croup
CROUP
Croup is a viral infection that causes erythema and edema of the tracheal walls and narrowing of the subglottic region. It is often characterized by an acute, rapidly progressing respiratory disease.
It is a medical emergency in children and requiring immediate treatment.
Most common causes are parainfluenza virus 1&2 and respiratory syncytial virus.
Occurrence of symptoms is usually at night and with abrupt onset and improve during daytime.

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
Corticosteroid (Systemic)
  • 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
Dexamethasone
  • 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
Corticosteroid (Nebulized)
  • 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
Helium-Oxygen (Heliox) Inhalation
  • 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
Oxygen Therapy
  • Provide supplemental O2 if necessary, especially in hypoxemic patients with O2 saturation of <92%
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