Page 69 - Portuguese Journal - SPORL - Vol 61. Nº2

abscess, but is not recommended for the were shown to influence airway impairment
initial diagnosis of epiglottitis because it
cannot replace laryngoscopy. In our sample,
most patients underwent imaging exams on
admission, which may have been because
our SU functions as an emergency center to
which patients from other hospitals in the
center and south of the country are referred.
Moreover, CT was requested for some patients
due to suspected complications. In this
study, the most commonly used empirical
antibiotic was ceftriaxone—a third-generation
cephalosporin—to ensure broad-spectrum
coverage. There is a consensus in the literature
about the administration of antibiotics in all
cases of epiglottitis, unlike corticosteroids,
whose benefits are not fully confirmed 6, 18 .
Corticosteroids were prescribed in 94.1% of
cases. This high percentage does not allow a
comparison analysis to establish the role of
these drugs in the treatment of epiglottitis.
AAM in patients diagnosed with epiglottitis
continues to be somewhat controversial.
Some authors argue in favor of prophylactic
protection of the airway because many cases
of sudden obstruction have been described,
even in patients with a benign disease
course 7-8, 19-20 .
Nevertheless, other authors state that this early
intervention may not be needed because most
patients recover without complications 20-21 .
The MEWS is a simple method to evaluate
a patient’s clinical deterioration and can be
used in the medical and/or surgical settings .
7-8
A MEWS > 2 was shown to be associated
with the need for orotracheal intubation or
tracheotomy. This reinforces the importance
of using the score in the initial evaluation
of patients diagnosed with epiglottitis to
improve the efficacy and safety of AAM.
Dyspnea, MEWS, and presence of
comorbidities were significantly associated
with the need for AAM. Nonetheless, most
patients in this study did not require airway
protection, and a selective approach appears
to be more reasonable, as mentioned by Lam
et al. . However, the presence of comorbidities,
12
number and duration of symptoms, and MEWS
independently and are considered predictors
of this emerging complication; thus, they
warrant a higher level of suspicion of
complications. The limitations of this study
are its retrospective nature, the fact that it
was conducted in a single center, and its small
sample size. Therefore, the results obtained
herein may not represent the entire clinical
spectrum of the disease.
Conclusion
Epiglottitis is now more common among adults
than before. Its clinical presentation varies and
may easily be overlooked. Most patients have
a benign disease course, but sudden airway
obstruction may occur in some cases, which
can be fatal; thus, maintaining a selective
approach to the airway is recommended. The
MEWS is a useful tool for making this decision,
with a score > 2 being associated with the need
for orotracheal intubation or tracheotomy.
The presence of suppuration in the supraglottis,
elevated CRP, or neutrophilia, as well as
symptoms or presence of comorbidities, may
be associated with severe complications and
length of hospital stay. All these factors should
be considered during clinical evaluation
and monitoring to ensure the best quality
of medical management of patients with
epiglottitis.
Conflicts of Interest
The authors declare that there is no conflict
of interests regarding the publication of this
paper.
Data Confidentiality
The authors declare having followed the
protocols in use at their working center
regarding patients’ data publication.
Protection of humans and animals
The authors declare that the procedures
were followed according to the regulations
established by the Clinical Research and Ethics
Committee and to the 2013 Helsinki Declaration
of the World Medical Association.
Volume 61 . Nº2 . June 2023 211