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At least 19 recordsLinked to original sources

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↗

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↗

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↗

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↗

PubMed1975

Treatment of laryngotracheobronchitis (croup). Use of intermittent positive-pressure breathing and racemic epinephrine.

Use of racemic epinephrine hydrochloride (Vaponefrin), delivered by intermittent positive-pressure breathing, in the treatment of laryngotracheobronchitis (croup) produced acute beneficial results in a controlled study. However, symptoms often recurred within two hours, suggesting that this form of treatment should not be used in the emergency room and the patient then sent home. This treatment had no effect on arterial oxygen gas pressure. The changes in clinical status 24 to 36 hours after admission into the study were similar for the patients in the treatment and control groups, suggesting that the natural history of the disease was not drastically altered by this form of treatment.

Acute Disease↗

PubMed1978

Treatment of acute viral croup.

Total respiratory resistance (RT) was measured before and after nebulised alpha-adrenergic stimulant therapy in 8 children aged 4 to 18 months who had the clinical symptoms of acute viral croup. In 7 children there was a mean fall in RT of 30% after treatment, associated with an improvement in their clinical condition. This improvement was shortlived, the resistance returning to pretreatment levels within 30 minutes. The remaining child showed no improvement after phenylephrine but was subsequently found to have acute epiglottitis. Nebulised water did not produce any change, indicating that the response was not due to moisture alone.

Acute Disease↗

PubMedDate not supplied

Airway intervention in croup and epiglottitis: the changing role of the otolaryngologist.

Recent evidence indicates that endotracheal intubation is supplanting tracheostomy for the short-term treatment of airway obstruction in epiglottitis and croup. Care should be provided by a triumvirate of physicians to include and otolaryngologist, a pediatrician, and an anesthesiologist. Intensive care facilities are also a prerequisite. Standard tracheostomy should be considered in cases requiring intubation longer than 72 hours.

Child↗

PubMed1978

[On the pharmacological treatment of acute spasmodic laryngitis (Pseudo-Croup) (author's transl)].

Three aspects of the pharmacological treatment of pseudo-croup are discussed in this article. Sedatives should be given only when close clinical supervision is guaranteed. Otherwise the apparent drowsiness observed in patients passing from stage III to stage IV of the disease may be masked or misinterpreted due to these sedatives. Emetics used occasionally in the USA, and also frequently administered in Europe to the turn of the present century, are no longer used for treatment in Germany. There are no controlled studies showing their effectiveness. In contrast to the common practice in Germany, glucocorticosteroids are less frequently used in the USA. Theoretical considerations suggest their usefulness, but to data there is still no convincing proof of their clinical effectiveness.

Acute Disease↗

PubMed1977

Pulmonary edema associated with croup and epiglottitis.

Two children, ages 9 and 2 1/2 years, with clinical diagnoses of laryngotracheitis (croup) and epiglottis, respectively, developed florid pulmonary edema without evidence of cardiac enlargement. Both children responded to vigorous therapy, which included endotracheal intubation, mechanical ventilation with high oxygen concentrations and positive end expiratory pressure, diuretics, and support of the intravascular volume with colloid infusions. Swan-Ganz catheterization was performed in the child with epiglottitis to elucidate any hemodynamic malfunction. Pulmonary artery occluded pressure was found to be normal. We postulate that pulmonary edema may be the result of any of three major physiologic alterations: alveolar hypoxia, increased alveolar-capillary transmural pressure gradient, and a catechol-mediated shift of blood volume from the systemic to the pulmonary circulation. These alterations acting in concert would increase the volume of blood presented to the pulmonary capillaries, the pore size in those capillaries, and the hydrostatic pressure gradient promoting transduation. Failure of pulmonary lymphatics to effectively clear this fluid would result in pulmonary edema. Although pulmonary edema associated with acute upper airway obstruction is unusual, physicians should be altered to its possible appearance and the need for early and vigorous therapeutic measures.

Airway Obstruction↗

PubMed1979