Safe Alternative to Tracheostomy in Acute Epiglottitis

Children with epiglottitis may suddenly and without warning develop total upper airway obstruction, followed by asphyxia and cardiorespiratory arrest. An alternate airway is required about 50% of the time, and often a tracheostomy is done under emergency circumstances.1The mortality and morbidity from such an emergency tracheostomy is greater than for elective tracheostomy, and since airway obstruction is unpredictable, elective tracheostomy has been recommended as soon as possible after the diagnosis of epiglottitis and has been shown to be associated with decreased mortality.2-4Another approach to providing the child with an airway on an elective basis is by nasotracheal intubation.5-8 Report of a Case.—An 18-month-old girl developed fever, drooling, tachypnea, and stridor four hours prior to admission. On admission, her epiglottis was edematous and red. She was immediately started on a regimen of fluids and ampicillin sodium given intravenously and placed in a mist tent. Her