Epiglottitis 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

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