Stridor in the young infant is evaluated by careful laryngoscopy. When a lesion of the larynx is diagnosed, the necessity and risk of bronchoscopy are challenged. To assess the need for careful examination of both the upper and lower respiratory tract, a 2-year retrospective study was performed at the Children's Hospital of Pittsburgh. Of 103 infants who underwent diagnostic laryngoscopy and bronchoscopy for airway obstruction, stridor, or both, 18 (17.5%) had two or more synchronous airway lesions detected. Laryngoscopy alone, without further workup of the entire respiratory tract (ie, bronchoscopy, radiographic studies) may fail to detect concurrent disorders in infants with airway obstruction.

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Nasotracheal intubation has been demonstrated to be effective in supporting the airways of children with acute epiglottitis. Length of intubation and criteria used for extubation are still controversial. A 6-year retrospective review at Children's Hospital of Pittsburgh identified 100 cases of acute epiglottitis, which were initially managed with nasotracheal intubation. Extubation was based on direct laryngeal inspection performed in the operating room (1979-1981) and, more recently, in the intensive care unit (1982-1984). Length of intubation decreased from 63.8 hours in 1979 to 42.1 hours in 1984. The percent of children intubated longer than 48 hours decreased from 69% to 22% in the same time period. These data indicate that a shorter period of intubation is aided by daily laryngeal inspection in the ICU. We propose a staging system for acute epiglottitis to aid in the decision to safely extubate these children.

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