Acute epiglottitis: evolution of management in the community hospital.

One hundred and forty-eight cases of acute epiglottitis in children treated at the University of Rochester's Strong Memorial Hospital and two affiliated community hospitals between 1965 and 1983 are reviewed retrospectively. Patients seen prior to 1975 were usually managed with tracheotomy and intravenous antibiotics, while those after 1975 with nasotracheal intubation, antibiotics and steroids. Tracheotomy and nasotracheal intubation were equally safe in controlling the upper airway. We compared our results with other series, primarily from children's hospitals, using nasotracheal intubation and found comparable results. Steroids provided no significant effect on the duration of intubation or infectious complications, but was associated with gastrointestinal bleeding. Long- and short-term complications of intubation, including self-extubation are discussed. We conclude that nasotracheal intubation is a safe method of management for acute epiglottitis in the community hospital.