From the Guidelines
The most critical step in managing suspected epiglottitis in a child is securing the airway in a controlled environment with specialists present, ideally in an operating room. When epiglottitis is suspected, the child should not be agitated or examined with tongue depressors or throat instruments, as this could trigger complete airway obstruction 1. The child should be kept calm, in a position of comfort (typically sitting upright), and transported urgently to a facility capable of emergency airway management.
Key Considerations
- Specialists including an anesthesiologist, otolaryngologist, and pediatric critical care physician should be summoned immediately to prepare for a controlled intubation in the operating room.
- Supplemental oxygen should be provided without distressing the child.
- Once the airway is secured, treatment includes intravenous antibiotics (typically a third-generation cephalosporin like ceftriaxone 50-75 mg/kg/day) to target Haemophilus influenzae type B and other potential pathogens.
- Corticosteroids (dexamethasone 0.6 mg/kg/day) may be administered to reduce inflammation. This approach is critical because epiglottitis can rapidly progress to complete airway obstruction, which can be fatal within minutes if not properly managed. The patient's presentation, including inspiratory stridor, restlessness, drooling, and a muffled voice, along with the refusal to lie back and the preference for a sniffing position, are all indicative of severe airway compromise, underscoring the need for immediate and careful management by specialists, as outlined in guidelines for referral to pediatric surgical specialists 1.
From the Research
Management of Suspected Epiglottitis in a Child
The clinical presentation of the 5-year-old female, including high fever, inspiratory stridor, restlessness, drooling, muffled voice, and preference for a sniffing position, is suggestive of epiglottitis. Given the potential for airway compromise, the most critical step in management is:
- Securing the airway to prevent obstruction and ensure adequate oxygenation 2, 3, 4 The decision to intubate should be made promptly, considering the patient's symptoms and the risk of airway compromise. Nasotracheal intubation is a suitable alternative to tracheostomy in epiglottitis 4.
Key Considerations
- The patient's refusal to lie back and preference for a sniffing position may indicate an attempt to maintain airway patency, highlighting the need for careful airway management 3
- The presence of stridor, hypoxia, and shortness of breath are statistically more frequent amongst cases requiring airway intervention, emphasizing the importance of close monitoring and prompt intervention 5
- Antibiotic therapy, such as ceftriaxone, is effective in treating epiglottitis caused by Haemophilus influenzae type b, but the initial priority is securing the airway 6, 2