Acute adult supraglottitis: Difficult intubation & potential airway loss

Abstract

Acute Adult Supraglottitis (AAS), formerly called epiglottitis, can lead to life-threatening inflammatory oedema of the epiglottis and adjacent structures resulting in constriction of the airway directly over the vocal cords. We are introducing a patient with supraglottitis with mild nonspecific upper airway symptoms which proceed swiftly within a few hours resulting in complete occlusion of the airway.Case:A young male was admitted to ICU due to a picture of supraglottitis. A confirmed diagnosis of supraglottitis was done by serial investigations. Ceftriaxone, dexamethasone, and adrenaline nebulization started early. He deteriorated in the next 2 hours, with drooling of oral sections and severe dysphagia. It was decided to perform tracheal intubation in the operating theater (OT) in the presence of an ENT surgeon because no OT is available at this time, so the airway was managed in ICU. Tracheal intubation became impossible despite intubation attempts by senior anesthesiologists using advanced airway devices including Video Laryngoscope, and fiberscope, requiring surgical tracheostomy. He underwent drainage of pockets of pus after the second CT.AAS can lead to life-threatening airway obstruction. A high index of suspicion along with early involvement of multidisciplinary team and close observation in the monitored areas will prevent hypoxic catastrophes.