ABSTRACT
BACKGROUND AND OBJECTIVE: Acute epiglottitis, bacterial tracheitis, and severe viral laryngotracheobronchitis continue to cause life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in treatment, to clarify the role of airway endoscopy, and to identify current reasons for fatalities in these diseases. MATERIALS AND PATIENTS: During the observation period from 1980 to 1996, we identified 61 patients treated in the pediatric intensive care unit of the University Hospital of Cologne for severe inflammatory airway obstruction. RESULTS: Critical points in the appropriate airway management were (1) the confirmation of the admission diagnosis, (2) whether an artificial airway or rigid tracheobronchoscopy was required; and (3) appropriate timing of extubation. Since 1989 airway evaluation with flexible or small, rigid endoscopes was used to confirm the diagnosis and to determine the appropriate management. Endoscopic findings were extremely helpful to decide not to intubate and to monitor in the pediatric intensive care unit first. Three patients with acute epiglottitis died after out-of-hospital cardiorespiratory arrest. CONCLUSION: Endoscopy should be a part of every established treatment protocol of childhood stridor. The most decisive factor to decrease mortality seems to be timely presentation to a referral center.
Subject(s)
Airway Obstruction/therapy , Critical Care , Respiratory Sounds/etiology , Respiratory Tract Infections/therapy , Airway Obstruction/diagnosis , Airway Obstruction/mortality , Bronchitis/diagnosis , Bronchitis/mortality , Bronchitis/therapy , Bronchoscopy , Child , Child, Preschool , Epiglottitis/diagnosis , Epiglottitis/mortality , Epiglottitis/therapy , Female , Humans , Infant , Laryngitis/diagnosis , Laryngitis/mortality , Laryngitis/therapy , Laryngoscopy , Male , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/mortality , Retrospective Studies , Tracheitis/diagnosis , Tracheitis/mortality , Tracheitis/therapy , Treatment OutcomeABSTRACT
PURPOSE: To show that cardinal signs of upper airway obstruction are characteristically absent in the early phases of potentially fatal supraglottitis. PATIENTS AND METHODS: The hospital records of 9 previously healthy adults who died from autopsy-proven supraglottitis within 12 hours after sudden onset of severe sore throat. RESULTS: Six patients who were discharged from the emergency room with a diagnosis of pharyngitis died at home within 4 hours after dismissal. Three patients suspected of supraglottitis were admitted and treated medically; by the time signs of respiratory obstruction appeared, attempts at airway intervention failed. None of the 9 patients presented with symptoms or signs of respiratory distress, but all gave a history of fulminant sore throat associated with chills and fever. In all patients, the pulse rate was above 100 per minute. CONCLUSION: In the early phases of acute supraglottitis, the most reliable indicator of impending airway obstruction is a rapidly developing severe sore throat. Dyspnea, tachypnea, retractions, stridor, and cyanosis are manifestations of advanced stages of the infection and should not be awaited to determine the need for airway intervention.
Subject(s)
Airway Obstruction/diagnosis , Laryngitis/diagnosis , Adult , Airway Obstruction/etiology , Airway Obstruction/mortality , Glottis , Humans , Laryngitis/complications , Laryngitis/mortality , Male , Time FactorsABSTRACT
42 lethal outcomes have been registered for 9 years in the ENT department of the Andizhan regional hospital and in the department of the head and neck tumors of the regional cancer hospital. Among the causes of the patients' death, ENT cancer ranked the first (73.6%) followed by intracranial otogenic complications. The least frequent causes were esophageal and respiratory foreign bodies, acute stenotic laryngotracheitis. The averaged annual lethality was stable (0.25%). A further decrease of lethality depends on fitting out updated medical units and instruments, on perfection of the personal's skill, on earlier hospitalization of priority cases with ENT diseases.
Subject(s)
Otorhinolaryngologic Diseases/mortality , Adolescent , Adult , Child , Esophagus , Female , Foreign Bodies/mortality , Head and Neck Neoplasms/mortality , Humans , Laryngitis/mortality , Male , Middle Aged , Otorhinolaryngologic Neoplasms/mortality , Respiratory System , Tracheitis/mortalitySubject(s)
Death, Sudden/etiology , Epiglottitis/mortality , Laryngitis/mortality , Acute Disease , Child, Preschool , Epiglottitis/etiology , Epiglottitis/therapy , Female , Haemophilus Infections/complications , Haemophilus influenzae , Humans , Hypoxia, Brain/etiology , Hypoxia, Brain/mortality , Infant , Male , Respiration, Artificial , ResuscitationABSTRACT
During an autopsy the clinician, as well as the pathologist, should insist on a culture and adequate examination of the neck. Failure to examine the neck structures in this catastrophic illness may result in an incorrect determination of the cause of death [12,13]. Many autopsy surgeons assume pneumonia is present but later find only microscopic evidence of pulmonary edema. By then the decedent has been buried. Untreated fatalities are seldom reported [3,5,14]. Future reports should include statistics from the medical examiner's or coroner's office in their jurisdiction. This will promote knowledge of the true incidence of acute epiglottitis.
Subject(s)
Laryngitis/mortality , Acute Disease , Adult , Child, Preschool , Diagnosis, Differential , Epiglottis/pathology , Female , Humans , Infant , Laryngitis/pathology , Male , Middle AgedABSTRACT
Two adults were admitted to the University Hospital of Geneva with acute Haemophilus influenzae type b epiglottitis. The disease was characterized by rapid progression of sore throat, upper dysphagia, fever and dyspnea. Acute upper airway obstruction required emergency tracheotomy in both cases. The patients recovered under ampicillin therapy. All the 100 cases from the literature for which clinical data were available have been analyzed:--Epiglottitis in adult is not exceptional.--Haemophilus influenzae type b is the most common infective organism documented, and was found in all positive blood cultures but one.--The typical presentation is severe sore throat, with upper dysphagia, fever and dyspnea.--Clinical course is rapid and serious, and acute respiratory distress develops in 57% of cases; overall mortality is 27%.--Emergency routine tracheotomy appears to be the most reliable treatment.
