AIRWAY ENDOSCOPY IN THE INTERDISCIPLINARY MANAGEMENT OF ACUTE EPIGLOTTITIS

Introduction: Acute epiglottitis (AE) continues to cause life-threaten ing airway obstruction in children. The aim of this retrospective stud y was to evaluate deficiencies in the management of AE, to clarify the role of airway endoscopy, and to establish the cause of death in this disease. Material: The subjects of our retrospective study were 24 ch ildren with AE treated in the paediatric intensive care unit (PICU) of the University of Cologne between 1980 and 1994. The records of all p atients were reviewed. Results: Laryngoscopy with fibreoptic or small rigid endoscopes allowed accurate diagnosis of AE, particularly in pat ients presented with atypical clinical signs. Furthermore, endoscopic information of the degree of inflammation were helpful in the critical decision, whether artificial airway was required. The number of patie nts managed without intubation increased (8% vs. 45%) since airway end oscopy became available in 1989. No evidence of beta-lactamase-produci ng strains of Haemophilus influenzae was observed. The most remarkable finding was the high mortality in AE (12.5%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespi ratory arrest. Conclusion: The most decisive factor to decrease mortal ity seems to be timely appropriate presentation at referring centres, if AE is suspected or strider remains unclear. Fibreoptic airway endos copy represents a major step forward in the management of acute epiglo ttitis, and this requires close interdisciplinary collaboration betwee n paediatricians, anaesthetists and otorhinolaryngologists.