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At least 19 recordsLinked to original sources
PubMed1991

[Croup and air pollutants: results of a two-year prospective longitudinal study].

The Reutlingen/Tübingen/Rottenburg region in Baden-Württemberg is characterized by medium and small sized towns and rural areas. In 1986/87 875 cases of croup were registered there by the treating physicians during a 24-months period. In consideration of meteorological and virological "disturbing variables" the influence of the measured air pollution by SO2, NO, NO2, CO, ozone and dust on croup frequency was computed by means of statistical regression methods. For the months September till March, the main manifestation period of croup, weak but statistically significant influences of the daily means of NO and NO2 were found, for the whole year influences of NO, NO2, and CO. During the winter months temperature correlates positively and velocity of wind negatively, both statistically with significance, to croup frequency. The essential conditions of croup are individual and familiar disposition on the one hand, virus infections on the other. Air pollution of a concentration like given in the investigated region was found to be a weak additional factor that favours the manifestation of croup.

Air Pollutants↗
PubMed1975

The safety of intubation in croup and epiglottitis: an eight-year follow-up.

A series of 815 infectious croup (i.e., laryngotracheobronchitis) cases and 55 epiglottitis cases, encompassing an eight-year interval, is reviewed to determine the incidence of adverse effects of nasotracheal intubation used to manage upper airway obstruction. The racial, sex, and age distributions, in addition to modalities of treatment, are presented. The intubated cases (86 patients), representing 6.5 percent of all croup cases and 60 percent of all epiglottitis cases, are described in more detail with respect to presenting symptoms and physical findings. The average duration of intubation is 55 hours for epiglottis and 88 hours for croup. The incidence of immediate, reversible complications for the entire intubated series is 7 percent. The incidence of delayed, irreversible complications, as determined by: 1. noting any persistent post-extubation symptoms; 2. measuring peak expiratory flow rates; and 3. laryngeal polytomography, is 1.6 percent. The mortality secondary to intubation is 0 percent. The complication rate (1.6 percent) in this series of nasotracheal intubations is lower than the mortality (3.6 percent) in a large collective series of pediatric tracheotomies performed for airway obstruction in croup or epiglottitis. Other advantages of intubation vs. tracheotomy are described (i.e., shorter hospital stay, dilatatory effect of endotracheal tube). The authors conclude that nasotracheal intubation is safer than pediatric tracheotomy and should be considered the procedure of choice in the management of upper airway obstruction secondary to croup or epiglottitis.

Age Factors↗
PubMed1992

Hospitalized croup (bacterial and viral): the role of rigid endoscopy.

This is a retrospective study of 500 cases of hospitalized patients with the diagnosis of croup (laryngotrachitis), admitted between January 1986 and August 1988, at the Montreal Children's Hospital. The patient's age, sex, clinical history, physical examination, number of admissions, season of admission, method of diagnosis, treatment and management were reviewed. Two per cent of these patients were diagnosed as bacterial croup. All of them required intubation and endoscopic evaluation in their management. Of all the viral croup patients, less than one-third were severe enough to require an intensive care setting for their management. In these patients, 6% required endotracheal intubation, and on endoscopy, a significant number of these patients had an endoscopic airway abnormality in addition to croup (subglottic edema). According to our findings, we suggest diagnostic micro-laryngoscopy and bronchoscopy be performed on certain groups of croup patients because of their higher yield of airway abnormality on endoscopy.

Bacterial Infections↗
PubMed1992

Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis (croup).

Aerosolized racemic epinephrine, but not L-epinephrine, is commonly used in treating croup. The efficacy and adverse effects of nebulized racemic and L-epinephrine in the treatment of laryngotracheitis were compared. Children 6 months to 6 years of age with a croup score of 6 or above were assigned in a randomized double-blind fashion to receive either racemic (n = 16) or L-epinephrine (n = 15) aerosols. Croup score, heart rate, blood pressure, respiratory rate, fraction of inspired oxygen, and oxygen saturation were recorded before treatment and at 5, 15, 30, 60, 90, and 120 minutes after the aerosol. Patients in both groups showed significant transient reduction of the croup score and respiratory rate following the aerosol (P less than .001), but there were no differences between treatment groups when croup score, heart rate, blood pressure, and respiratory rate were assessed over time. It is concluded that L-epinephrine is at least as effective as racemic epinephrine in the treatment of laryngotracheitis and does not carry the risk of additional adverse effects. L-Epinephrine is also more readily available worldwide, is less expensive, and can be recommended for this purpose.

Aerosols↗
PubMed1992

Candida laryngotracheitis: a complication of combined steroid and antibiotic usage in croup.

The use of corticosteroids to reduce the morbidity associated with laryngotracheobronchitis (croup) has been a controversial issue for many years. Recent literature, however, does support a decreased morbidity and increased clinical response when short-term steroids are used. As a prophylactic measure against bacterial superinfection, antibiotics are commonly utilized in the treatment of croup. We present the case of an otherwise healthy infant with severe croup who was hospitalized and treated with both steroids and antibiotics. A relapse in her symptoms led to the diagnosis of candida laryngotracheitis. We recommend close monitoring of patients with croup treated aggressively with steroids and antibiotics. Steroid use should be limited to 24 h with antibiotics reserved for patients with signs of bacterial infection.

Amphotericin B↗
PubMed1992

Diagnosis and treatment of croup.

Croup is a common childhood disease that has no specific diagnostic test. It must be differentiated from life-threatening diseases, such as epiglottitis, that demand specific interventions. A high degree of toxicity, the presence of dysphagia and the absence of cough help distinguish epiglottitis from croup. The usefulness and safety of visualization of the epiglottis in patients with croup are controversial. Clinical recognition of respiratory distress and failure is vital. Hypoxia is common. Pulse oximetry is helpful in the assessment of hypoxia, but readings do not correlate with clinical status or respiratory failure. Although studies have not proved that mist therapy is beneficial, the efficacy of racemic epinephrine is well documented. High dose corticosteroids have proved effective in the treatment of croup. Outpatient use of racemic epinephrine and steroids remains controversial.

Croup↗
PubMed1978

Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study.

Racemic epinephrine has been advocated for the treatment of croup, but controlled studies have not proved it more effective than saline. Twenty patients (aged 4 months to 5 years) hospitalized with acute croup and persistent inspiratory stridor at rest were randomly assigned to one of two treatment groups: saline or racemic epinephrine, both nebulized and delivered by intermittent positive pressure breathing. Clinical scores were significantly improved (P less than .01) at ten and 30 minutes following the treatment with racemic epinephrine but not at 120 minutes. Racemic epinephrine was significantly more effective than saline at 10 (P less than .01) and 30 minutes (P less than .05) but not at 120 minutes after the treatment. We conclude that nebulized racemic epinephrine is effective treatment for the acute signs of croup.

Acute Disease↗
PubMed1992

Racemic epinephrine use in croup and disposition.

The purpose of this study was to determine the effectiveness of a protocol for the outpatient management of laryngotracheitis (croup) using racemic epinephrine and steroids. The authors retrospectively reviewed fifty consecutive charts of children with croup who were treated under this protocol in the Scottish Rite Children's Medical Center Emergency Department (Atlanta, GA) and discharged to home after 2 hours of observation. Forty-seven of the 50 children had stridor at rest and/or retracting at rest on presentation to the emergency department. Forty-seven of the 50 patients did not require further medical care within 48 hours. One patient required another emergency visit and additional treatment with racemic epinephrine. Two patients were lost to follow-up. This study suggests that selected children presenting with croup and significant distress may be effectively treated with racemic epinephrine and steroids, observed for at least 2 hours, and safely discharged home.

Aerosols↗
PubMed1979

Membranous laryngotracheobronchitis (membranous croup).

Membranous laryngotracheobronchitis (membranous croup), not previously described as a distinct entity, is characterized by diffuse inflammation of the larynx, trachea, and bronchi with adherent or semiadherent mucopurulent membranes in the subglottic trachea (conus elasticus) and in the upper trachea distal to the conus elasticus. We reviewed 28 cases of membranous croup diagnosed by endoscopy and/or radiographic examination. The importance of the recognition of membranous croup as a distinct entity is discussed. The characteristic radiologic findings consist of subglottic tracheal narrowing, irregularity of contour of the proximal tracheal mucosa, and sometimes detached or partially detached proximal tracheal membranes, which can be mistaken for tracheal foreign bodies.

Bronchitis↗
PubMed1978

The relationship between croup and asthma.

In 241 outpatients with asthma a higher prevalence of croup (33.2%) was found than in 131 controls (20.6%). The difference for recurrent croup was even more significant. Among inpatients with croup, compared with controls without, a greater tendency towards asthma, but not towards other atopic diseases, was found.

Asthma↗
PubMed1979

Efficacy of helium--oxygen mixtures in the management of severe viral and post-intubation croup.

An appreciable number of children with viral or post-intubation croup progress to respiratory failure necessitating an artificial airway. We report seven such patients with critical airway narrowing in whom we reduced the work of breathing by developing helium rather than air as a carrier gas for oxygen. Assessment of patients by a croup-scoring system and blood gas analysis suggests helium-oxygen mixtures to be a useful alternative to intervention with tracheostomy or tracheal intubation. The rationale and limitations of this treatment are discussed.

Airway Obstruction↗
PubMed1992

Placebo-controlled trial of prednisolone in children intubated for croup.

Many studies have attempted to find out whether steroid treatment is beneficial in children with croup, but the results have been inconclusive. We have done a prospective placebo-controlled study of the effect of prednisolone on two clinical endpoints--the duration of intubation and the need for reintubation. Reasons for exclusion were age under 6 months, congenital airway anomalies, and previous intubation. 70 eligible children were randomly assigned treatment with prednisolone 1 mg/kg (n = 38) or placebo (n = 32) every 12 h given by nasogastric tube until 24 h after extubation. 11 (34%) placebo-treated and only 2 (5%) prednisolone-treated patients required reintubation after accidental or elective extubation (p = 0.004, Fisher's exact test; odds ratio 8.9, 95% confidence interval 1.7-59.3). Survival analysis with log-normal regression showed that the duration of intubation was shorter with steroid therapy (p less than 0.003) and increasing age (p less than 0.02), but was not influenced by endotracheal tube size or abnormality on chest radiograph. The median duration of intubation was 138 (95% CI 118-160) h in children who received placebo and 98 (85-113) h in the prednisolone group. Steroid therapy reduces the duration of intubation and the need for reintubation in children intubated for croup.

Age Factors↗
PubMed1979

A prospective randomized study to determine the efficacy of steroids in treatment of croup.

We evaluated the use of dexamethasone in the management of acute laryngotracheobronchitis (croup). Thirty patients, ranging in age from eight to 60 months, were evaluated in a prospective, double-blind study. Patients received dexamethasone, 0.3 mg/kg at the time of admission and a similar dose 2 hours later, and were compared with a placebo group receiving saline. Sixteen patients received dexamethasone and 14 patients received the placebo. Severity of each group was scored by a standardized system. Patients receiving dexamethasone had a mean admission score of 8.46 points; patients receiving placebo, 8.14. Twenty-four hours after admission the patients in the treatment group had a mean score of 1.19 as contrasted with a score of 5.58 for the placebo group (P less than 0.01). We concluded that dexamethasone when administered in adequate dosage by an intramuscular route hastens the recovery of infants and children with acute uncomplicated croup.

Child, Preschool↗
PubMed1991

Experience of pulse oximetry in children with croup.

We report our experience with 199 patients requiring admission with a diagnosis of croup over an 18 month period. The value of using pulse oximetry to monitor these children was critically examined. Twenty-nine patients with clinically significant stridor were monitored for an average of 12 hours. There was poor correlation of clinical status and respiratory rate with hypoxia as shown by the technique, with frequent dips in oxygen saturation being caused by technical problems such as movement artefact. Pulse oximetry is a useful adjunct to the clinical assessment of croup, but cannot be relied upon solely for monitoring these labile patients.

Body Temperature↗
PubMed1991

Croup. A common cause of airway obstruction in children.

Although viral croup is usually a self-limiting disease, its signs and symptoms are distressing enough to make parents seek immediate medical advice. This is fortunate because a much more serious disorder may be present. Indeed, morbidity requiring hospitalization may occur, as may a true emergency. Drs Thomsen and Edmonds discuss the epidemiology and current management of croup and related conditions.

Airway Obstruction↗
PubMedDate not supplied

Home management of the child with viral croup (laryngotracheobronchitis).

Laryngotracheobronchitis (LTB), also known as "croup," is a perennial viral infection that commonly affects young children in the cold season of the year. Croup, with its distinguishable symptoms of "barking seal cough," inspiratory stridor, and late-night occurrence, can be frightening for child and parents but can be managed effectively at home. This article outlines the nurse practitioner's (NP) instructions for LTB home management, triage of symptoms, and anticipatory guidance regarding course of the illness. Guidelines for assessment of the parent's self-care abilities and referral criteria are also given. The differential diagnosis of epiglottitis is reviewed and the need for immediate referral is emphasized.

Acute Disease↗
PubMed1975

Recent advances in diagnosis and management of croup.

Croup is a syndrome of inspiratory stridor, cough, and hoarseness, due to varying degrees of laryngeal obstruction. It is a viral disease and must be differentiated from epiglottitis. In addition to a careful clinical assessment, neck films are the most valuable diagnostic tool in differentiating these two. The principle modes of therapy for croup include provision of adequate hydration, ensuring maximum available humidification, sedation, and administration of intermittent positive pressure breathing (IPPB) with nebulized racemic epinephrine. The latter mode of therapy will provide symptomatic relief and may eliminate the need for hospitalization and tracheostomy. Steroids offer little benefit in treating this disease, and antibiotics offer none.

Child↗
PubMed1977

Airway management in croup and epiglottitis.

Treatment techniques for airway obstruction in croup and epiglottitis are reviewed in the medical literature. Series totaling 295 nasotracheal intubations, and 591 tracheostomies were reviewed. There were two deaths attributable to airway complications in 126 patients in whom nasotracheal intubation was carried out. In three patients subglottic granulation tissue and subglottic stenoses developed from short-term nasotracheal intubation. There were no subglottic stenoses or tracheal stenoses reported in the 591 tracheostomies. From this review, it would seem feasible to use nasotracheal intubation for short-term airway treatment in croup and epiglottitis. The increasing occurrence of laryngeal and tracheal complications with long-term intubation suggests that tracheostomy be considered in such cases.

Airway Obstruction↗