pediatrics
Croup
Treatment of Croup
For outpatients, cool humidified air and possibly a single dose of a long-acting corticosteroid For inpatients, humidified oxygen, racemicepinephrine, and corticosteroids The illness usually lasts 3 to 4 days and resolves spontaneously. A mildly ill child may be cared for at home with hydration and antipyretics. Keeping the child comfortable is important because fatigue and crying can aggravate the condition. Humidification devices (eg, cold-steam vaporizers or humidifiers) may ameliorate upper airway drying and are frequently used at home by families but have not been shown to alter the course of the illness. The vast majority of children with croup recover completely. Hospitalizationis typically indicated for Increasing or persistent respiratory distress Tachycardia Fatigue Cyanosis or hypoxemia Dehydration Pulse oximetry is helpful for assessing and monitoring severe cases. If oxygen saturation falls below 92%, humidified oxygen should be given and arterial blood gases should be measured to assess CO2 retention. A 30 to 40% inspired oxygen concentration is usually adequate. CO2 retention (PaCO2>45 mm Hg) generally indicates fatigue and the need for endotracheal intubation, as does inability to maintain oxygenation. Nebulized racemicepinephrine5 to 10 mg in 3 mL of saline every 2 hours offers symptomatic relief and relieves fatigue. However, the effects are transient; the course of the illness, the underlying viral infection, and the PaO2 are not altered by its use. Tachycardia and other adverse effects may occur. This drug is recommended mainly for patients with moderate to severe croup. High-dosedexamethasone0.6 mg/kg IM or orally once (maximum dose 10 mg) may benefit children early in the first 24 hours of the disease. It can help prevent hospitalization or help the child who is hospitalized with moderate to severe croup; hospitalized children who do not respond quickly may require several doses. The viruses that most commonly cause croup do not usually predispose to secondary bacterial infection, and antibiotics are rarely indicated. 