Click here to view next page of this article

Epiglottitis

Epiglottitis is a life-threatening condition that is caused by bacterial infection of the epiglottis, aryepiglottis, and arytenoids. It is differentiated from viral croup and foreign body aspiration by the acutely ill appearance of epiglottitis.

Epiglottitis is a pediatric emergency and it is the most dangerous cause of upper airway obstruction. It is a bacterial infection characterized by marked edema of the epiglottis, aryepiglottic folds, and arytenoid soft tissues. Generally, the process does not extend into the subglottic region.

Epiglottitis is now rare because of Haemophilus influenzae type B (Hib) conjugate vaccine administration. Acute disease generally occurs in children between the ages of 2 and 6 years. More than 75% of cases are caused by H influenzae type b. Rarely, other bacterial causes include beta-hemolytic streptococci, staphylococci.

Epiglottitis in the child older than 2 years is distinguished easily by its severe, abrupt presentation. Respiratory problems become prominent within 12 hours of the first clinical manifestations. High fever (38.8-40.5EC) and sore throat are the earliest features, followed rapidly by the development of a muffled or absent voice, wet stridor, retractions, tachycardia, and tachypnea. Swallowing difficulties, characterized by dysphagia and excessive drooling.

The child appears quite toxic and is apprehensive, anxious, and pale. The child will characteristically, assume the sitting up posture, leaning forward with neck extended, mouth open and jaw thrust forward.

Treatment of Epiglottitis

Airway Management

The first priority is to secure the airway by immediate endotracheal intubation. The decision to intubate must be based on clinical grounds. Extreme agitation, obtundation, pronounced stridor with use of accessory muscles of breathing, and a compatible history are indications for 

If the child is cyanotic, bradycardic or sustains respiratory arrest, the child should be

If decompensation occurs before the patient can be intubated, positive-pressure ventilation, with a non-rebreathing 100% oxygen bag should be initiated as a temporary measure

If time permits and the child is stable, the child should be taken to the operating room where anesthesia can be given and the upper airway visualized directly.

The administration of topical 4% cocaine spray aids in intubation, and atropine, 0.01 mg/kg intravenously decreases the vagal response.

Antibiotic Therapy

Second-and-third-generation cephalosporins, such as ceftriaxone, cefuroxime, or cefotaxime, are

Ceftriaxone (50 mg/kg/d given once a day IV);

Cefuroxime (100-150 mg/kg/d divided q8h IV);

Cefotaxime (150 mg/kg/d divided q8h IV).

Cephalosporins should be avoided in patients with a history of an allergic reaction to penicillin because of the 10% cross hypersensitivity between penicillin and cephalosporins. Chloramphenicol (50-75 mg/kg/d divided q6h IV) is