Intubation decision criteria in adult epiglottitis

Pineau, Pascal; Gautier, J C; Pineau, Alain; Emam, Nermin; Laccourreye, L.; Boucher, Sophie

doi:10.1016/j.anorl.2020.12.001

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…[ 8 , 10 ] The present case responded poorly to conservative treatment with antibiotics or steroids and developed dyspnea with a decrease in SPO 2 , which was a sign of airway compromise. According to the studies by Pineau [ 1 ] and Katori, [ 8 ] the occurrence of dyspnea and a rapidly progressive clinical course in acute epiglottitis necessitates airway intervention. Therefore, gaining airway access was crucial for our patients.…”

Section: Discussionmentioning

confidence: 99%

“…Acute epiglottitis is not an uncommon disease, and it can cause high mortality due to airway obstruction. [1] Reportedly, <10% of cases of acute epiglottitis require airway intervention. [2] Cervical necrotizing fasciitis is a rare, rapidly progressive, and life-threatening disease, with a fatality rate of 7% to 50%.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Difficult intubation in a patient with acute epiglottitis and abscess complicated with cervical necrotizing fasciitis: A case report

Fu,

Yang,

2024

Medicine

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Introduction: Acute epiglottitis is not uncommon and it can cause high mortality due to airway obstruction. Acute epiglottitis complicated with cervical necrotizing fasciitis has rarely been reported, and it is also a life-threatening disease with a fatality rate of 7% to 50%. Patient concerns: A 64-year-old woman presented to our hospital with chief complaints of sore throat and cervical swelling, long with foreign body sensation and hoarseness. Endoscopic laryngoscopy showed erythematous and swollen epiglottis with purulent secretions on the surface. Computed tomography (CT) scan showed swollen epiglottis and swelling of the neck with air- and fluid-containing necrotizing tissue. Diagnoses: The diagnosis was acute epiglottitis and abscess complicated with cervical necrotizing fasciitis. Interventions: With the patient in awake condition, airway access was established by performing intubation with adjunctive use of gum elastic bougie, followed by surgical debridement under general anesthesia; a flap was used for skin coverage and intravenous piperacillin-tazobactam was administered. Outcomes: The patient was discharged without complications. Conclusion: Gum elastic bougie is a usable tool in difficult intubation. Adequate pre-anesthesia evaluation, patient sedation, and gentle manipulation assured the intubation success in this case.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Difficult intubation in a patient with acute epiglottitis and abscess complicated with cervical necrotizing fasciitis: A case report

Fu,

Yang,

2024

Medicine

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“…Proper protection of the airway with close surveillance of respiratory function and adequate infection control are important for the management of concurrent DNI and AE [ 19 ]. Airway specialists, such as otolaryngologists and anesthesiologists, should ideally evaluate the patient immediately to give sufficient time for preparation to secure the airway.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis

Wang

Chin

et al. 2021

Diagnostics

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Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905–158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961–4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187–175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131–5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.

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“…Рекомендована ранняя интубация практически всем пациентам для профилактики внезапной асфиксии [7,11,20,21,[35][36][37][38]. (Уровень убедительности рекомендаций -C; уровень достоверности доказательств -5.…”

Section: консервативное лечение эпиглоттитаunclassified

Modern Approaches to the Management of Children with Acute Obstructive Laryngitis and Epiglottitis

et al. 2022

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Experts of the Union of Pediatricians of Russia have developed modern guidelines on the management of children with acute obstructive laryngitis and epiglottitis. Croup is the most common cause of acute upper respiratory obstruction in children aged from 6 months to 6 years. Usually respiratory viruses are the pathogenic agents of the disease. The etiological factor of epiglottitis is Haemophilus influenzae type b in the vast majority of cases (> 90%). However, nowadays, epiglottitis caused by this pathogen agent is more common in adults in countries with mass immunization against hemophilic infection. This article considers in detail etiology, pathogenesis, and classification issues. Special attention is given to diagnosis, differential diagnosis, and therapy (via evidence-based approach) of acute obstructive laryngitis in children.

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Intubation decision criteria in adult epiglottitis

Cited by 9 publications

References 19 publications

Difficult intubation in a patient with acute epiglottitis and abscess complicated with cervical necrotizing fasciitis: A case report

Difficult intubation in a patient with acute epiglottitis and abscess complicated with cervical necrotizing fasciitis: A case report

Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis

Modern Approaches to the Management of Children with Acute Obstructive Laryngitis and Epiglottitis

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