Skip to main content
Top
Published in: European Archives of Oto-Rhino-Laryngology 11/2019

Open Access 01-11-2019 | Enterostomy | Laryngology

Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis

Authors: Laura K. Tapiovaara, Katri L. S. Aro, Leif J. J. Bäck, Anni I. M. Koskinen

Published in: European Archives of Oto-Rhino-Laryngology | Issue 11/2019

Login to get access

Abstract

Purpose

In acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do.

Methods

We retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed.

Results

The cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p < 0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 € and 5.856 € in the intubated and tracheotomized patient groups, respectively (p < 0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097).

Conclusion

Tracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients.

Level of evidence

2b
Literature
1.
go back to reference Ng HL, Sin LM, Li MF, Que TL, Anandaciva S (2008) Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong. Emerg Med J 25(5):253–255CrossRefPubMed Ng HL, Sin LM, Li MF, Que TL, Anandaciva S (2008) Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong. Emerg Med J 25(5):253–255CrossRefPubMed
2.
go back to reference Baird SM, Marsh PA, Padiglione A, Trubiano J, Lyons B, Hays A et al (2018) Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era. ANZ J Surg 88(11):1135–1140CrossRefPubMed Baird SM, Marsh PA, Padiglione A, Trubiano J, Lyons B, Hays A et al (2018) Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era. ANZ J Surg 88(11):1135–1140CrossRefPubMed
3.
go back to reference Guardiani E, Bliss M, Harley E (2010) Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: evolving principles in diagnosis and management. Laryngoscope 120(11):2183–2188CrossRefPubMed Guardiani E, Bliss M, Harley E (2010) Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: evolving principles in diagnosis and management. Laryngoscope 120(11):2183–2188CrossRefPubMed
4.
go back to reference Bizaki AJ, Numminen J, Vasama JP, Laranne J, Rautiainen M (2011) Acute supraglottitis in adults in Finland: review and analysis of 308 cases. Laryngoscope 121(10):2107–2113CrossRefPubMed Bizaki AJ, Numminen J, Vasama JP, Laranne J, Rautiainen M (2011) Acute supraglottitis in adults in Finland: review and analysis of 308 cases. Laryngoscope 121(10):2107–2113CrossRefPubMed
5.
go back to reference Suzuki S, Yasunaga H, Matsui H, Fushimi K, Yamasoba T (2015) Factors associated with severe epiglottitis in adults: analysis of a Japanese inpatient database. Laryngoscope 125(9):2072–2078CrossRefPubMed Suzuki S, Yasunaga H, Matsui H, Fushimi K, Yamasoba T (2015) Factors associated with severe epiglottitis in adults: analysis of a Japanese inpatient database. Laryngoscope 125(9):2072–2078CrossRefPubMed
6.
go back to reference Ovnat Tamir S, Marom T, Barbalat I, Spevak S, Goldfarb A, Roth Y (2015) Adult supraglottitis: changing trends. Eur Arch Otorhinolaryngol 272(4):929–935CrossRefPubMed Ovnat Tamir S, Marom T, Barbalat I, Spevak S, Goldfarb A, Roth Y (2015) Adult supraglottitis: changing trends. Eur Arch Otorhinolaryngol 272(4):929–935CrossRefPubMed
7.
go back to reference Piccirillo JF, Johnston A, Claybour P, Littenberg B, Creech C, Anderson S, Grove L, Costas I (2003) Comorbidity coding book. Washington University School of Medicine, Washington Piccirillo JF, Johnston A, Claybour P, Littenberg B, Creech C, Anderson S, Grove L, Costas I (2003) Comorbidity coding book. Washington University School of Medicine, Washington
8.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral
9.
go back to reference Banfi P, Robert D (2013) Early tracheostomy or prolonged translaryngeal intubation in the ICU: a long running story. Respir Care 58(11):1995–1996CrossRefPubMed Banfi P, Robert D (2013) Early tracheostomy or prolonged translaryngeal intubation in the ICU: a long running story. Respir Care 58(11):1995–1996CrossRefPubMed
10.
go back to reference Hunter A, Johnson L, Coustasse A (2014) Reduction of intensive care unit length of stay: the case of early mobilization. Health Care Manag (Frederick) 33(2):128–135 Hunter A, Johnson L, Coustasse A (2014) Reduction of intensive care unit length of stay: the case of early mobilization. Health Care Manag (Frederick) 33(2):128–135
11.
go back to reference Brookes JT, Seikaly H, Diamond C, Mechor B, Harris JR (2006) Prospective randomized trial comparing the effect of early suturing of tracheostomy sites on postoperative patient swallowing and rehabilitation. J Otolaryngol 35(2):77–82CrossRefPubMed Brookes JT, Seikaly H, Diamond C, Mechor B, Harris JR (2006) Prospective randomized trial comparing the effect of early suturing of tracheostomy sites on postoperative patient swallowing and rehabilitation. J Otolaryngol 35(2):77–82CrossRefPubMed
12.
go back to reference Hammarfjord O, Ekanayake K, Norton J, Stassen LF (2015) Limited dissection and early primary closure of the tracheostomy stoma in head and neck oncology operations: a retrospective study of 158 cases. Int J Oral Maxillofac Surg 44(3):297–300CrossRefPubMed Hammarfjord O, Ekanayake K, Norton J, Stassen LF (2015) Limited dissection and early primary closure of the tracheostomy stoma in head and neck oncology operations: a retrospective study of 158 cases. Int J Oral Maxillofac Surg 44(3):297–300CrossRefPubMed
13.
go back to reference Hyde GA, Savage SA, Zarzaur BL, Hart-Hyde JE, Schaefer CB, Croce MA et al (2015) Early tracheostomy in trauma patients saves time and money. Injury 46(1):110–114CrossRefPubMed Hyde GA, Savage SA, Zarzaur BL, Hart-Hyde JE, Schaefer CB, Croce MA et al (2015) Early tracheostomy in trauma patients saves time and money. Injury 46(1):110–114CrossRefPubMed
14.
go back to reference Bontempo LJ, Manning SL (2019) Tracheostomy emergencies. Emerg Med Clin N Am 37(1):109–119CrossRef Bontempo LJ, Manning SL (2019) Tracheostomy emergencies. Emerg Med Clin N Am 37(1):109–119CrossRef
15.
go back to reference Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ (2000) Tracheotomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck Surg 123(4):495–500CrossRefPubMed Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ (2000) Tracheotomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck Surg 123(4):495–500CrossRefPubMed
16.
go back to reference Sittitrai P, Siriwittayakorn C (2018) Perioperative antibiotic prophylaxis in open tracheostomy: a preliminary randomized controlled trial. Int J Surg 54(Pt A):170–175CrossRefPubMed Sittitrai P, Siriwittayakorn C (2018) Perioperative antibiotic prophylaxis in open tracheostomy: a preliminary randomized controlled trial. Int J Surg 54(Pt A):170–175CrossRefPubMed
17.
go back to reference Halum SL, Ting JY, Plowman EK, Belafsky PC, Harbarger CF, Postma GN et al (2012) A multi-institutional analysis of tracheotomy complications. Laryngoscope 122(1):38–45CrossRefPubMed Halum SL, Ting JY, Plowman EK, Belafsky PC, Harbarger CF, Postma GN et al (2012) A multi-institutional analysis of tracheotomy complications. Laryngoscope 122(1):38–45CrossRefPubMed
18.
go back to reference Ezemba N, Echieh CP, Chime EN, Okorie CO, Okonna FG, Idoko FL et al (2019) Postintubation tracheal stenosis: surgical management. Niger J Clin Pract 22(1):134–137PubMed Ezemba N, Echieh CP, Chime EN, Okorie CO, Okonna FG, Idoko FL et al (2019) Postintubation tracheal stenosis: surgical management. Niger J Clin Pract 22(1):134–137PubMed
19.
go back to reference Shen KR, Mathisen DJ (2003) Management of persistent tracheal stoma. Chest Surg Clin N Am 13(2):369, 73, ixCrossRef Shen KR, Mathisen DJ (2003) Management of persistent tracheal stoma. Chest Surg Clin N Am 13(2):369, 73, ixCrossRef
20.
go back to reference Keiser GJ, Bozentka NE, Gold BD (1991) Laryngeal granuloma: a complication of prolonged endotracheal intubation. Anesth Prog 38(6):232–234PubMedPubMedCentral Keiser GJ, Bozentka NE, Gold BD (1991) Laryngeal granuloma: a complication of prolonged endotracheal intubation. Anesth Prog 38(6):232–234PubMedPubMedCentral
21.
go back to reference Rubin AD, Hawkshaw MJ, Moyer CA, Dean CM, Sataloff RT (2005) Arytenoid cartilage dislocation: a 20-year experience. J Voice 19(4):687–701CrossRefPubMed Rubin AD, Hawkshaw MJ, Moyer CA, Dean CM, Sataloff RT (2005) Arytenoid cartilage dislocation: a 20-year experience. J Voice 19(4):687–701CrossRefPubMed
22.
go back to reference Xin G, Ruohoalho J, Back L, Aro K, Tapiovaara L (2019) Analysis of 255 tracheostomies in an otorhinolaryngology-head and neck surgery tertiary care center: a safe procedure with a wide spectrum of indications. Eur Arch Otorhinolaryngol 276:2069CrossRefPubMedPubMedCentral Xin G, Ruohoalho J, Back L, Aro K, Tapiovaara L (2019) Analysis of 255 tracheostomies in an otorhinolaryngology-head and neck surgery tertiary care center: a safe procedure with a wide spectrum of indications. Eur Arch Otorhinolaryngol 276:2069CrossRefPubMedPubMedCentral
Metadata
Title
Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis
Authors
Laura K. Tapiovaara
Katri L. S. Aro
Leif J. J. Bäck
Anni I. M. Koskinen
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 11/2019
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-019-05624-0

Other articles of this Issue 11/2019

European Archives of Oto-Rhino-Laryngology 11/2019 Go to the issue