Management Of Acute Epiglottitis Research Articles

Acute epiglottitis in elderly age group: Our experiences at a tertiary care teaching hospital in Eastern India

Background: Acute epiglottitis (AE) is a potentially life-threatening condition which can lead to airway obstruction. It is less commonly encountered in elderly persons but has more potential for poor outcome due to the indolent property of the clinical presentations. Objective: The objective of this study is to assess the clinical presentations and management of the elderly patients who visited the outpatient department of otorhinolaryngology with AE. Materials and Methods: This is a retrospective study done at a tertiary care teaching hospital from December 2014 to November 2019. We searched our electronic medical records for patient details with the diagnosis of AE. The patients of more than the age 50 years were included in this study. Results: A total of 21 patients were included in this study. The age ranges were from 52 to 78 years, with the mean age of the patients was 59.21 years. The most common symptom was sore throat (n = 19, 90.47%), followed by odynophagia (n = 13, 61.90%), fever (n = 9, 42.85%), change in voice (n = 7, 33.33%), drooling of saliva (n = 4%, 19.04%), and dyspnea (n = 4, 19.04%). Seventeen patients were treated conservatively with the help of broad-spectrum antibiotics and steroids without the requirement of definite airway intervention. Two patients were intubated, one underwent tracheostomy and one underwent cricothyrotomy. Conclusion: In elderly patients with AE, sore throat is the most common clinical symptom, but stridor is less common. Conservative management is commonly utilized for the management of AE in elderly patients. If AE left untreated, can progress to life-threatening airway obstruction and so the diagnosis not be missed.

Management of acute epiglottitis in adults

Management of acute epiglottitis in adults

Acute epiglottitis in adults: a recent experience with 10 cases

Our objective was to examine the presentation, clinical course and management of acute epiglottitis in a recent series of adult patients. All consecutive adults with acute epiglottitis or supraglottitis admitted to a tertiary referral centre over a recent six-month period were included in this retrospective study. The diagnosis of epiglottitis or supraglottitis was established by flexible nasolaryngoscopy. Ten patients were included. Two patients had concurrent acute tonsillitis and one had a peritonsillar abscess. Blood cultures were negative in all cases. Pathogens were isolated by throat swabs only in the two patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of cefotaxime and metronidazole was the most common antibiotic regimen used. The rising incidence of acute epiglottitis in the adult population mandates vigilance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with airway obstruction of more than 50 per cent.

Acute epiglottitis in adults: the Royal Melbourne Hospital experience.

To examine the common presentations and management of acute epiglottitis in adults. Retrospective clinical study of 17 consecutive adult patients who presented to the Royal Melbourne Hospital between January 1988 and December 2000 was undertaken. The mean patient age was 47 years (range 20-87 years) and the male-to-female ratio was 1.8 : 1.0. Peak incidence occurred in September during early spring. All patients presented with sore throat and dysphagia; however, respiratory distress was only noted in 65%. The most common signs were temperature and tachycardia. Four patients (23%) required endotracheal intubation, which was performed electively in three and as an emergency in one. Three of 14 blood cultures were positive, two yielded Haemophilus influenzae type b and one yielded Streptococcus mitis. One of the four throat cultures was positive for Haemophilus influenzae type b. Twelve patients underwent awake flexible laryngoscopy under topical anaesthetic as part of their initial assessment, and there were no complications associated with this procedure. There was no mortality. The diagnosis of acute epiglottitis in the adult population is difficult as respiratory distress may be absent. Patients who have a significant sore throat with no obvious aetiology should have direct visualization of their larynx by flexible laryngoscopy. Lateral X-ray of neck is of limited value. Once diagnosed, these patients should be hospitalized and monitored as airway obstruction may develop rapidly.

Airway endoscopy in the interdisciplinary management of acute epiglottitis

Introduction: Acute epiglottitis (AE) continues to cause life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in the management of AE, to clarify the role of airway endoscopy, and to establish the cause of death in this disease. Material: The subjects of our retrospective study were 24 children with AE treated in the paediatric intensive care unit (PICU) of the University of Cologne between 1980 and 1994. The records of all patients were reviewed. Results: Laryngoscopy with fibreoptic or small rigid endoscopes allowed accurate diagnosis of AE, particularly in patients presented with atypical clinical signs. Furthermore, endoscopic information of the degree of inflammation were helpful in the critical decision, whether artificial airway was required. The number of patients managed without intubation increased (8% vs. 45%) since airway endoscopy became available in 1989. No evidence of β-lactamase-producing strains of Haemophilus influenzae was observed. The most remarkable finding was the high mortality in AE (12.5%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespiratory arrest. Conclusion: The most decisive factor to decrease mortality seems to be timely appropriate presentation at referring centres, if AE is suspected or stridor remains unclear. Fibreoptic airway endoscopy represents a major step forward in the management of acute epiglottitis, and this requires close interdisciplinary collaboration between paediatricians, anaesthetists and otorhinolaryngologists.

Oropharyngeal Examination for Suspected Epiglottitis

Sir .—The management of acute epiglottitis is rendered uncertain by the common use of the term total [or complete ] obstruction in describing the pathogenesis of its disastrous consequence. Mauro et al recommend cautious direct examination to diagnose acute epiglottitis and minimize the danger of total airway obstruction. Were total obstruction a substantial risk, cautious direct examination might be appropriate, as it is following total obstruction due to the aspiration of a foreign body. In such circumstances time is available, labored respirations continue, circulation persists, and death is not abrupt. There is no evidence, however, that total obstruction occurs in acute epiglottitis. Even those reports that call the feared deterioration total (or complete) obstruction uniformly describe the cessation of respiration and the frequently associated asystole. 1,2 The airway is still patent. Bag ventilation through an external mask is still effective 3,4 and is probably the optimal emergency procedure. 5,6 The problem is

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

A review was performed of the treatment of 92 patients with acute epiglottitis with special reference to the different procedures employed in children and adults. Intubation was performed in 74 per cent of the children but in only six per cent of the adults. More than half of the children were initially observed only, but of these 58 per cent eventually needed intubation. No deaths occurred. We present our management protocol as well as a survey of the routine management of acute epiglottitis in children in the five Scandinavian countries. The number of initially observed patients ranged from nil per cent in Iceland to 35 per cent in Finland. When an artificial airway is needed, 92-100 per cent of the patients are intubated, 0-8 per cent tracheostomized, and 0-5 per cent one or the other, as a standard procedure. Tracheostomy is performed in departments where the facilities do not permit sufficient observation of patients treated by intubation.

Management of Acute Epiglottitis

Management of Acute Epiglottitis

Management of Acute Epiglottitis in Pediatric Patients

Management of Acute Epiglottitis in Pediatric Patients

A comparison of endotracheal intubation and tracheostomy in the management of acute epiglottitis in children in the tropics

In children, acute epiglottitis is rapidly fatal due to airway obstruction by swollen supraglottic structures, but the oedema is short-lived. Therefore, in many centres short-term endotracheal intubation has replaced tracheostomy as the method of choice for relieving the obstruction. We have tried both methods in 15 children over a period of three years under conditions of limited material and human resources. Tracheostomy was found to be safer. It was concluded that it is better to have a live healthy child with a small scar in the neck than a dead child without a scar.

Acute epiglottitis: management by short duration of intubation and hospitalisation

One hundred and thirty-seven patients with acute epiglottitis were studied retrospectively with regard to the efficacy and safety of short duration of intubation and hospitalisation. All patients were treated by nasotracheal intubation and antibiotic therapy. Inhalation anesthesia with halothane/oxygen was the preferred method for intubation (80.3%). Extubation was based on clinical improvement in 88.1% and on laryngoscopy in 11.9% of cases. Fifty-four percent of the patients were extubated successfully within 24 h and 94.8% within 48 h. Three patients (2.2%) had to be reintubated once. The mean duration of intubation was 27.6 h (range 8-86) and of hospitalisation 4.0 days (range 2-9). Two children (1.5%) died because of severe hypoxic brain damage due to cardiorespiratory arrest prior to hospital admission. A follow-up study conducted via the family physician revealed only two major complications (granulation polyp of the vocal cords, 1; long-lasting hoarseness, 1). It is concluded that short duration of intubation and hospitalisation are effective and safe in the management of acute epiglottitis.

Management of acute epiglottitis in pediatric patients.

Of 41 pediatric cases of acute epiglottitis treated at the same institution during an 8-yr period, 33 patients were managed by nasotracheal intubation, one by tracheostomy performed at a referring hospital, and seven by intensive care observation and iv antibiotics. Twenty of the 33 nasotracheally intubated patients underwent intubation in the pediatric ICU by the pediatric anesthesiologist-intensivist, who used iv anesthetic agents and muscle relaxants. The remainder were intubated at referring hospitals. All of the intubated patients were paralyzed, sedated, and mechanically ventilated. The intubation technique caused no apparent complications; however, it required the skill and expertise of an experienced pediatric anesthesiologist-intensivist.

Diagnosis and management of acute epiglottitis — report of 90 consecutive cases

Ninety children with acute epiglottitis were admitted from 1971 - 1977. Lateral extended neck radiograph was found to be a quick, safe and reliable way to establish the diagnosis. Out of 79, 77 (97%) had blood cultures yielding Hemophilus influenzae type b. Immediate institution of airway and antibiotics were the mainstay of treatment. All patients in the series survived. For short-term airway management, as in acute epiglottitis, nasotracheal intubation under general anesthesia was found to be the airway of choice.

Management of acute epiglottitis

Airway obstruction secondary to acute epiglottitis is a dramatic, life-threatening emergency. Early diagnosis and provision of an adequate artificial airway are critical in the management of these patients. Tracheostomy has been the traditional method of securing the airway in acute epiglottitis, but more recently, endotracheal intubation has been advocated. Whichever method of airway management is preferred, it is imperative that every hospital have a protocol for the management of acute epiglottitis so that immediate action can be taken.

Comparison of Nasotracheal Intubation and Tracheostomy in Management of Acute Epiglottitis

Acute epiglottitis is a life-threatening respiratory emergency of early childhood. The disease may progress so rapidly that complete upper airway obstruction occurs within hours.1 Trachostomy has been the procedure of choice2–4 to relieve airway obstruction; however, in recent years several investigators have reported the encouraging results of nasotracheal intubation5–12 as an alternate procedure in the management of acute epiglottitis. The purpose of this report is to evaluate the relative effectivenesses of two procedures, nasotracheal intubation and tracheostomy, using an interdisciplinary protocol.