What percentage of patients with acute epiglottitis require airway management?

Updated: Apr 28, 2020
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

In a retrospective study of 216 adult cases of acute epiglottitis, Nonoyama et al found that most cases received conservative treatment, with just 39 patients (18.1%) requiring airway management. The investigators also found that the mean number of days between symptom onset and hospital visit for patients differed between the airway management and conservative treatment groups (1.9 vs 2.9 days, respectively). [26]

A systematic review and meta-analysis by Sideris et al suggested that airway securement is required in 10.9% of adult cases (down from 18.8% prior to the introduction of Haemophilus influenzae vaccine). [27]

A study by Hanna et al using the Nationwide Emergency Department Sample database found that out of more than 33,000 emergency-department (ED) cases of adult epiglottitis identified between 2007 and 2014, fewer than 1% underwent laryngoscopic or airway procedures in the ED. Moreover, the use of radiography and computed tomography (CT) scanning was less than 10%. The investigators suggested that this indicates, in ED management of adult epiglottitis, “a lack of recognition of the need and utilization of critical airway interventions early in the patient encounter.” [28]

Obstruction in acute epiglottitis can be reduced by using dexamethasone therapy or budesonide aerosols to treat pharyngeal edema. In addition, research suggests that length of stay in the intensive care unit (ICU) and in the hospital overall can be reduced with corticosteroid use. [29, 30]

See also Pediatric Epiglottitis and Emergent Management of Pediatric Epiglottitis.


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