Croup Dr. Khalil Sendi King Abdulaziz University

Basic Science l glottis l supraglottic l subglottic l intrathoracic trachea

Basic Science l pedi airway narrowest at subglottis cross-section of airway proportional to square of radius (  r 2 )

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

Supraglottitis l odynophagia l fever l irritability l stridor l rapidly progressive

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

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

Laryngotracheobronchitis l URI symptoms l barking cough l hoarseness l inspiratory stridor l low-grade fever

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

Laryngotracheobronchiti s

l usually self-limited l humidified air l racemic epinephrine l steroids l heliox l intubation for severe, refractory cases

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

Bacterial Tracheitis l Jackson , Jones l 6 months to 8 years old l bacterial infection complicating viral LTB l Staph aureus most common

Bacterial Tracheitis l URI symptoms l acute onset high fever and respiratory distress l no odynophagia

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

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

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

Subglotic Stenosis

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