epiglottitis
EPIGLOTTITIS
Epiglottitis is the inflammation of the epiglottis and supraglottic tissues (aryepilottic folds, arytenoid, uvula).
It is often characterized by an acute, rapidly progressing respiratory disease.
It is a medical emergency in children requiring immediate treatment and typically artificial airway placement.
H. influenzae type B is the most common etiologic agent in children.

Airway Management

  • A physician well-versed in airway management & use of intubation apparatus should accompany patients w/ suspected epiglottitis at all times
  • In patients w/ epiglottitis, an airway should be established to prevent airway obstruction, regardless of the degree of respiratory distress, by either nasotracheal intubation or tracheostomy
    • If possible, the procedure should be done in either an operating room or intensive care unit (ICU)
    • Using a nasotracheal tube that is 0.5-1 mm smaller than that estimated by age is recommended for easier intubation & lesser long-term sequelae
  • Bag-valve-mask ventilation may be done if there is an delay in intubation
  • If intubation & ventilation both can not be performed, cricothyroidotomy may be considered if airway obstruction is imminent
  • The duration of intubation depends on the patient’s clinical progress & duration of epiglottic swelling
    • Reduction in swelling can be determined by direct laryngoscopy or flexible fiber optic laryngoscopy
    • Patient should improve sufficiently & should be able to handle secretions adequately
  • The tube should be removed as soon as possible, which is usually within a few days
    • Intubation is required for <24 hours in most cases

Prevention

Haemophilus influenzae type B (Hib) vaccine

  • Studies have shown a decrease in the incidence of epiglottitis because of increased H influenzae type b vaccination

Please refer to Pneumonia - Community-Acquired Disease Management Chart for details on vaccination against S pneumonia

Further Evaluation

  • Antibiotic prophylaxis w/ Rifampicin should be given to the following household members:
    • Children ≤4 years of age w/o or w/ incomplete vaccination against H influenzae type b
    • There is 1 or more contact <48 months of age in the household who is incompletely immunized
    • Within the household of an immunocompromised child
  • Chemoprophylaxis w/ Rifampin, Ceftriaxone, or Ciprofloxacin is recommended for older children & adults who came in contact w/ patients infected w/ H influenzae type b or meningococcal epiglottitis
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