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  • Croup PDF

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    Amanda Fairuz
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    Croup is a common illness that manifests most commonly with barking cough, hoarse voice, inspiratory stridor, and varying degrees of respiratory distress. Croup syndrome refers to any number of diseases that vary based on anatomic location of involvement. The most common of these is acute laryngotracheitis, involving the larynx, subglottic tissues and trachea.

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    Croup is a common illness that manifests most commonly with barking cough, hoarse voice, inspiratory stridor, and varying degrees of respiratory distress. Croup syndrome refers to any number of diseases that vary based on anatomic location of involvement. The most common of these is acute laryngotracheitis, involving the larynx, subglottic tissues and trachea.

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    47 vizualizări2 pagini

    Croup PDF

    Încărcat de

    Amanda Fairuz
    Croup is a common illness that manifests most commonly with barking cough, hoarse voice, inspiratory stridor, and varying degrees of respiratory distress. Croup syndrome refers to any number of diseases that vary based on anatomic location of involvement. The most common of these is acute laryngotracheitis, involving the larynx, subglottic tissues and trachea.

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    din 2

    InpatientCurriculum20052006

    CROUP
    Introduction
    Croupisacommonillnessthatmanifestsmostcommonlywithbarkingcough,hoarsevoice,inspiratorystridor,and
    varyingdegreesofrespiratorydistress.Croupsyndromereferstoanynumberofdiseasesthatvarybasedon
    anatomiclocationofinvolvement.Themostcommonoftheseisacutelaryngotracheitis,involvingthelarynx,
    subglottictissuesandtrachea.Casescanextendtolaryngotracheobronchitis(LTB)or
    laryngotracheobronchopneumonitis(LTBP).
    Epidemiology:
    accountsfor15%ofrespiratoryillnessinpediatrics
    averageincidencein<6yoof 3%,with1.531%ofthesegettingadmitted
    averageageforviralcroupis16yo,withameanof18mo,peakin2nd year
    multiplestudiesinN.AmericahavedemonstratedpeaksinOctoberofoddnumberedyears
    Etiology:

    6575%ofcasesareduetoParainfluenze(types1,2,3)
    mostseverecasesareduetoInfluenzaA
    AlsoseenwithRSV,Adenovirus,Measles
    LTBandLTBParemoreoftencausedbybacterialinfection(S.aureus,S.pyogenes,S.penumoniae)

    Pathogenesis:
    Nasopharynxinvolvementspreadsdownrespiratorytreewithvaryingdegrees
    Causesinflammationoftrachealwalls,limitingvocalcordmovement
    Subglotticareaisalreadymostnarrowpartofpediatricupperairway,andnowtheresultantedema
    narrowsthisfurther
    Diseaseprogressionresultsinobstructionbyexudatesandpseudomembranes
    Clinical Presentation
    Acutelaryngotracheitis:

    Upperrespiratorysymptoms(rhinorrhea,pharyngitis,lowgradefever,cough)
    After1224hours,patientdevelopsabarkingcough,possiblystridor
    Themajorityofcaseshaveonlyhoarsevoiceandcough
    Acutelaryngotracheobronitis/pneumonitis:
    initiallythesamesymptomsasacutetracheitis
    after57days, symptomssuddenlyworsenwithhighfeverandincreasedWOB
    Differentialdiagnosisincludesforeignbody,trauma,angioneuroticedema,retropharyngealorperitonsillar
    abscess,bacterialtracheitis,ANDEPIGLOTTITIS!
    Laboratory Workup
    Laboratoryworkupisminimallyuseful:
    AnteriorCXRmayshowsubglotticnarrowing(steeplesign),althoughthiscanbeseeninhealthychildren
    dependingonphaseofrespiration
    CBCmayshowelevatedwbcwithleftshift,thoughnonspecific
    NPaspirateswillnotaffect managementdecisions,onlycohorting

    Treatment

    Treatmentisdependentuponseverityofdisease.Mild,moderate,severediseasecanbedefinedas
    follows:
    MILD:barkingcough,no/intermittentstridor atrest,happy,playful
    MODERATE:stridoratrest,trachealtug/chestwallretraction,canbeplacated
    SEVERE:stridoratrest,severetrachealtug/chestwallretraction,apathetic/restless
    Epinephrine:
    Proveneffectiveformoderatetoseverecroup
    Racemicnebulizedepinephrinestimulatesalphaadrenergic receptorsforcapillaryconstrictionandthus
    fluidresorptionleadingtodecreasedlaryngealmucosaledema
    Effectslastapproximately2hours,resultinginpotentialReboundEffect(inERwillmonitorforfourhours
    priortodischarge)
    Corticosteroids:
    Recommendedinmoderatetoseverecroup
    Oral,nebulised,intramuscular,andintravenoussteroidsallproveneffectiveoverplacebo (at6,12,and24
    hours)
    Inmildcroup, onestudyhasshownasingledoseofdexamethasonehasreducednumberofpatients
    requiringsubsequentcarein710days
    Dexamethasoneorallydosedfrom0.150.6mg/kgareeffectivemostuse0.150.3mg/kg
    Heliox:
    Twosmallstudiesavailableregardinghelioxinmoderatecroup:
    o Oneshowednodifferencebetweenhelioxandoxygen
    o Oneshowednodifferencebetweenhelioxandracemicepinephrine
    Misttreatment:
    Thestandardofhometreatmentsincethe19th century
    Noadequatestudieshaveeverproventheefficacyofmisttreatment
    Presumedmechanismthroughmoistureandsoothinginflamedairwayscoolequaltowarmmist
    Misttherapycanbedetrimentalincroupwithwheezeasitinducesbronchospasm
    DischargeCriteria
    FromtheERandtheinpatientservice,thegoalofdischargeisverysimilar:
    Nostridoratrest,notrequiringracemicepinephrine(atleastfourhours),normalrespiratory
    effort,goodparentaleducationandcomfort
    References
    FitzgeraldDA,KilhamHA.Croup:assessmentandevidencebasedmanagement. MedJAust.2003179:372377.
    MalhotraA,KrilovL.Viralcroup. PedsinRev. 200122:511.
    SegalAO,etal.CrouphospitalizationsinOntario:a14yeartimeseriesanalysis. Pediatrics. 2005116:5155.

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