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—We appreciate Dr Deeb's comments regarding indications for airway intervention in adults with epiglottitis. In our study, we found that stridor and an erect posture were significantly associated with airway intervention when retrospectively reviewed; however, we believe that airway intervention in an adult with epiglottitis demands clinical judgment on an individual basis. We did not state that airway intervention should be reserved for patients with stridor, erect posture, or drooling. All the signs and symptoms of airway compromise must be considered when making this decision. If there is any question of respiratory compromise, the safest course of action is to secure the airway.Airway intervention is not required in all patients with epiglottitis and tachycardia. In our study, 48% of patients initially presented with tachycardia. If all of these patients had been managed with endotracheal intubation or tracheotomy, most of these procedures would have been performed unnecessarily.
Frantz TD. Acute Epiglottitis in Adults-Reply. JAMA. 1995;273(12):920. doi:10.1001/jama.1995.03520360034033