Long-Term Outcome of Critically Ill Adult Patients with Acute Epiglottitis

Abstract

BackgroundAcute epiglottitis is a potentially life threatening disease, with a growing incidence in the adult population. Its long-term outcome after Intensive Care Unit (ICU) hospitalization has rarely been studied.Methodology and Principal FindingsThirty-four adult patients admitted for acute epiglottitis were included in this retrospective multicentric study. The mean age was 44±12 years (sex ratio: 5.8). Sixteen patients (47%) had a history of smoking while 8 (24%) had no previous medical history. The average time of disease progression before ICU was 2.6±3.6 days. The main reasons for hospitalization were continuous monitoring (17 cases, 50%) and acute respiratory distress (10 cases, 29%). Microbiological documentation could be made in 9 cases (26%), with Streptococcus spp. present in 7 cases (21%). Organ failure at ICU admission occurred in 8 cases (24%). Thirteen patients (38%) required respiratory assistance during ICU stay; 9 (26%) required surgery. Two patients (6%) died following hypoxemic cardiac arrest. Five patients (15%) had sequelae at 1 year. Patients requiring respiratory assistance had a longer duration of symptoms and more frequent anti inflammatory use before ICU admission and sequelae at 1 year (p<0.05 versus non-ventilated patients). After logistic regression analysis, only exposure to anti-inflammatory drugs before admission was independently associated with airway intervention (OR, 4.96; 95% CI, 1.06-23.16).Conclusions and SignificanceThe profile of the cases consisted of young smoking men with little comorbidity. Streptococcus spp. infection represented the main etiology. Outcome was favorable if early respiratory tract protection could be performed in good conditions. Morbidity and sequelae were greater in patients requiring airway intervention.

Adult Epiglottitis: A Case Series

“…Patient populations at particular risk for epiglottitis include middle-aged white men, those with smoking history, and those with comorbid medical conditions such as diabetes. 1,3,4 Retrospective reviews have also revealed that infants younger than age 1 year and the elderly older than age 85 years are particularly vulnerable to this disease. 4 However, a large number of patients have no contributing risk factors.…”

“…4 However, a large number of patients have no contributing risk factors. [2][3][4] Stridor and respiratory distress are considered strong predictors for airway intervention. 2 However, more subtle signs and symptoms, such as subjective shortness of breath, tachycardia, tachypnea, and rapid symptom onset (less than 24 hours), have also been shown to be predictors for airway intervention.…”

Acute Epiglottitis in Adults: a Case Series

“…influenza sur une hémoculture [9]. Par ailleurs, l'hypothèse d'une saisonnalité est discutable au vu des données de la littérature (pic en saison hivernale [4,6] ; pic sur la période printemps/été [10]).…”

Acute Subglottic Laryngitis. Etiology, Epidemiology, Pathogenesis and Clinical Picture

“…The disease is mainly seen in children aged 2-10 years, peaking in the third to fourth year of life (82%). It should be noted that recently there has been an increase in the incidence of infections in adults [34][35][36][37][38][39]. Morbidity may be associated with reduced levels of immune antibodies, es pecially in the latter case.…”