The safety of intubation in croup and epiglottitis: an eight-year follow-up

Abstract

A series of 815 infectious croup (i.e., laryngotracheobronchitis) cases and 55 epiglottitis cases, encompassing an eight-year interval, is reviewed to determine the incidence of adverse effects of nasotracheal intubation used to manage upper airway obstruction. The racial, sex, and age distributions, in addition to modalities of treatment, are presented. The intubated cases (86 patients), representing 6.5 percent of all croup cases and 60 percent of all epiglottitis cases, are described in more detail with respect to presenting symptoms and physical findings. The average duration of intubation is 55 hours for epiglottis and 88 hours for croup. The incidence of immediate, reversible complications for the entire intubated series is 7 percent. The incidence of delayed, irreversible complications, as determined by: 1. noting any persistent post-extubation symptoms; 2. measuring peak expiratory flow rates; and 3. laryngeal polytomography, is 1.6 percent. The mortality secondary to intubation is 0 percent. The complication rate (1.6 percent) in this series of nasotracheal intubations is lower than the mortality (3.6 percent) in a large collective series of pediatric tracheotomies performed for airway obstruction in croup or epiglottitis. Other advantages of intubation vs. tracheotomy are described (i.e., shorter hospital stay, dilatatory effect of endotracheal tube). The authors conclude that nasotracheal intubation is safer than pediatric tracheotomy and should be considered the procedure of choice in the management of upper airway obstruction secondary to croup or epiglottitis.