Intubation decision criteria in adult epiglottitis - 23/09/21

Doi : 10.1016/j.anorl.2020.12.001

P.M. Pineau ^a,⁎ , J. Gautier ^b, A. Pineau ^c, N. Emam ^c, L. Laccourreye ^a, S. Boucher ^a,^d
^a Service d’ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire d’Angers, 4, Rue Larrey, 49100 Angers, France
^b Pôle “Neurosciences, Vieillissement, Médecine et Société”, Centre de Recherche sur l’Autonomie et la Longévité (CeRAL), Service de Gériatrie, Centre Hospitalier Universitaire d’Angers, 4 Rue Larrey, 49100 Angers, France
^c Service d’ORL et Chirurgie Cervico-Faciale, Centre Hospitalier du Mans, 194 Avenue Rubillard, 72037 Le Mans, France
^d Équipe MitoLab, UMR CNRS 6015, U1083 INSERM, Institut MitoVasc, SFR ICAT, Université d’Angers, Centre Hospitalier Universitaire d’Angers, Bâtiment IRIS/IBS, Rue des Capucins, 49933 Angers cedex 9, France

^⁎Corresponding author.

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Abstract

Objectives

To identify contributive criteria in decision-making for intubation in acute epiglottitis, based on clinical and endoscopic data in adult patients, and to study clinical and biological characteristics and management.

Materials and methods

Diagnosis was established by flexible endoscopy showing epiglottic edema in association with general signs of sepsis in 28 patients consulting into two French hospitals between 2005 and 2016. Retrospective univariate and multivariate analysis between patients managed by intubation (Group I) or surveillance (Group S) was performed on clinical and endoscopic data.

Results

Ten patients were intubated (36%). On univariate analysis, 4 variables were suggestively associated with intubation. On multivariate analysis, associations remained suggestive for dyspnea (OR=50.6; 95% CI=[2.7; 940.1]) and supraglottic edema extension (OR=42.2; 95% CI=[2.2; 799.5]). The area under the curve identifying intubated patients on these 2 criteria was 90.8%, testifying to high discrimination.

Conclusion

Intubation must always be considered in epiglottitis. Dyspnea and supraglottic extension of the edema seem to be the two main criteria to be considered in airway control decision-making.

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Keywords : Epiglottitis, Supraglottis, Intubation, Airway management, Decision-making