Management of acute inflammatory childhood stridor

BACKGROUND AND OBJECTIVE: Acute epiglottitis, bacterial tracheitis, and sev ere viral laryngotracheobronchitis continue to cause life-threatening airwa y obstruction in children. The aim of this retrospective study was to evalu ate deficiencies in treatment, to clarify the role of airway endoscopy, and to identify current reasons for fatalities in these diseases. MATERIALS AND PATIENTS: During the observation period from 1980 to 1996, we identified 61 patients treated in the pediatric intensive care unit of the University Hospital of Cologne for severe inflammatory airway obstruction. RESULTS: Critical points in the appropriate airway management were (1) the confirmation of the admission diagnosis, (2) whether an artificial airway o r rigid tracheobronchoscopy was required; and (3) appropriate timing of ext ubation. Since 1989 airway evaluation with flexible or small, rigid endosco pes was used to confirm the diagnosis and to determine the appropriate mana gement. Endoscopic findings were extremely helpful to decide not to intubat e and to monitor in the pediatric intensive care unit first, Three patients with acute epiglottitis died after out-of-hospital cardiorespiratory arres t. CONCLUSION: Endoscopy should be a part of every established treatment proto col of childhood strider. The most decisive factor to decrease mortality se ems to be timely presentation to a referral center.