• D Madhotra, J E Fenton, Z G G Makura, P Charters, and N J Roland.
• Department of Otolaryngology, Head and Neck Surgery, University Hospital Aintree, Liverpool, UK.
• Ir J Med Sci. 2004 Oct 1; 173 (4): 197199197-9.

BackgroundThe timing of aggressive airway intervention in adult epiglottitis is controversial.AimsTo correlate Friedman's staging of epiglottitis on admission with the airway interventions undertaken.MethodsA 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.ResultsThree 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.ConclusionsFriedman 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.

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