Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis

Tapiovaara, Laura; Aro, Katri; Bäck, Leif; Koskinen, Anni

doi:10.1007/s00405-019-05624-0

Cited by 9 publications

(16 citation statements)

References 21 publications

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“…This is an area that requires additional research to help further determine the exact indications of a tracheostomy in adults with URTIs. 10 With regard to malignancies, Gilyoma et al have reported results comparable to the present study. 11 Their second most common indication for receiving a tracheostomy was for malignancies causing upper airway obstruction, whereas this was the most common indication in the present study.…”

Section: Causative Pathologysupporting

confidence: 88%

“…Previous research has shown the potential benefits of tracheostomy; therefore, the early identification of patients who may benefit from tracheostomy is vital. [8][9][10] This is a difficult area to research as the main clinical factors for proceeding with a tracheostomy in the acute scenario concern the degree of airway obstruction alongside the clinician's judgement of potential loss of airway, with both factors being difficult to quantify and document in a medical record.…”

Section: Introductionmentioning

confidence: 99%

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Associative factors for tracheostomy in patients presenting with stridor or upper airway obstruction

et al. 2022

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Objective This study aimed to identify associative factors for tracheostomy in patients presenting with airway obstruction. Methods Data from a tertiary hospital were reviewed to identify patients who presented with airway obstruction between 2009 and 2020. Patient demographics, causative pathology and treatments were analysed. Results The study identified 297 admitted patients. Of these, 66 underwent a tracheostomy and formed the ‘tracheostomy’ group and 231 formed the ‘other intervention’ group. The tracheostomy group had a higher mean age (p = 0.003), and higher percentages of males (p = 0.031) and smokers or ex-smokers (p = 0.020), compared to the other intervention group. The tracheostomy group also had a higher number of patients with a malignancy (p < 0.001) compared to the other intervention group. Conclusion Being older, male, a previous or current smoker, or developing airway obstruction due to a malignancy were found to be the main associative factors for requiring a tracheostomy.

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Section: Causative Pathologysupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Associative factors for tracheostomy in patients presenting with stridor or upper airway obstruction

et al. 2022

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“…However, other studies reported a lower proportion of tracheotomies, ranging from 0.9 to 2.89% [ 1 , 6 ]. A study published by Tapiovaara et al [ 9 ] reported that tracheotomy was a more economical way to manage the airway, and they did not encounter any significant difference in complication rates between intubation and tracheotomy.…”

Section: Discussionmentioning

confidence: 99%

Acute infectious supraglottitis in adult population: epidemiology, management, outcomes and predictors of airway intervention

Penella

Mesalles-Ruíz

Portillo

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose The purpose is to analyze the incidence of acute infectious supraglottitis in our center between 2010 and 2020, define the characteristics and trends of those patients and identify factors associated with the need of airway intervention. Methods A retrospective single-center observational study of a cohort of patients diagnosed with acute infectious supraglottitis between January 2010 and December 2020. Patients were stratified according to airway management. Results Eighty eight patients were included: 59 men (67%) and 29 women (33%). A significant upward trend of 9% in the annual incidence rate of supraglottitis was seen during 2010–2020, with an important increase in cases during 2019. Muffled voice (41%) and respiratory distress (38%) were the most common presenting symptoms; and the median duration of symptoms before hospital admission was 2 days [IQR 1; 3]. Airway intervention was performed in fifteen patients (17%). Nine patients (10%) were intubated and six required tracheotomy (7%). Comparing the patients who required airway intervention with those who received a conservative treatment, younger patients ( p < 0.01) were more likely to need airway intervention. In logistic regression analysis, we found that epiglottic abscess ( p = 0.015), hypersalivation ( p = 0.027) and smoking ( p = 0.036) were independent factors with a significant association with airway intervention. Conclusion There was an important increase in cases and its severity in 2019, but due to COVID-19 pandemic, it was not possible to define if it was an isolate event or an upward trend. Epiglottic abscess, hypersalivation and smoking could be possible risk factors for airway intervention.

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“…Frantz et al reported an intubation rate of 9% in supraglottitis patients, as their patients were not managed in the ICU and had milder infections [ 18 ]. In a recent study, Tapiovaara et al found 50% of AAS patients required intubations [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ng et al reported that only 0.9% of their AAS patients required tracheostomy [ 4 ]. Tapiovaara et al reported that half of their patients required tracheostomy, whereas, in a recent meta-analysis and systematic review of AAS, Sideris et al found that 10% of patients required airway interventions [ 19 - 20 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Adult Supraglottitis: An Impending Threat to Patency of Airway and Life

Shaikh

Nawaz

Ahmad

et al. 2020

Cureus

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Introduction Acute adult supraglottitis (AAS) is one of the upper airway infections that can potentially cause upper airway obstruction and, if not treated promptly, can be life-threatening. The widespread use of vaccines against Hemophilus influenzae has decreased the incidence of epiglottitis in children, whereas the incidence of AAS is on the rise. We aim to highlight the presentation, diagnosis, and management in AAS with our study. Patients and Methods A retrospective analysis was performed on all patients admitted to a tertiary health care facility surgical intensive care unit (SICU) where AAS was identified and the demographic data, duration of symptoms, imaging studies, management, and complications were recorded. In these patients, the diagnosis of AAS was confirmed by nasopharyngeal endoscopy. Data was entered in the IBM Statistical Package for Social Sciences (SPSS), version 23 (IBM SPSS Statistics, Armonk, NY), and groups were compared using student t-test and chi-square test. P values of ≤ 0.05 were considered statistically significant. Results A total of 118 patients were admitted to the SICU. The male: female ratio was 3.9: 1. Major risk factors were smoking and drinking cold liquids. The common presenting symptom was sore throat (89.8%). The thumb sign was positive in 65% of the patients. Common bacteria were the Streptococcus species (11.9%). Ceftriaxone was the most commonly prescribed inpatient antibiotic. All patients received steroids as adjuvant therapy. Adrenaline nebulization was used in 66% of the cases. Forty-six percent of patients required endotracheal intubation. In 10.2% of patients, intubation was not possible and in 12.7% of patients, a tracheostomy was done. Ludwig’s angina was the most frequent complication. Patients presenting with dysphagia and fever had a significantly higher incidence of Ludwig’s angina (P ≤ 0.02 and 0.005, respectively). AAS patients complicating into Ludwig’s angina (severe cellulitis of submandibular, submental, and sublingual spaces) had a significantly longer duration of symptoms, a higher incidence of streptococcal infection, airway interventions, and prolonged stay in an intensive care unit (p ≤ 0.05). Conclusion Male gender, smoking, and drinking cold liquids were the risk factors associated with AAS, and thumb sign on lateral neck soft tissue x-ray was suggestive of it. AAS caused by Streptococcus species was a relatively serious condition, leading to complications like Ludwig’s angina.

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Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis

Cited by 9 publications

References 21 publications

Associative factors for tracheostomy in patients presenting with stridor or upper airway obstruction

Associative factors for tracheostomy in patients presenting with stridor or upper airway obstruction

Acute infectious supraglottitis in adult population: epidemiology, management, outcomes and predictors of airway intervention

Acute Adult Supraglottitis: An Impending Threat to Patency of Airway and Life

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