To the Editor.
—In their Brief Report on acute epiglottitis in adults,1 Dr Frantz and colleagues conclude that stridor and sitting erect were the factors highly associated with airway intervention. I hope your readers did not draw the wrong conclusions regarding the proper timing of airway intervention in patients with acute epiglottitis or supraglottitis.Most clinicians recognize that in a developing acute obstructive laryngitis, stridor indicates an advanced stage of the process, whether it involves the supraglottic or infraglottic regions of the larynx.2 It is also a physiological fact that tachycardia is an earlier indicator of airway compromise and hypoxemia than is the respiratory rate. It explains why, in the early phases of the inflammation, patients present with a very rapid pulse rate3,4 but without a change in the respiratory rate. Based both on my review of the medical records of 12 adults from around the United
Deeb ZE. Acute Epiglottitis in Adults. JAMA. 1995;273(12):920. doi:10.1001/jama.1995.03520360034031