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Acute epiglottitis: current management and review
Insights
Nasotracheal intubation and tracheostomy are effective treatments for acute epiglottitis, with no mortality in either group. Nasotracheal intubation resulted in significantly lower morbidity compared to tracheostomy in children.
Area of Science:
- Pediatric Otolaryngology
- Anesthesiology
- Emergency Medicine
Background:
- Acute epiglottitis is a life-threatening condition requiring prompt airway management.
- Traditional management often involved tracheostomy, a procedure associated with significant morbidity.
- Nasotracheal intubation presents an alternative airway management strategy.
Purpose of the Study:
- To compare the outcomes of nasotracheal intubation versus tracheostomy in children with acute epiglottitis.
- To evaluate the morbidity associated with each airway management technique.
- To present a management protocol for acute epiglottitis.
Main Methods:
- Retrospective comparison of 47 patients treated with nasotracheal intubation and 61 patients treated with tracheostomy.
- Both groups received general anesthesia and airway intervention.
- Clinical follow-up and laryngeal endoscopic examination in a subset of nasotracheal intubation patients.
Main Results:
- No mortality was observed in either the nasotracheal intubation or tracheostomy group.
- Morbidity rates were significantly higher in the tracheostomy group compared to the nasotracheal intubation group.
- Endoscopic examination in nasotracheal intubation patients showed no significant laryngeal complications.
Conclusions:
- Artificial airway insertion is crucial for managing acute epiglottitis in children.
- Nasotracheal intubation is associated with significantly less morbidity than tracheostomy when performed by experienced clinicians.
- Inhalation anesthetic agents are recommended for airway management in acute epiglottitis.
Abstract:
Forty-seven patients treated for acute epiglottitis by nasotracheal intubation under general anaesthesia following a preset protocol are presented. The results are compared with 61 cases treated by tracheostomy following induction of general anaesthesia and intubation in the same institution. Both groups were followed clinically, and 13 of the children treated by nasotracheal intubation alone had a follow-up endoscopic examination of the larynx. There was no mortality in either group, but the morbidity was significantly higher in the children who had tracheostomy. Details of the management protocol are presented. Only inhalation anaesthetic agents are recommended and it is concluded that children with acute epiglottitis should always have an artificial airway inserted. Nasotracheal intubation seems to be associated with less morbidity than tracheostomy in experienced hands.