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Lu F, Wang Y, Miao F, Han C, Meng X. Rising Incidence of Acute Epiglottitis in Eastern China: An Eight-Year Retrospective Study and Its Association with the 24 Solar Terms. Int J Gen Med 2024; 17:1665-1676. [PMID: 38706753 PMCID: PMC11068044 DOI: 10.2147/ijgm.s458019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose This study aimed to investigate the clinical characteristics of acute epiglottitis (AE) patients in East China and examine the correlation between the incidence of AE and the 24 solar terms (24 STs). Methods A retrospective, observational study was conducted on patients diagnosed with AE between January 2014 and December 2021 at a single-center medical institution in East China. The clinical characteristics of patients with AE and their correlation with the 24 STs were investigated. Results A total of 287 patients with AE were included in this study, among which there were 179 males (62.37%) and 108 females (37.63%), with a mean age of 47.79 ± 13.83 years (range 16-87 years). Of these patients, 100 (34.84%) had at least one comorbidity and the most common comorbidities were hypertension, smoking and type 2 diabetes. The duration of hospitalization was 3 days (IQR, 1-16 days). All patients, except for one who required tracheal intubation, were cured with intravenous antibiotic administration and the combined use of corticosteroids. The incidence of AE showed significant fluctuations between the 24 STs and the highest number of cases occurred during the Summer solstice (24 cases, 8.36%). Conclusion The incidence of AE was seen to increase annually in this study. The main features of AE are sore throat, dysphagia, odynophagia and fever, which may be accompanied by inflammation in surrounding areas. A clear correlation exists between the incidence of AE and the fluctuations within the 24 STs, notably with the peak incidence observed during the Summer solstice, which approximately corresponds to June 21 to July 7 in the Gregorian calendar.
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Affiliation(s)
- Feng Lu
- Department of Emergency Medicine, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
| | - Yangyang Wang
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
| | - Fangyu Miao
- Information Centre, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
| | - Chengzhou Han
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
| | - Xiangming Meng
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
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Booth AW, Pungsornruk K, Llewellyn S, Sturgess D, Vidhani K. Airway management of adult epiglottitis: a systematic review and meta-analysis. BJA OPEN 2024; 9:100250. [PMID: 38230383 PMCID: PMC10789606 DOI: 10.1016/j.bjao.2023.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
Background Adult epiglottitis is a life-threatening airway emergency where airway protection is the immediate priority. Despite its importance, the optimal approach to airway management remains unclear. We performed a systematic review of the airway management for adult epiglottitis, including meta-analysis of trends over time. Methods We systematically searched PubMed, Ovid MEDLINE®, and Embase® for adult epiglottitis studies that described the airway management between 1980 and 2020. The primary outcome was the prevalence of airway intervention. Secondary outcomes were prevalence of tracheal intubation, tracheostomy, and failed intubation. A random-effects model meta-analysis was performed with subgroups defined by decade of study publication. Cases that described the specific method of airway intervention and severity of epiglottitis were included in a separate technique summary. Results Fifty-six studies with 10 630 patients were included in the meta-analysis. The overall rate of airway intervention was 15.6% (95% confidence interval [CI] 12.9-18.8%) but the rate decreased from 20% to 10% between 1980 and 2020. The overall rate of tracheal intubation was 10.2% (95% CI 7.1-13.6%) and that of failed intubation was 4.2% (95% CI 1.4-8.0%). The airway technique summary included 128 cases, of which 75 (58.6%) were performed awake and 53 (41.4%) involved general anaesthesia. We identified 32 cases of primary technique failure. Conclusion The rate of airway intervention for adult epiglottitis has decreased over four decades to a current level of 10%. Tracheal intubation is a high-risk scenario with a 1 in 25 failure rate. Specific technique selection is most likely influenced by contextual factors including the severity of epiglottitis.
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Affiliation(s)
- Anton W.G. Booth
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Karla Pungsornruk
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia
| | - Stacey Llewellyn
- Statistics Unit, QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - David Sturgess
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- The University of Queensland (UQ) and Surgical Treatment and Rehabilitation Service (STARS), Brisbane, Australia
| | - Kim Vidhani
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Sideris G, Papadimitriou N, Korres GF, Karaganis A, Maragkoudakis P, Nikolopoulos T, Delides A. Clinical and Microbiological Factors Associated With Abscess Formation in Adult Acute Epiglottitis. Ann Otol Rhinol Laryngol 2021; 131:1194-1201. [PMID: 34841913 DOI: 10.1177/00034894211051817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate clinical and microbiological findings that are correlated with abscess formation in adult acute epiglottitis (AE). METHODS We reviewed 140 cases of adult AE. Demographic, clinical, imaging, and microbiological findings are analyzed for all patients with AE in comparison to those with epiglottic abscess (EA). RESULTS A total of 113 patients presented with AE and 27 presented or progressed to EA (19.3%). Age, sex, seasonality, smoking, body mass index (BMI), and comorbidities were statistically insignificant between the 2 groups. Muffled voice (P < .013), respiratory distress (P < .001), and pre-existence of epiglottic cyst (P < .001) are symptoms and signs connected with abscess formation. A total of 120 patients were treated conservatively. Surgical treatment was performed on 20 patients with EA. About 72 out of 80 cultures revealed monomicrobial infection. Mixed flora was isolated in 8 patients with EA. Streptococcus was isolated in 51 out of 80 positive cultures (64%). Haemophilus Influenza (Hib) was not isolated in any sample. EA and mixed flora relates to a higher rate of airway intervention (P < .001). CONCLUSION A high level of suspicion for abscess formation is required if clinical examination reveals dyspnea, muffled voice, or an epiglottic cyst in adult with AE. The existence of EA doubles the duration of hospitalization. EA is typically found on the lingual surface of the epiglottis. Supraglottic or deep neck space expansion should be treated surgically. EA is associated with a mixed flora and a higher rate of airway obstruction. Streptococcus is discovered to be the most common pathogen.
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Affiliation(s)
- Giorgos Sideris
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papadimitriou
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Georgios F Korres
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karaganis
- Department of Economic and Regional Development, Panteion University of Social and Political Sciences, Athens, Greece
| | - Pavlos Maragkoudakis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Thomas Nikolopoulos
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Alexander Delides
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
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Kjaerulff AMG, Rusan M, Klug TE. Clinical evaluation of intravenous ampicillin as empirical antimicrobial treatment of acute epiglottitis. Acta Otolaryngol 2018; 138:60-65. [PMID: 28826305 DOI: 10.1080/00016489.2017.1363912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The significant pathogens in acute epiglottitis (AE) are poorly defined in the post Haemophilus influenza type b-vaccine era. Furthermore, there is a lack of clinical evaluations of antibiotic regimens in patients with AE. We aimed to evaluate the effectiveness of empiric intravenous ampicillin in the treatment of patients with AE. MATERIALS & METHODS All patients admitted with AE to the Ear-Nose-Throat Department, Aarhus University Hospital, Denmark, from 2001 to 2015 were included. RESULTS In total, 103 (51 males) patients were included in the study. The median duration of hospitalization was four days. There was no statistical significant difference between patients initially treated with intravenous ampicillin (n = 83) or other antibiotics (n = 20) (p = .26). The antibiotic regimen was altered during admission in 11% of patients, without significant difference between antibiotic groups (ampicillin 10% vs non-ampicillin 15%, p = .44). Complications potentially related to insufficient antibiotic treatment were observed in four (5%) patients initially treated with ampicillin, but in none of the patients initially treated with antibiotics other than ampicillin (p = 1.00). Throat swab cultures and blood cultures frequently yielded negative results. CONCLUSIONS Intravenous ampicillin is efficient as empiric antibiotic therapy for AE patients, leading to a quick recovery and low complication rates.
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Affiliation(s)
| | - Maria Rusan
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Adult Acute Epiglottitis: Predictors for Airway Intervention and Intensive Care Unit Admission. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives (1) to characterise the clinical features of acute epiglottitis in adults in Hong Kong; (2) to identify predictors for airway intervention and uneventful recovery without intensive care unit (ICU) admission. Modified Early Warning Score (MEWS) was also applied in risk stratification. Methods A retrospective cohort study of 122 consecutive laryngoscopically confirmed cases admitted to Pamela Youde Nethersole Eastern Hospital from 1998 to 2007. Results The mean patient age was 51 years (range 18–84 years) and the male-to-female ratio was 1.9 to 1. Sore throat, dysphagia and odynophagia were the commonest symptoms and the median MEWS on presentation was 1 (range 0–10). Nine patients (7.4%) required airway intervention (5 orotracheal intubations, 2 nasotracheal intubations and 2 tracheostomies) and one patient died. Univariate analysis showed that recurrent attack (OR 35.0, 95% CI 2.77–442.69, p=0.013), dyspnoea (OR 17.41, 95%CI 2.09–144.79, p=0.001), stridor (OR 30.0, 95%CI 2.42–372.65, p=0.016) and MEWS equal to or greater than 4 (OR 5.81. 95%CI 1.16–29.17, p=0.049) were significantly associated with airway intervention. Only stridor remained a reliable predictor in multivariate analysis (OR 88.46, 95%CI 5.48–1427.45, p=0.001). Performance of MEWS in prediction for airway intervention was evaluated with the Receiver Operating Characteristic (ROC) curve. The area under curve (AUC) was 0.71 (95%CI 0.503–0.909). Forty-five patients did not require ICU admission (36.9%). Multiple logistic regression showed that absence of hoarseness (OR 3.10, 95%CI 1.10–8.79, p=0.033), absence of fever (OR 3.2, 95%CI 1.25–8.16, p=0.015) and MEWS <1 (OR 7.07, 95%CI 1.31–38.07, p=0.023) were predictors of uneventful recovery without ICU care. Conclusion A selective approach should be adopted in airway management but those with stridor on presentation should have their airway secured without delay. MEWS cannot replace clinical judgement but a low MEWS on presentation may help in identifying low risk patients who can be managed safely without ICU admission.
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Suzuki S, Yasunaga H, Matsui H, Fushimi K, Yamasoba T. Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database. Laryngoscope 2014; 125:2072-8. [DOI: 10.1002/lary.25114] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/14/2014] [Accepted: 12/01/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Sayaka Suzuki
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
- Department of Otolaryngology and Head and Neck Surgery; Faculty of Medicine, The University of Tokyo; Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics; Tokyo Medical and Dental University Graduate School of Medicine; Tokyo Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery; Faculty of Medicine, The University of Tokyo; Tokyo Japan
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Bizaki AJ, Numminen J, Vasama JP, Laranne J, Rautiainen M. Acute supraglottitis in adults in Finland: Review and analysis of 308 cases. Laryngoscope 2011; 121:2107-13. [DOI: 10.1002/lary.22147] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/24/2011] [Indexed: 11/10/2022]
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Qazi IM, Jafar AM, Hadi KAA, Hussain Z. Acute epiglottitis: a retrospective review of 47 patients in Kuwait. Indian J Otolaryngol Head Neck Surg 2009; 61:301-5. [PMID: 23120655 DOI: 10.1007/s12070-009-0087-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Acute epiglottitis is a potentially life threatening condition which can lead to fatal airway obstruction in previously healthy individuals. The present study was undertaken to assess the clinical features, management and patient outcomes of epiglottitis in Kuwait over an eight year period. DESIGN Case series. SETTING Al Sabah Hospital, Kuwait. METHODS All patients admitted to the ENT department of Al Sabah hospital between January 2000 and January 2008 with the diagnosis of acute epiglottitis were included in this retrospective study. The diagnosis of acute epiglottitis was established by visualization of inflamed epiglottis either on indirect laryngoscopy or flexible fibreoptic/direct laryngoscopy. RESULTS 47 cases were identified, 5 children and 42 adults. There were 32 males and 15 females, in the age range of 5 to 66 years. Peak incidence was in the third decade. 31 patients had co-morbid conditions, 18 patients (38.2%) had diabetes, 8 patients (17%) had hypertension and 3 patients (6.3%) had dental caries. Majority of the patients (89.3%) presented with sore throat as their chief complaint. All patients were febrile on presentation. The classical "thumb sign" on lateral neck radiograph was seen in 32 patients (68%). Blood cultures were collected from 22 patients (46.8%), all were negative. Ceftriaxone was the commonest empirical antibiotic prescribed. 7 patients required airway intervention (5 with endotracheal intubation and 2 with tracheostomy). There were no deaths in our study. CONCLUSION In Kuwait, acute epiglottis is commoner in adults than in children. It is imperative to secure the airway and to start the patients on broad spectrum antibiotics and steroids as early as possible. In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention, in the form of intubation / tracheostomy, for patients with stridor or shortness of breath.
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Affiliation(s)
- Imtiaz Majid Qazi
- Department of ENT, Zain and Al Sabah Hospitals, P O Box 4078, Safat, Kuwait, 13041 Kuwait
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10
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Acute epiglottitis in Iceland 1983–2005. Auris Nasus Larynx 2009; 36:46-52. [DOI: 10.1016/j.anl.2008.03.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 12/30/2007] [Accepted: 03/15/2008] [Indexed: 11/18/2022]
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Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. The Journal of Laryngology & Otology 2007; 122:818-23. [PMID: 17892608 DOI: 10.1017/s0022215107000473] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAims:To describe the incidence trends, clinical presentation, management and outcome of acute epiglottitis in a Danish population after the introduction of Haemophilus influenzae type b vaccine.Methods:Retrospective review of the health records of all patients discharged with a diagnosis of acute epiglottitis from the otolaryngology department, Roskilde County Hospital, Denmark, from 1996 to 2005.Results:One infant and 34 adults were identified. The incidence of acute epiglottitis in children was 0.02 cases/100 000/year. Before introduction of the H influenzae type b vaccination (1983–1992), the mean national incidence of acute epiglottitis was 4.9 cases/100 000/year. The incidence of acute epiglottitis in adults was constant, with a mean value of 1.9 cases/100 000/year. Twenty-nine per cent of the patients required an artificial airway, and respiratory distress was found to be associated with airway intervention (p = 0.010). All patients recovered completely.Conclusions:In the H influenzae type b vaccine era, acute epiglottitis in children has almost disappeared. The incidence in the adult population has been constant. A discriminate approach to airway management seems safe in adults.
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Affiliation(s)
- L-A Guldfred
- Department of Otolaryngology, Roskilde County Hospital, Denmark.
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Pino Rivero V, González Palomino A, Pantoja Hernández CG, Mora Santos ME, Gil Calero M, Rodríguez Carmona M, del Castillo Beneyto F. Epiglotitis aguda en adultos. Nuestra experiencia clínica en 30 casos. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pino Rivero V, Palomino AG, Pantoja Hernández CG, Elena Mora Santos M, Calero MG, Carmona MR, del Castillo Beneyto F. Acute Epiglottitis in Adults. Diagnosis and Treatment in Our Experience of 30 Cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lon SA, Lateef M, Sajad M. Acute epiglottitis: A review of 50 patients. Indian J Otolaryngol Head Neck Surg 2006; 58:178-80. [PMID: 23120278 PMCID: PMC3450762 DOI: 10.1007/bf03050781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We reviewed 50 patients admitted to the department of Otorhinolaryngology and Head & Neck Surgery of Govt Medical College Srinagar from September 19% to September 2002 diagnosed with acute epiglottitis. Male were more commonly involved than females in the ratio of 2.8:1 with only 6 cases younger than 10 years of age. The highest incidence was in the month of January (22%). The common symptoms of acute epiglottitis were sorethroat(92%) and odynophagia(88%). Any patient with sudden onset of these symptoms should be suspected of having acute epiglottitis and should have an indirect laryngoscopy. Blood culture was obtained in 20 cases Cultures were positive only in 5 cases, out of which 4 were positive for Hemophilus influenzae type B. Throat cultures were not obtamed The primary treatment of acute epiglottitis is intravenous antibiotics, steriods, and humidified air. Treacheostomy was needed only in 4 patients. There were no deaths.
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Affiliation(s)
- Shafkat Ahmad Lon
- Department of Otorhinolaryngology and Head & Neck Surgery, Govt Medical college Srinagar, Kashmir
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Abstract
In this chapter we have reviewed the complicated medical conditions that exist in many head and neck surgical patients. Common surgical procedures that frequently require postoperative monitoring and several infectious disorders requiring intensive care unit admission were also reviewed. Intensivists need to be familiar with these procedures and diseases. Collaboration with the surgical specialist is required to optimize patient care.
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Affiliation(s)
- Arvind Bansal
- Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York NY 10128, USA
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Pino Rivero V, Pando Pinto JM, Mogollón Cano-Cortés T, Rejas Ugena E, Trinidad Ramos G, Blasco Huelva A. [Acute epiglottitis in adults. Our case load in 11 years]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2002; 53:674-8. [PMID: 12584883 DOI: 10.1016/s0001-6519(02)78363-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a retrospective study of 20 cases of acute epiglottitis in adults admitted at our hospital between 1991 and 2001. We gather a series of variables: Patient sex, age, year and month of admission, personal history, initial clinical symptoms, complementary tests asked, given treatment, evolution and hospital average stay. We found an obvious predominance in male (19:1 with respect to female), with an average age of 45 years. The main symptoms were dysphagia-odynophagia (85%), followed by fever (55%) and pharyngocervical pain. Dyspnea was confirmed in 9 of 20 patients (45%); 5 of them required airway control with the help of intubation in one case, urgent coniotomy in three cases and tracheotomy in another one. A patient suffered from an acute mediastinitis and required assistance and medical i.v. extended treatment in UCI. We show a case of another patient who suffered sudden cardiorespiratory arrest a followed by death. He did not present previous dyspnea. Acute epiglottitis in adults is a rare pathology with a good prognosis in general, but may lead to an unpredictable and serious complication even in the absence of airway blockage. We carry out a medical literature review in this respect.
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Abstract
The objective of this study was to determine stable estimates of the incidence, case fatality, and epidemiologic features of adult epiglottitis, and risk factors for intubation. The authors designed a retrospective cohort combined with a nested case-control study, followed by detailed analysis of cases from two tertiary care institutions. Among 813 cases, the incidence was 2.02 cases/10(5) population per year. Ten recorded deaths constituted a case fatality rate of 1.2% (95% confidence interval [CI]: 0.5% to 1.9%). The eight fully documented deaths indicated no sudden episodes of catastrophic upper airway obstructions without previous dyspnea. A detailed review of 51 cases revealed that 18% of patients underwent expeditious intubation. Patients managed without initially requiring intubation did not need emergency airway interventions. Only the presence of dyspnea (noted in 29% of patients) at the time of admission (P < 0.001) predicted the need for intubation. A low case fatality rate in a conservatively managed cohort and the absence of sudden upper airway catastrophes in patients without dyspnea suggest that prophylactic intubation and intensive care unit monitoring is not warranted in all patients. An early complaint of dyspnea may safely discriminate between patients requiring invasive airway management and close observation.
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Affiliation(s)
- P C Hébert
- Critical Care Program, University of Ottawa, Ontario, Canada
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Abstract
Acute epiglottitis has become a disease of adults, probably as a result of immunization of children against Haemophilus influenzae. This article is a review of the literature on epiglottitis, including signs and symptoms, investigation, differential diagnosis, and treatment in the emergency department. The microbiology is discussed and the importance of prophylaxis in exposed persons is stressed.
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Affiliation(s)
- M J Carey
- Veterans Affairs Medical Center, Seattle, WA 98144, USA
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Mayo-Smith MF, Spinale JW, Donskey CJ, Yukawa M, Li RH, Schiffman FJ. Acute epiglottitis. An 18-year experience in Rhode Island. Chest 1995; 108:1640-7. [PMID: 7497775 DOI: 10.1378/chest.108.6.1640] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To assess the incidence, clinical characteristics, management, and outcome of epiglottitis in a defined population over an 18-year period. DESIGN Case series. SETTING The state of Rhode Island, 1975 through 1992. PATIENTS OR OTHER PARTICIPANTS Cases who met predetermined criteria for acute epiglottitis identified from hospital discharges and the State Medical Examiner's log of prehospitalization deaths. MAIN OUTCOME MEASURES Incidence by year and age, clinical presentation, results of diagnostic evaluations, management, and outcome. RESULTS Four hundred seven cases were identified, 134 in children and 273 in adults. Incidence in children dropped from 38 cases in the first 3 years of the study to 1 case in the last 3 years (p < 0.001). Adult cases increased from 17 in the first 3 years to 69 in the last 3 years (p < 0.001). Seventy-nine percent of adults and 32% of children were treated without an artificial airway. Factors associated with airway obstruction included symptomatic respiratory difficulty, stridor, drooling, shorter duration of symptoms, enlarged epiglottis on radiograph, and Haemophilus influenzae bacteremia (p < 0.001 for each). Twelve patients died (3 children and 9 adults), with all cases of fatal respiratory obstruction occurring within 12 h of presentation. CONCLUSIONS There have been significant changes in the clinical epidemiology of epiglottitis, which now occurs almost exclusively in adults, often with less severe symptoms and a lower incidence of H influenzae infection. While careful observation is indicated for all patients, the data suggest that those with certain clinical characteristics can be treated safely without an immediate artificial airway.
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Affiliation(s)
- M F Mayo-Smith
- Section of General Medicine and Primary Care, Veterans Affairs Medical Center, Manchester, NH 03104, USA
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Crausman RS, Pluss WT, Jennings CA. Acute epiglottitis in the adult caused by Neisseria meningitidis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1995; 27:77-8. [PMID: 7784820 DOI: 10.3109/00365549509018978] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Acute epiglottitis is being increasingly encountered in the adult population. While it has many similarities to its pediatric counterpart, the presentation and associated pathogens are distinct. In addition, although the recent literature has suggested that acute epiglottitis in the adult follows a benign course this is not always the case. Here we describe a case of acute, fulminant epiglottitis in an immunocompetent host, caused by Neisseria meningitidis.
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Affiliation(s)
- R S Crausman
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, USA
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