What is the treatment for epiglottitis?

Treatment of Epiglottitis

Epiglottitis requires immediate airway management as the top priority, with preparation for difficult airway intervention and avoidance of any examination that could precipitate complete airway obstruction. 1

Immediate Airway Assessment and Stabilization

Critical First Steps

• Do NOT attempt throat examination with tongue depressors as this may precipitate complete airway obstruction 1, 2
• Position the patient upright if conscious to optimize airway patency 1
• Immediately discuss with intensivist and anesthesia for emergency airway intervention 1
• Maintain oxygenation as the primary goal throughout management 1

Airway Intervention Strategy

• Prepare for difficult airway management before any intervention attempt with appropriate equipment and personnel immediately available 1
• Have supraglottic airway devices, videolaryngoscope, and surgical airway equipment for emergency cricothyroidotomy ready 1
• Follow a structured difficult airway algorithm with clear plans for failed intubation 1
• Endotracheal intubation is the safest and most direct means of securing the airway in severely affected patients 3

Definitive Airway Management

Indications for Immediate Intubation

• Respiratory distress or hypoxemia requires immediate ICU transfer and airway intervention 1
• Severe airway obstruction symptoms warrant immediate intubation rather than expectant management 3
• The mortality difference between tracheostomy (0.86%) and endotracheal intubation (0.92%) is negligible, while medical management without artificial airway carries 6.1% mortality 4

Important caveat: No presenting symptom or sign reliably predicts the need for intubation, making clinical judgment and preparation paramount 3. Staging systems should not be relied upon to predict disease course in this inherently unpredictable condition 3.

Airway Technique Selection

• Either endotracheal intubation or tracheostomy may be used based on local expertise and resources 4, 5
• Both methods show similar duration (2.3 days for intubation vs 2.9 days for tracheostomy) and low complication rates when properly managed 5
• Intubation is generally preferred as first-line due to being less invasive 3

Antimicrobial Therapy

Microbiological Diagnosis and Treatment

• Obtain blood cultures immediately to identify the causative organism, typically Haemophilus influenzae 1, 2
• Blood cultures are the preferred diagnostic sample due to risk of airway obstruction with direct throat examination 2
• Initiate parenteral antibiotics immediately after cultures obtained 6

Adjunctive Medical Management

Additional Therapies

• Corticosteroids were used in 10 of 12 patients in one series, though evidence is limited 6
• Adrenaline resolved respiratory distress in 2 patients and avoided airway intervention in these cases 6
• Close monitoring in ICU setting is essential throughout treatment course 7

Surgical Considerations

When Conservative Management Fails

• Abscess formation around the epiglottis may require surgical drainage 7
• Tracheotomy may be necessary if intubation fails or prolonged airway support is needed 7
• Full recovery is expected with proper treatment including selective airway intervention, antimicrobial therapy, and close monitoring 7

Common Pitfalls to Avoid

• Never attempt visualization with tongue depressor - this is the most critical error that can cause complete obstruction 1, 2
• Failing to prepare difficult airway equipment before attempting intubation leads to significant complications 1
• Relying on clinical staging to predict need for intubation is unreliable 3
• Expectant management without artificial airway should be avoided given the significantly higher mortality 4