Bacterial tracheitis: A therapeutic approach

Objectives/Hypothesis: tracheitis is an acute, infectious, potentially life‐threatening condition of the pediatric airway. Historically, patients have often required urgent invasive airway support, and have been treated with broad‐spectrum antibiotics, often combined with direct laryngoscopy and bronchoscopy. Study Design: Retrospective chart review. Methods: Six patients between the ages of 10 months and 16 years were treated at Children's Hospital, Boston, Massachusetts, for bacterial tracheitis between January 2009 and March 2009. All patients underwent urgent direct laryngoscopy and bronchoscopy for debridement of mucopurulent debris and tissue culture. Broad‐spectrum intravenous antibiotics were administered, and patients were kept on acute cardiopulmonary monitoring for 48 to 72 hours, after which time the airway was re‐evaluated by direct laryngoscopy and bronchoscopy in five of the patients, and by fiberoptic nasolaryngoscopy in one patient. All of the patients were transitioned to oral antibiotic therapy for 10 to 14 days after discharge. Results: Following debridement, all of the patients did well with aggressive medical management. None of the patients required urgent intubation, although one patient was kept on ventilator support for 48 hours until disease resolution was confirmed. No patients required tracheotomy, and there were no cardiopulmonary arrests. The mean hospital length of stay was 4.8 days (range, 3–8 days). Conclusions: This study highlights the importance of early disease identification and urgent surgical intervention in the management of bacterial tracheitis. It also demonstrates an approach with the potential to improve patient outcomes from this dangerous condition. Laryngoscope, 120:2498–2501, 2010