croup is laryngotracheobronchitis, supraglootic infection, most common cause of stridor, clinical feature and treatment Abbas Wael Abbas NNU

1. Abbas Wael Abbas
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2. croup refers to a heterogeneous group of
mainly acute and infectious processes that are
characterized by a bark- like or brassy cough
and may be associated with hoarseness,
inspiratory stridor, and respiratory distress
spasmodic or laryngotracheobronchitis
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3. Most common cause of upper airway acute
infection is virus , except ?
parainfuenza viruses (types 1, 2, and 3) 75% of
cases
Infuenza A is associated with severe
laryngotracheobronchitis
adenovirus, RSV , and measles
M.pneumoniae rare cause, mild
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4. Most patient between 3 mo and 5 yr, with the
peak in the 2nd yr of life
more common in boys
most commonly in the late fall and winter
15% of patients have a strong family history of
croup
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5. most common form of acute upper respiratory
obstruction
low-grade fever 1-3 days before the signs and
symptoms of upper airway obstruction become
apparent
rhinorrhea, pharyngitis, mild cough
barking cough, hoarseness, and inspiratory
stridor
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6.  child may prefer to sit up in bed or be held upright
 Symptoms are characteristically worse at night
And aggravated by agitation and crying
 resolve completely within a week
 Other family members might have mild respiratory
illnesses with laryngitis.
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7. hoarse voice
coryza
normal to moderately inflamed pharynx
 slightly increased respiratory rate
Rarely respiratory distress
alveolar gas exchange ?
 severe laryngotracheobronchitis is difficult to
differentiate from epiglottitis
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8.  children 1-3 yr of age
cause is allergic, psychologic. Viral in some cases
 similar to acute laryngotracheobronchitis, except?
 most commonly in the evening or nighttime, begins
suddenly
Child awake with a barking, metallic cough, noisy
inspiration, and respiratory distress
 symptoms generally diminishes within several
hours
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9. 9

10. 1-33m-5y
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11. 15% of patient
middle ear, terminal bronchioles, or pulmonary
parenchyma infection .
Bacterial tracheitis
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14. The mainstay of treatment for children with
croup is airway management and treatment of
hypoxia
Most children with either acute spasmodic
croup or infectious croup can be managed
safely at home
observation showed cold night air is benefcial,
a Cochrane review has found no evidence
supporting
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15.  Beneficial in mild, moderate, sever if given in the
first 3 days
 single dose of 0.6 mg/ kg. a dose as low as 0.15
mg/kg may be just as effective
 oral dose of dexamethasone as effective as
intramuscular. Nebulized budesonide
 oral prednisolone is less effective
 adverse effect candida albican laryngotracheitis in
patient who received dexamethasone, 1 mg/ kg/24
hr, for 8 days.
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16. Nebulized racemic epinephrine is an
accepted treatment for moderate or severe
croup
decrease the laryngeal mucosal edema
dose of 0.25-0.5 mL of 2.25% racemic epineph-
rine in 3 mL of normal saline.
can be used as often as every 20 min
There is evidence that l-epinephrine (5 mL of
1:1,000 solution) is equally effective as
racemic epinephrine
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17.  Duration of activity < 2h
 observe 2-3 h then discharge
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18. Antibiotics are not indicated in croup.
Nonprescription cough and cold medications
should not be used in children < 4 yr
A helium-oxygen mixture (heliox) may be
considered in children with severe croup for
whom intubation is being considered
although the evidence is inconclusive
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19. progressive stridor
severe stridor at rest
 respiratory distress
hypoxia
cyanosis
depressed mental status
 poor oral intake
the need for reliable observation
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20. Does not require a radiograph of the neck
Steeple sign (PA)
Not specific
Does not correlate with disease activity
Considered after airway stabilization in
atypical presentation
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21. Thank you
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