Research Article: Long-Term Outcome of Critically Ill Adult Patients with Acute Epiglottitis

Date Published: May 6, 2015

Publisher: Public Library of Science

Author(s): Tomasz Chroboczek, Martin Cour, Romain Hernu, Thomas Baudry, Julien Bohé, Vincent Piriou, Bernard Allaouchiche, François Disant, Laurent Argaud, Cristina Costa.

http://doi.org/10.1371/journal.pone.0125736

Abstract

Acute epiglottitis is a potentially life threatening disease, with a growing incidence in the adult population. Its long-term outcome after Intensive Care Unit (ICU) hospitalization has rarely been studied.

Thirty-four adult patients admitted for acute epiglottitis were included in this retrospective multicentric study. The mean age was 44±12 years (sex ratio: 5.8). Sixteen patients (47%) had a history of smoking while 8 (24%) had no previous medical history. The average time of disease progression before ICU was 2.6±3.6 days. The main reasons for hospitalization were continuous monitoring (17 cases, 50%) and acute respiratory distress (10 cases, 29%). Microbiological documentation could be made in 9 cases (26%), with Streptococcus spp. present in 7 cases (21%). Organ failure at ICU admission occurred in 8 cases (24%). Thirteen patients (38%) required respiratory assistance during ICU stay; 9 (26%) required surgery. Two patients (6%) died following hypoxemic cardiac arrest. Five patients (15%) had sequelae at 1 year. Patients requiring respiratory assistance had a longer duration of symptoms and more frequent anti inflammatory use before ICU admission and sequelae at 1 year (p<0.05 versus non-ventilated patients). After logistic regression analysis, only exposure to anti-inflammatory drugs before admission was independently associated with airway intervention (OR, 4.96; 95% CI, 1.06-23.16). The profile of the cases consisted of young smoking men with little comorbidity. Streptococcus spp. infection represented the main etiology. Outcome was favorable if early respiratory tract protection could be performed in good conditions. Morbidity and sequelae were greater in patients requiring airway intervention.

Partial Text

Acute epiglottitis is a potentially life threatening disease, especially with severe airway obstruction. Respiratory impairment results from inflammation of the supraglottic structures, usually due to bacterial infection [1,2]. Since the introduction of Haemophilus influenza type b (Hib) vaccinations in child immunization programs, the epidemiology of acute epiglottitis has changed, with a significant decline in the incidence among children (and in Hib etiology), and an increase among adults [1–6]. Annual incidence of pediatric epiglottitis in the post-vaccine era has been evaluated as affecting 0.3 to 0.7 per 100,000 patients, with the frequency in adults now greater than in children [2].

Thirty-four cases (sex ratio: 5.8) were investigated. Epidemiological and clinical results are reported in Table 1. Only 8 patients (24%) had no past medical history while 20 (59%) had a history of smoking, alcoholism, or immune depression.

In this study, we retrospectively investigated 34 cases of acute epiglottitis admitted to the ICU. The profile of the cases consisted of young smoking men, with little comorbidity. Streptococcus spp. infection represented the main etiology. Outcome was favorable if early respiratory tract protection could be performed in good conditions. Morbidity and sequelae were heavier in patients requiring airway intervention.

In summary, in the present study we found that the majority of patients did not have severity criteria. A few cases presented severe forms of the disease, with vital prognosis threatened by acute airway obstruction. This underlines the need for respiratory screening and early respiratory tract protection. Further studies are needed to outline risk factors associated with airway compromise in adult acute epiglottitis. Long-term sequelae, mainly aesthetic, were also heavier when airway intervention was necessary.

 

Source:

http://doi.org/10.1371/journal.pone.0125736