INTERDISCIPLINARY MANAGEMENT OF SEVERE BA CTERIAL-INFECTIONS OF THE CENTRAL AIRWAY IN CHILDREN

Background: Apart from all advances made in the management of central airway infections, Acute Epiglottitis (AE) and Bacterial Tracheitis (B T) continue to be causes of life-threatening airway obstruction in chi ldren. The aim of this retrospective study was to evaluate deficiencie s in the diagnostical protocol, to clarify the role of airway endoscop y in acute childhood strider, and to identify current reasons for fata lities in these diseases. Material: In the observation period between 1980-92, we found 12 patients suffering from BT and 21 from AE managed in close cooperation of the involved disciplines at the pediatric int ensive care unit of the University of Cologne. Results: Laryngoscopy w ith fiberoptic or small rigid endoscopes allowed in awake cooperative children accurate diagnose of AE, and the exclusion of supraglottic in flammation in BT without complications. furthermore, additional endosc opic information of the degree of inflammation was helpful in the next critical decision, whether artificial airway or rigid tracheobronchos copy was required. Nasotracheal intubation was necessary in 76% of our patients, in one child tracheostomy was performed (5%). Premature ext ubation necessitating reintubation occurred in 33% of the children suf fering from BT. In these patients, our method of advancing a flexible endoscope for tracheoscopy through the respiration tube failed because of a low tube diameter. Another remarkable finding was the high morta lity in AE (14%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespiratory arrest. Conclusion: In the analysis of the clinical course we found three decisive turning p oints in managing the disorder: First, the confirmation of the correct admission diagnosis; second, the decision, as to whether an artificia l airway should be established; and third, the proper time of extubati on. The most decisive factor in decreasing mortality seems to be timel y, appropriate presentation at referral centers if AE or BT is suspect ed. Clinically, progressive management of childhood strider requires c lose cooperation between the Pediatric, Anesthesiologic, and ENT Depar tments. Fiberoptic endoscopy as a guide to current airway management i s a major step forward and should be a part of every established proto col.