Damm M, Eckel H E, Jungehülsing M, Roth B
Department of Oto-Rhino-Laryngology and Children's Hospital, University of Cologne, Germany.
Otolaryngol Head Neck Surg. 1999 Nov;121(5):633-8. doi: 10.1016/S0194-5998(99)70071-9.
Acute epiglottitis, bacterial tracheitis, and severe viral laryngotracheobronchitis continue to cause life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in treatment, to clarify the role of airway endoscopy, and to identify current reasons for fatalities in these diseases.
During the observation period from 1980 to 1996, we identified 61 patients treated in the pediatric intensive care unit of the University Hospital of Cologne for severe inflammatory airway obstruction.
Critical points in the appropriate airway management were (1) the confirmation of the admission diagnosis, (2) whether an artificial airway or rigid tracheobronchoscopy was required; and (3) appropriate timing of extubation. Since 1989 airway evaluation with flexible or small, rigid endoscopes was used to confirm the diagnosis and to determine the appropriate management. Endoscopic findings were extremely helpful to decide not to intubate and to monitor in the pediatric intensive care unit first. Three patients with acute epiglottitis died after out-of-hospital cardiorespiratory arrest.
Endoscopy should be a part of every established treatment protocol of childhood stridor. The most decisive factor to decrease mortality seems to be timely presentation to a referral center.
急性会厌炎、细菌性气管支气管炎以及严重的病毒性喉气管支气管炎仍会导致儿童出现危及生命的气道梗阻。这项回顾性研究的目的是评估治疗中的不足之处，阐明气道内镜检查的作用，并找出这些疾病当前的致死原因。
在1980年至1996年的观察期内，我们确定了61例在科隆大学医院儿科重症监护病房接受治疗的严重炎性气道梗阻患者。
恰当气道管理的关键点包括：（1）确诊入院诊断；（2）是否需要建立人工气道或进行硬质气管支气管镜检查；（3）合适的拔管时机。自1989年起，使用可弯曲或小型硬质内镜进行气道评估，以确诊并确定合适的治疗方案。内镜检查结果对于决定不插管并首先在儿科重症监护病房进行监测极为有用。3例急性会厌炎患者在院外发生心肺骤停后死亡。
内镜检查应成为儿童喘鸣既定治疗方案的一部分。降低死亡率的最关键因素似乎是及时转诊至转诊中心。
