What is the treatment for epiglottitis?

Treatment for Epiglottitis

The treatment of epiglottitis requires immediate airway management, appropriate antimicrobial therapy, and close monitoring in an intensive care setting to prevent potentially fatal airway obstruction.

Immediate Management

Airway Management

• Airway assessment and intervention is the top priority

  • Avoid disturbing the epiglottis during examination as this may precipitate complete airway obstruction
  • Blood cultures are the preferred diagnostic sample rather than direct swabbing of the epiglottis 1
  • If examination is necessary, it should be performed in a setting with emergency airway equipment readily available 1

• Decision for airway intervention should be based on severity:

  1. Severe cases with significant airway compromise:

     • Immediate endotracheal intubation under controlled conditions 2, 3
     • Intubation should be performed in an operating room with equipment for emergency surgical airway 4
     • For children, nasotracheal intubation under general anesthesia is often preferred 5

  2. Less severe cases:

     • Close monitoring in ICU setting
     • Selective airway intervention for patients with >50% airway obstruction 3
     • Low threshold for intubation if clinical deterioration occurs

Antimicrobial Therapy

• Empiric broad-spectrum antibiotics should be started immediately
• Common regimen: cefotaxime plus metronidazole 3
• Therapy should cover Haemophilus influenzae (most common pathogen, especially in children) 5
• Duration typically 7-10 days based on clinical response

Supportive Care

• Oxygen supplementation
• IV hydration
• Anti-inflammatory medications (NSAIDs)
• Possibly inhaled epinephrine to reduce airway edema 4
• Corticosteroids may be beneficial to reduce inflammation, though evidence is mixed

Special Considerations

Complications Management

• If abscess formation occurs around the epiglottis, surgical drainage may be required 6
• Some patients may require tracheostomy if prolonged airway protection is needed

Extubation Protocol

When ready for extubation, follow a structured approach:

1. Ensure no further surgical stimulation
2. Balance adequate analgesia without respiratory depression
3. Deliver 100% oxygen
4. Position patient appropriately
5. Remove oropharyngeal secretions using suction
6. Apply positive pressure, deflate the cuff and remove tube while lung is near vital capacity
7. Confirm airway patency and adequacy of breathing
8. Continue oxygen delivery until recovery is complete 1

Monitoring and Follow-up

• Continuous monitoring of vital signs and oxygen saturation
• Reassessment of airway with flexible laryngoscopy before extubation
• Patients should not be discharged until they can maintain adequate oral intake and show no signs of respiratory distress

Common Pitfalls

• Misdiagnosis: Epiglottitis in adults is often misdiagnosed as pharyngitis or tonsillitis 4
• Delayed intervention: Waiting for respiratory distress before securing the airway can be fatal
• Inadequate examination: Routine oropharyngeal examination may appear normal in up to 44% of cases; diagnosis requires visualization of the epiglottis via flexible laryngoscopy 4
• Attempting examination without airway equipment: Never examine the epiglottis without emergency airway equipment immediately available

Remember that epiglottitis remains a potentially life-threatening condition with risk of sudden complete airway obstruction. Early recognition, prompt airway management, and appropriate antimicrobial therapy are essential for favorable outcomes.