Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: Evolving principles in diagnosis and management

Authors

  • Elizabeth Guardiani MD,

    Corresponding author
    1. Georgetown University Hospital, Department of Otolaryngology–Head and Neck Surgery, Washington, D.C.
    2. Washington Hospital Center, Department of Otolaryngology–Head and Neck Surgery, Washington, D.C.
    • Department of Otolaryngology–Head and Neck Surgery, 1st Floor Gorman Building, 3800 Reservoir Rd NW, Washington, DC 20007
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  • Morgan Bliss BS,

    1. and Georgetown University School of Medicine, Washington D.C., U.S.A
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  • Earl Harley MD, FACS

    1. Georgetown University Hospital, Department of Otolaryngology–Head and Neck Surgery, Washington, D.C.
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  • Parts of the data were presented at the Triological Combined Sections Meeting, Orlando, Florida, U.S.A., February 4–7, 2010.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To review the demographics, presentation, interventions, and outcomes of acute supraglottitis in the post–Haemophilus influenzae type B (Hib) vaccination era and make updated recommendations for treatment.

Study Design:

Retrospective review.

Methods:

Patients with the discharge diagnosis of acute epiglottitis or supraglottitis from two tertiary hospitals from 1995 to 2005 were identified. Patient characteristics, signs and symptoms at presentation, interventions, hospital course, and outcomes were reviewed and analyzed.

Results:

Sixty adults and one child were identified. The most common presenting symptom was odynophagia (100%), followed by dysphagia (85%) and voice change (75%). Thirteen patients (21%) required airway intervention; 11 patients were intubated, and two required tracheotomy. Stridor, respiratory distress, tachycardia, tachypnea, rapid onset of symptoms, and shortness of breath were all associated with the need for airway intervention. Patients without any of these symptoms recovered without airway intervention. A total of 62% of patients were admitted to the intensive care unit (ICU), and the average length of ICU stay was 2.3 days. All patients were treated with intravenous antibiotics, most commonly ceftriaxone and ampicillin/sulbactam, and 87% of patients received at least one dose of steroids. The average overall length of stay was 3.8 days. There were no deaths. The use of corticosteroids was associated with shorter ICU and overall lengths of stay.

Conclusions:

The patient demographics, presentation, and course of supraglottitis have changed since the widespread use of the Hib vaccine. Recognizing the signs and symptoms associated with airway obstruction is important in the safe and effective management of this condition. Laryngoscope, 2010

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