Do the clinical parameters provide the reliable indication of airway findings in adult patients with acute supraglottitis?

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Abstract

Airway management of adult patients with acute supraglottitis is challenging. The sign and symptoms of the disease may show marked variation in terms of severity and progression. Thorough evaluation is required before selecting any particular approach. We report the case of an adult patient with acute supraglottitis, in whom active airway intervention was planned. The clinical predictors were not suggestive of any airway compromise in our patient. However, the disease was found to have an unanticipated rapidly progressive course leading to the significant edema of the oropharynx and the surrounding structures as evidenced by the laryngoscope and computerized tomography scan findings.

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Most cited references 8

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Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: evolving principles in diagnosis and management.

Margaret Harley, Elizabeth Guardiani, Carly M. Bliss (2010)

To review the demographics, presentation, interventions, and outcomes of acute supraglottitis in the post-Haemophilus influenzae type B (Hib) vaccination era and make updated recommendations for treatment. Retrospective review. Patients with the discharge diagnosis of acute epiglottitis or supraglottitis from two tertiary hospitals from 1995 to 2005 were identified. Patient characteristics, signs and symptoms at presentation, interventions, hospital course, and outcomes were reviewed and analyzed. Sixty adults and one child were identified. The most common presenting symptom was odynophagia (100%), followed by dysphagia (85%) and voice change (75%). Thirteen patients (21%) required airway intervention; 11 patients were intubated, and two required tracheotomy. Stridor, respiratory distress, tachycardia, tachypnea, rapid onset of symptoms, and shortness of breath were all associated with the need for airway intervention. Patients without any of these symptoms recovered without airway intervention. A total of 62% of patients were admitted to the intensive care unit (ICU), and the average length of ICU stay was 2.3 days. All patients were treated with intravenous antibiotics, most commonly ceftriaxone and ampicillin/sulbactam, and 87% of patients received at least one dose of steroids. The average overall length of stay was 3.8 days. There were no deaths. The use of corticosteroids was associated with shorter ICU and overall lengths of stay. The patient demographics, presentation, and course of supraglottitis have changed since the widespread use of the Hib vaccine. Recognizing the signs and symptoms associated with airway obstruction is important in the safe and effective management of this condition.

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Acute epiglottitis: analysis of factors associated with airway intervention.

H Katori, Mamoru Tsukuda (2005)

We reviewed acute epiglottitis (AE) and identified factors associated with airway intervention. This report was a retrospective review of patients with AE and compared with factors associated with airway intervention. We reviewed 96 patients who were diagnosed with AE in our hospitals in Japan. Ninety-two (96 per cent) patients were adults, and no seasonal variation in the incidence of AE was encountered. Eight (8 per cent) patients had tracheostomy and endotracheal intubation had not been done. We found that symptoms of stridor and muffled voice, a rapid clinical course, and diabetes mellitus were the factors associated with airway intervention. Extremely severe swelling of the epiglottis such that only less than half of the posterior vocal fold (scope classification (SC): III) could be seen, and extension of the swelling to the arytenoids (SC: B) were the two factors that were strongly associated with airway intervention.

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Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong.

F Sin, Ronald A. Li, Roy Ng … (2008)

Acute epiglottitis in adult is a potentially life-threatening condition that may be underdiagnosed. The present study reports the clinical features, management and patient outcomes in an acute hospital in Hong Kong over a seven-year period. All adult patients aged 18 years or above admitted to Tuen Mun Hospital between July 1999 and June 2006 with the diagnosis of acute epiglottitis were included in this retrospective study. The diagnosis of acute epiglottitis was established by direct visualisation of inflamed epiglottis during laryngoscopic examination. 106 patients were identified. A total of 21 patients (20%) had co-morbidities, with diabetes mellitus (11%) being the most common. Five patients had a history of nasopharyngeal carcinoma and three patients had a previous history of acute epiglottitis. The majority (94%) of patients presented with sore throat as their major complaint. Blood cultures were collected from 15 patients and all were negative. A combination of cefotaxime and metronidazole was the most common empirical antibiotic regimen prescribed. Seven patients required active airway intervention (six with endotracheal intubation and one failed intubation with emergency tracheostomy performed). No mortality was reported. Acute epiglottitis in adults is not a rare entity and vigilance for this condition is needed. In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention.

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Author and article information

Journal

Journal ID (nlm-ta): J Anaesthesiol Clin Pharmacol

Journal ID (iso-abbrev): J Anaesthesiol Clin Pharmacol

Journal ID (publisher-id): JOACP

Title: Journal of Anaesthesiology, Clinical Pharmacology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0970-9185

ISSN (Electronic): 2231-2730

Publication date (Print): Jul-Sep 2012

Volume: 28

Issue: 3

Pages: 378-380

Affiliations

[1]Scarborough General Hospital, North and East Yorkshire, UK

Author notes

Address for correspondence: Dr. Faraz Shafiq, Speciality Doctor Anaesthetics, Scarborough General Hospital, North and East Yorkshire, UK. E-mail: farazshafiq76@ 123456yahoo.com

Article

Publisher ID: JOACP-28-378

DOI: 10.4103/0970-9185.98352

PMC ID: 3409954

PubMed ID: 22869951

SO-VID: d7e8bc35-b1f7-432a-8ae1-6ccc04996895

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Do the clinical parameters provide the reliable indication of airway findings in adult patients with acute supraglottitis?

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Irish Journal of Paramedicine

Most cited references 8

Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: evolving principles in diagnosis and management.

Acute epiglottitis: analysis of factors associated with airway intervention.

Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong.

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