Epiglottitis--duration of intubation and fever.

The present study reviewed the clinical course of 23 pediatric patients with epiglottitis to define criteria for the length of time children require nasotracheal intubation for relief of airway obstruction. All patients had a nasotracheal tube placed in the operating room, were treated with ampicillin or chloramphenicol, and tracheal extubation was performed when the epiglottis was markedly reduced in size to a point where examiners estimated the thickness of the proximal portion of the epiglottis to be 3-4 mm or less. The mean duration of intubation was 36 +/- 14 h (+/- SD), but there was marked variation between patients. There was no significant relationship between reduction in the size of the epiglottis and the febrile nature of the disease. Based on these observations, it would be imprudent to time tracheal extubation by the absence of fever or to establish an arbitrary time period for maintenance of nasotracheal intubation in epiglottis. Direct observation of the epiglottis should determine when airway support is no longer needed.