a childhood disease (Breivik and Klaastad, 1978;Editorial, 1978;Hannallah and Rosales, 1978), is today accepted to be a disease that affects both adults and children (Andreassen ef a/., 1984;Trollforsefa/., 1990;Hugossonefa/., 1991). In our material we have more adults than children (Table I) and this same age-distribution is found in The National Patient Register (NPR); a register of the diagnoses in all patients discharged from hospitals in Denmark (Table III).…”

Acute epiglottitis in children and adults. Nasotracheal intubation, tracheostomy or careful observation? Current status in Scandinavia

“…In accord with other recent reports, however, the greater part of our series consisted of adults (49 patients >15 years versus 43 children) (Fryksmark etal., 1981, Andreassen etal, 1984. As in other series, the highest incidence of AE was found among children less than six years of age, and the male:female ratio was about 2:1 (Breivik and Klaastad, 1978;Olofsson et al, 1984). The following history and symptoms were typical for most children: a sudden onset of high fever; a toxic appearance; a preference for leaning forward in the sitting position; dysphagia with drooling of saliva, and a thick muffled voice without any apparent hoarseness.…”

“…In our series only three (six per cent) of the adults needed intubation. To regard, on the other hand, AE in adujts as a non-life threatening disease would be erroneous, as shown in several reports of fatal cases (Breivik and Klaastad, 1978;Andreassen et al, 1983;McNelis, 1985). Therefore, adults with AE should also be handled with the utmost care.…”

“…Acute epiglottitis (AE) is still a dangerous bacterial infection which in a few hours may give rise to sudden total airway obstruction. Following correct diagnosis and treatment, however, the dangerous phase may be over in 12-14 hours (Breivik and Klaastad, 1978).…”