Acute laryngo-tracheobronchitis

Acute laryngo-tracheobronchitis

Laryngo-tracheobronchitis (croup) is an acute inflammation of the larynx, trachea, and bronchi that occurs in young children (usually between 6 months and 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 it may also be due to bacterial infection.

The airway obstruction is due to inflammation and oedema.

Clinical presentation

• Paroxysmal "barking" cough

• Inspiratory stridor

• Fever

• Wheezing

• Hoarseness of voice

• Tachypnoea

• Symptoms usually occur at night

• Respiratory failure and pneumonia are potentially fatal complications

Non-pharmacological treatment

General measures

• Prevent asphyxiation

• Treat inflammatory oedema

• Humidification of inhaled air

• Hospitalization may be necessary

Classification

Mild croup

Clinical features

• Stridor only when upset

• No moderate or severe acute respiratory infection (ARI)

• Likely of viral origin

Management of Mild croup

• Home care

• Steam inhalation

• Antibiotics are NOT required

Severe croup

Clinical features

• Likely bacterial origin

• Stridor in a calm child at rest

• Chest in-drawing

Management of Severe croup

• Admit to hospital

• Give oxygen therapy to all patients with chest in-drawing using nasal prongs only

• Do NOT use a nasopharyngeal or nasal catheter

• Continue oxygen therapy until lower chest wall in-drawing is no longer present

Pharmacological treatment of Acute laryngo-tracheobronchitis

Dexamethasone

• Dexamethasone (PO) 0.6 mg/kg every 24 hours in 1–2 divided doses

AND

Adrenaline

• Adrenaline (inhalation) 400 mcg/kg every 2 hours if effective

• Repeat after 30 minutes if necessary