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Croup

Croup. Dr. Khalil Sendi King Abdulaziz University. Basic Science. glottis supraglottic subglottic intrathoracic trachea. Basic Science. pedi airway narrowest at subglottis cross-section of airway proportional to square of radius (  r 2 ). Supraglottitis.

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Croup

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  1. Croup Dr. Khalil Sendi King Abdulaziz University

  2. Basic Science • glottis • supraglottic • subglottic • intrathoracic trachea

  3. Basic Science • pedi airway narrowest at subglottis • cross-section of airway proportional to square of radius (r2)

  4. Supraglottitis • “angina epiglottidea anterior” • bacterial cellulitis of supraglottis • 2 to 7 years old • Haemophilus influenzae type B most common • incidence greatly decreased since vaccine

  5. Supraglottitis • odynophagia • fever • irritability • stridor • rapidly progressive

  6. Supraglottitis • if suspected, diagnose by direct laryngoscopy in OR • lateral neck film - “thumb sign” • 1nasotracheal intubation • IV antibiotics • extubate when air leak noted - usually within 48 hours

  7. Laryngotracheobronchitis • croup - Scottish for barking cough • 6 months to 3 years old • Parainfluenza viruses types 1 and 2 most common

  8. Laryngotracheobronchitis • URI symptoms • barking cough • hoarseness • inspiratory stridor • low-grade fever

  9. Laryngotracheobronchitis • laryngoscopy for those with respiratory distress • AP neck - “steeple sign” • supraglottis normal

  10. Laryngotracheobronchitis

  11. Laryngotracheobronchitis • usually self-limited • humidified air • racemic epinephrine • steroids • heliox • intubation for severe, refractory cases

  12. Spasmodic Croup • presentation similar to LTB • sudden onset stridor • afebrile • recurrent episodes that resolve spontaneously • unknown cause

  13. Bacterial Tracheitis • Jackson - 1945, Jones - 1979 • 6 months to 8 years old • bacterial infection complicating viral LTB • Staph aureus most common

  14. Bacterial Tracheitis • URI symptoms • acute onset high fever and respiratory distress • no odynophagia

  15. Bacterial Tracheitis • “steeple sign” on AP neck • intraluminal soft tissue irregularities • endoscopy best diagnostic method

  16. Bacterial Tracheitis • subglottic edema • ulceration • pseudomembrane formation • suction and debride • nasotracheal intubation • IV antibiotics • extubate after 3-7 days

  17. Controversies and Future • drastic decrease in supraglottitis as a result of vaccine • nasotracheal intubation for supraglottitis • disposition of children treated for LTB with epinephrine • steroids in LTB

  18. Subglotic Stenosis

  19. Conclusion • cause of much morbidity in pediatric population • potentially life-threatening • prompt diagnosis • assure adequate airway

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