Treatment of Epiglottitis
Epiglottitis requires immediate airway management as the top priority, with preparation for difficult intubation and avoidance of any throat examination that could precipitate complete airway obstruction. 1, 2
Immediate Airway Management
The cornerstone of epiglottitis treatment is securing the airway before respiratory arrest occurs. 1, 3
Critical First Steps
- Position the patient upright if conscious to optimize airway patency and reduce the risk of obstruction 1
- Provide 100% oxygen while preparing for definitive airway intervention 1
- Immediately discuss with intensivist and anesthesiologist for emergency airway intervention, as this is a life-threatening emergency requiring specialist involvement 1
- Transfer to ICU immediately for close monitoring and airway management 1
Airway Intervention Strategy
Endotracheal intubation is the preferred method for securing the airway in epiglottitis, with comparable safety to tracheostomy but greater ease of placement. 4, 5, 6
- Prepare difficult airway equipment before any intubation attempt, including videolaryngoscope, supraglottic airway devices, and surgical airway equipment for emergency cricothyroidotomy 1
- Follow a structured difficult airway algorithm with clear plans for failed intubation scenarios 1
- Intubation versus tracheostomy shows equivalent mortality (0.92% vs 0.86%), but intubation is technically simpler and preferred in most settings 4, 7
- Medical management without artificial airway carries 6.1% mortality and should never be used 4
Antimicrobial Therapy
Start broad-spectrum intravenous antibiotics immediately after securing the airway. 3, 5
- Obtain blood cultures before antibiotics as these are the preferred diagnostic sample, since throat swabbing risks precipitating complete airway obstruction 1, 2
- Target Haemophilus influenzae as the most common causative organism 1, 7
Critical Pitfalls to Avoid
Never attempt throat examination with tongue depressors or throat swabs in suspected epiglottitis, as this can trigger sudden complete airway obstruction and death 1, 2
- Do not rely on clinical staging systems to predict need for intubation, as no presenting symptom reliably predicts airway compromise—the disease is inherently unpredictable 5
- Do not delay airway intervention with a "watch and wait" approach, as this significantly increases mortality 7
- Ensure difficult airway equipment is immediately available before attempting intubation, as failure to prepare leads to preventable complications 1
Duration and Monitoring
- Average intubation duration is 2-3 days with both intubation and tracheostomy approaches 7, 6
- Hospital stay averages 6-7 days with appropriate management 7, 6
- Adult mortality remains approximately 7% even with aggressive management, significantly higher than the 1% pediatric mortality, emphasizing the need for immediate specialist involvement 2