top of page

By ULY CLINIC

Acute Laryngo-tracheobronchitis

Introduction

Laryngo-tracheobronchitis (croup) is acute inflammation of the larynx, trachea and bronchi which occurs in young children (usually between 6 months to 3 years of age). It arises as a result of narrowing of the airway in the region of the larynx. The most common cause is viral infection (particularly parainfluenza viruses) but may also be due to bacterial infection. The obstruction is due to inflammation and oedema.  

 

Diagnostic Criteria

  • The symptoms include paroxysmal “barking” cough, inspiratory stridor, fever, wheezing, hoarseness of voice and tachypnoea

  • Such symptoms usually occur at night  

  • Respiratory failure and pneumonia are potentially fatal complications.

 Non-Pharmacological Treatment

  • Prevent asphyxiation

  • Treat inflammatory oedema

  • Humidification of inhaled air

  • Hospitalization may be necessary 

Note

  • No stridor at rest, give no antibiotics

  • Stridor at rest or chest in-drawing or fast breathing REFER IMMEDIATELY to hospital 

Mild Croup

  • Only stridor when upset, no moderate/severe ARI

  • Likely of viral origin

  • Home care – steam inhalation

  • Antibiotics NOT required

 Severe Croup

  • Likely bacterial origin

  • Stridor in a calm child at rest

  • Chest in drawing

  • Antibiotics are NOT effective and should not be given 

Pharmacological Treatment

  • Admit to hospital, give Oxygen therapy to all patients with chest in-drawing (using nasal prongs only, DO NOT use nasopharyngeal or nasal catheter) until the lower chest wall indrawing is no longer present

  • Dexamethasone 0.6 (PO) mg/kg daily in 1–2 divided doses  

AND

  • Nebulized Adrenaline 400 mcg/kg every 2 hours if effective; repeat after 30 min if necessary. 

Updated on, 2.11.2020

References

1. STG 

bottom of page