title: Airway intervention in adult supraglottitis.
abstract: BACKGROUND
  The timing of aggressive airway intervention in adult epiglottitis is controversial.
  
  
  OBJECTIVE
  To correlate Friedman's staging of epiglottitis on admission with the airway interventions undertaken.
  
  
  METHODS
  A retrospective study of 23 adult patients, mean age 51 years (range 29-81 years), who had been admitted with acute supraglottitis between March 1988 and December 2000 was undertaken.
  
  
  RESULTS
  Three patients (13%) had airway interventions; two with tracheostomy and one with tracheal intubation. All were Friedman stage III and had rapid symptom progression during the 24 hours prior to admission. Three other stage III patients with symptom progression longer than 24 hours and all the remaining patients (stage II or less) were managed with observation and intravenous therapy.
  
  
  CONCLUSIONS
  Friedman originally advocated airway intervention in any patient stage II or worse, but this intubation threshold should probably be lowered to those patients with rapid-onset stage Ill (moderate respiratory distress, stridor, respiratory rate > 30 per minute, pCO2 > 45mmHg) disease.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospital Aintree, Liverpool, UK.
authors.forename: D
authors.initials: D
authors.lastname: Madhotra
authors.forename: J E
authors.initials: JE
authors.lastname: Fenton
authors.forename: Z G G
authors.initials: ZG
authors.lastname: Makura
authors.forename: P
authors.initials: P
authors.lastname: Charters
authors.forename: N J
authors.initials: NJ
authors.lastname: Roland
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004826:Epiglottitis / Q000628:therapy*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014139:Tracheostomy; D016896:Treatment Outcome