Definitions
- Acute Infectious Croup (Acute Laryngotracheobronchitis): contagious disease in otherwise healthy children
- Often associated with respiratory illness in the family
- Acute Spasmodic Croup: most common in young children who are prone to recurrent attacks
- Possibly precipitated by a viral respiratory infection, allergic factors, or other factors
- Fever is usually absent
- Symptoms usually resolve within several hours
Epidemiology
Etiology
Physiology
- Infection of upper airway with rapid onset of glottic closure -> upper airway obstruction
Diagnosis
- CXR: glottic/subglottic edema -> may aid in differentiation from acute epiglottitis (although radiographs are of limited accuracy)
Clinical Manifestations
General Comments
- Symptoms are preceded by several days of an upper respiratory illness
- Symptoms are often worse at night
- A fluctuating course is typical
Otolaryngologic Manifestations
- Acute Upper Airway Obstruction (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
- Acute Respiratory Failure (see Respiratory Failure, [[Respiratory Failure]]): due to high-grade upper airway obstruction with excessive work of breathing
- Inspiratory Stridor (see Stridor, [[Stridor]])
- Hoarseness (see Hoarseness, [[Hoarseness]])
Pulmonary Manifestations
- Brassy or Barking Cough (see Cough, [[Cough]])
- Dyspnea (see Dyspnea, [[Dyspnea]])
Other Manifestations
Treatment
Natural Course
- A fluctuating course is typical
Supportive Care
- Humidified Oxygen/Mist Therapy
Hospitalization
- Home Management: since most children have symptoms which decrease in intensity over several days, they can be managed at home
- However, monitoring for upper airway obstruction is crucial
Nebulized Racemic Epinephrine (see Epinephrine, [[Epinephrine]])
- Indications: used for symptomatic relief of upper airway obstruction
- Mechanism: alpha adrenergic effect is believed to cause mucosal vasoconstriction, resulting in decreased subglottic edema
- Latency: min
- Duration of Action: <2 hr
- Clinical Efficacy: has not been demonstrated to improve oxygenation
Corticosteroids (see Corticosteroids, [[Corticosteroids]])
- Indications: mild, moderate, and severe croup
- Single-dose corticosteroids is probably indicated in any child with severe enough croup to require an emergency room or clinic visit
- Clinical Efficacy
- Increase rate of symptomatic improvement
- Decrease hospital length of stay
- Decrease the rate of intubation
- Adverse Effects: single-dose corticosteroids does not have significant adverse effects
Anti-Viral Agents
- Have not been evaluated in croup
Antibiotics
- Likely have no clinical benefit
References