Damm M, Eckel H E, Roth B, Schneider D, Streppel M
Klinik und Poliklinik der Hals-Nasen-Ohrenheilkunde, Universität zu Köln.
Laryngorhinootologie. 1996 May;75(5):293-300. doi: 10.1055/s-2007-997582.
Apart from all advances made in the management of central airway infections, Acute Epiglottitis (AE) and Bacterial Tracheitis (BT) continue to be causes of life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in the diagnostical protocol, to clarify the role of airway endoscopy in acute childhood stridor, and to identify current reasons for fatalities in these diseases.
In the observation period between 1980-92, we found 12 patients suffering from BT and 21 from AE managed in close cooperation of the involved disciplines at the pediatric intensive care unit of the University of Cologne.
Laryngoscopy with fiberoptic or small rigid endoscopes allowed in awake cooperative children accurate diagnose of AE, and the exclusion of supraglottic inflammation in BT without complications. Furthermore, additional endoscopic information of the degree of inflammation was helpful in the next critical decision, whether artificial airway or rigid tracheobronchoscopy was required. Nasotracheal intubation was necessary in 76% of our patients, in one child tracheostomy was performed (5%). Premature extubation necessitating reintubation occurred in 33% of the children suffering from BT. In these patients, our method of advancing a flexible endoscope for tracheoscopy through the respiration tube failed because of a low tube diameter. Another remarkable finding was the high mortality in AE (14%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespiratory arrest.
In the analysis of the clinical course we found three decisive turning points in managing the disorder; First, the confirmation of the correct admission diagnosis; second, the decision, as to whether an artificial airway should be established; and third, the proper time of extubation. The most decisive factor in decreasing mortality seems to be timely, appropriate presentation at referral centers if AE or BT is suspected. Clinically, progressive management of childhood stridor requires close cooperation between the Pediatric, Anesthesiologic, and ENT Departments. Fiberoptic endoscopy as a guide to current airway management is a major step forward and should be a part of every established protocol.
尽管在中央气道感染的管理方面取得了诸多进展，但急性会厌炎（AE）和细菌性气管支气管炎（BT）仍是儿童危及生命的气道阻塞的病因。这项回顾性研究的目的是评估诊断方案中的不足之处，阐明气道内镜检查在儿童急性喘鸣中的作用，并确定这些疾病目前的死亡原因。
在1980年至1992年的观察期内，我们在科隆大学儿科重症监护病房发现12例患有BT的患者和21例患有AE的患者，这些患者由相关学科密切合作进行管理。
使用纤维光学或小型硬质内镜进行喉镜检查，可在清醒且配合的儿童中准确诊断AE，并排除无并发症的BT患者的声门上炎症。此外，炎症程度的额外内镜信息有助于做出下一个关键决策，即是否需要人工气道或硬质气管支气管镜检查。我们76%的患者需要进行鼻气管插管，1名儿童进行了气管切开术（5%）。33%患有BT的儿童发生过早拔管，需要重新插管。在这些患者中，由于气管导管直径较小，我们通过呼吸管推进柔性内镜进行气管镜检查的方法失败了。另一个显著发现是AE的高死亡率（14%）。受影响的儿童在户外心肺骤停后因缺氧状态不佳而入院。
在分析临床病程时，我们发现了管理该疾病的三个决定性转折点；第一，确认正确的入院诊断；第二，决定是否应建立人工气道；第三，合适的拔管时间。降低死亡率的最决定性因素似乎是如果怀疑有AE或BT，应及时、适当地转诊至转诊中心。临床上，儿童喘鸣的渐进性管理需要儿科、麻醉科和耳鼻喉科密切合作。纤维光学内镜作为当前气道管理的指南是一大进步，应成为每个既定方案的一部分。
