The management of acute supraglottitis patients at the intensive care unit

Introduction: Acute supraglottitis is a potentially life-threatening condition that often necessitates intensive care unit (ICU) admission for airway monitoring. The objective of this study was to identify clinical criteria that predict a benign course for patients with acute supraglottitis. Methods: A prospective observational study was performed. Adult patients hospitalized in the ICU between 2007 and 2019 diagnosed with acute supraglottitis were included. All patients were treated with antibiotics and corticosteroids. Fiber optic laryngoscopy (FOL) was performed every 12 h, with each exam defined as “improving”, “no change” or “deteriorating” based on the presence of airway edema. Need for airway intervention was correlated to changes in the FOL exam. Results: Of 146 patients included, 14 (10%) required intubation, ten on admission, and four during the first 6 h of ICU admission. FOL follow-up was performed on 528 occasions—427 (81%) exams showed improvement, 16 (3%) deterioration, and 85 (16%) with no change. On no occasions was improvement in FOL followed by deterioration. The median ICU length of stay was 3 (IQR 2–3.5) vs. 1 (IQR 1.0–1.25) day for patients who did or did not require intubation (p < 0.001), respectively. Conclusion: Improvement in FOL exam accurately predicted the absence of need for intubation and might represent a criterion for early ICU discharge.