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Croup Treatment
Pharmacotherapy
Epinephrine (Nebulized)
- Should be given to patients with severe respiratory distress
- Reduces symptoms within minutes but exerts no effect beyond 1 hour
- Hold discharge & observe patient for at least 2 hours after administration of Epinephrine
- Combination with oral Dexamethasone is indicated for moderate to severe croup
- Eg Dexamethasone, Prednisolone
- Should be given to children diagnosed with croup regardless of severity
- Improves symptoms & reduces risk of hospital admission
- Well-absorbed, relatively safe
- Multiple doses do not provide additional benefit over a single dose
- Should not be given to a child w/ known immune deficiency or recent varicella exposure
- Recommended first-line corticosteroid therapy for croup due to its long half-life and route options
- May reduce return visit, hospital admission and readmission rates
- Eg Budesonide
- May be given to children diagnosed with croup who are intolerant to Dexamethasone
- Administration may cause more agitation to the child
- Not routinely given to a child due to its cost, length of administration and anxiety that it causes
- Indicated only in patients with persistent vomiting and with severe respiratory distress
- Budesonide may be mixed with Epinephrine and administered simultaneously
Non-Pharmacological Therapy
Parent/Guardian Reassurance
- Actions that minimize anxiety are appropriate until the airway is secure
- Child should be held & comforted
- Avoid anxiety-provoking maneuvers (eg blood extraction, IV line placement, placing the child in a supine position or direct inspection of the oral cavity) until the airway is secure
- Further studies are needed to prove the use of heliox in patients with croup
- May be useful in reducing resistance of airflow & turbulence, thereby decreasing the work during respiration
- Provide supplemental O2 if necessary, especially in hypoxemic patients with O2 saturation of <92%
