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Acute epiglottitis: evolution of management in the community hospital
Insights
Nasotracheal intubation is a safe and effective airway management strategy for acute epiglottitis in children. This method, along with antibiotics, proved comparable to tracheotomy in controlling the airway, with fewer complications.
Area of Science:
- Pediatrics
- Otolaryngology
- Critical Care Medicine
Background:
- Acute epiglottitis in children historically required tracheotomy for airway management.
- Management strategies evolved with the introduction of nasotracheal intubation, antibiotics, and steroids.
Purpose of the Study:
- To retrospectively review the safety and efficacy of different airway management techniques for acute epiglottitis in children.
- To compare outcomes between tracheotomy and nasotracheal intubation.
- To evaluate the role of steroids in managing acute epiglottitis.
Main Methods:
- Retrospective chart review of 148 pediatric cases of acute epiglottitis treated between 1965 and 1983.
- Comparison of management strategies: tracheotomy (pre-1975) versus nasotracheal intubation (post-1975).
- Analysis of airway control, infectious complications, and intubation-related issues.
Main Results:
- Tracheotomy and nasotracheal intubation demonstrated comparable safety in securing the airway.
- Nasotracheal intubation, antibiotics, and steroids were used for later cases, with steroids showing no benefit but increasing gastrointestinal bleeding risk.
- No significant difference in duration of intubation or infectious complications was observed between management groups.
Conclusions:
- Nasotracheal intubation is a safe and effective alternative to tracheotomy for managing acute epiglottitis in children.
- Steroids do not appear to improve outcomes and may be associated with adverse gastrointestinal effects.
- Community hospitals can safely manage acute epiglottitis using nasotracheal intubation.
Abstract:
One hundred and forty-eight cases of acute epiglottitis in children treated at the University of Rochester's Strong Memorial Hospital and two affiliated community hospitals between 1965 and 1983 are reviewed retrospectively. Patients seen prior to 1975 were usually managed with tracheotomy and intravenous antibiotics, while those after 1975 with nasotracheal intubation, antibiotics and steroids. Tracheotomy and nasotracheal intubation were equally safe in controlling the upper airway. We compared our results with other series, primarily from children's hospitals, using nasotracheal intubation and found comparable results. Steroids provided no significant effect on the duration of intubation or infectious complications, but was associated with gastrointestinal bleeding. Long- and short-term complications of intubation, including self-extubation are discussed. We conclude that nasotracheal intubation is a safe method of management for acute epiglottitis in the community hospital.