a severe, rapidly progressing bacterial infection of the upper respiratory tract that occurs in young children, primarily between 2 and 7 years of age. It is characterized by sore throat, croupy stridor, and inflamed epiglottis, which may cause sudden respiratory obstruction and possibly death. The infection is generally caused by Haemophilus influenzae, type B, although streptococci may occasionally be the causative agents. Transmission occurs via infection with airborne particles or contact with infected secretions. The diagnosis is made by bacteriological identification of H. influenzae, type B, in a specimen taken from the upper respiratory tract or in the blood. A lateral x-ray film of the neck shows an enlarged epiglottis and distension of the hypopharynx, which distinguishes the condition from croup. Direct visualization of the inflamed, cherry-red epiglottis by depression of the tongue or indirect laryngoscopy is also diagnostic but may produce total acute obstruction and should be attempted only by trained personnel with equipment to establish an airway or to provide respiratory resuscitation, if necessary. Epiglottitis caused by H. influenzae can be prevented by administration of H. influenzae type B conjugate vaccines to infants at or before the age of 2 months. Compare croup.
observations The infection is abrupt in onset, and it progresses rapidly. The first signs-sore throat, hoarseness, fever, and dysphagia-may be followed by an inability to swallow, drooling, varying degrees of dyspnea, inspiratory stridor, marked irritability and apprehension, and a tendency to sit upright and hyperextend the neck to breathe. Difficulty in breathing may progress to severe respiratory distress in minutes or hours. Suprasternal, supraclavicular, intercostal, and subcostal inspiratory retractions may be visible. The hypoxic child appears frightened and anxious; the skin color ranges from pallor to cyanosis.
interventions Establishment of an airway is urgent, either by endotracheal intubation or by tracheostomy. Humidity and oxygen are provided, and airway secretions are drained or suctioned. IV fluids are usually required, and antibiotic therapy is initiated immediately, usually with ceftriaxone, cefuroxime sodium, or ampicillin/sulbactam. Sedatives are contraindicated because of their depressant effect on the respiratory system, and antihistamines and adrenergic drugs usually have no therapeutic value. Steroids are useful.
nursing considerations The nurse may assist with intubation or tracheostomy once the diagnosis is confirmed. Intensive nursing care is required for a child with acute epiglottitis. The most acute phase of the condition passes within 24 to 48 hours, and intubation is rarely needed beyond 3 to 4 days. As the child responds to therapy, breathing becomes easier; rapid recovery usually occurs, so bed rest and quiet activity to relieve boredom become primary nursing concerns. The infection may spread, causing complications such as otitis media, pneumonia, and bronchiolitis. Complications of the tracheostomy may also develop and include infection, atelectasis, cannula occlusion, tracheal bleeding, granulation, stenosis, and delayed healing of the stoma. Also called acute epiglottiditis.