Sandbox:Croup medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The primary medical therapy used to treat croup depends on the severity of the case. For mild croup, [[glucocorticoid]] therapy is primarily used to alleviate symptoms by reducing [[tracheal]] swelling and [[inflammation]]. The main [[corticosteroids]] used are [[dexamethasone]] and/or [[budesonide]], administered orally or, rarely, via a [[parenteral]] method. These are usually effective beginning 6 hours post-treatment. For moderate and severe croup, [[epinephrine]] is used in conjunction with glucocorticoids. The primary epinephrine therapies used are [[racemic]] epinephrine or L-epinephrine, both in nebulized form. Epinephrine alleviates symptoms within 10-30 minutes, but they usually return within 2 hours, requiring repeated dosing for long-term relief. Hospitalization is rarely required and is primarily used for observation and symptom management in children. [[Intubation]] is rare treatment necessity for hospitalized children with the most severe croup cases. | |||
==Medical Therapy== | ==Medical Therapy== | ||
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*[[Epinephrine]] is indicated for '''moderate''' and '''severe''' cases of croup.<ref name="Everard2009">{{cite journal|last1=Everard|first1=Mark L.|title=Acute Bronchiolitis and Croup|journal=Pediatric Clinics of North America|volume=56|issue=1|year=2009|pages=119–133|issn=00313955|doi=10.1016/j.pcl.2008.10.007}}</ref> | *[[Epinephrine]] is indicated for '''moderate''' and '''severe''' cases of croup.<ref name="Everard2009">{{cite journal|last1=Everard|first1=Mark L.|title=Acute Bronchiolitis and Croup|journal=Pediatric Clinics of North America|volume=56|issue=1|year=2009|pages=119–133|issn=00313955|doi=10.1016/j.pcl.2008.10.007}}</ref> | ||
*Symptoms are usually alleviated within 10-30 minutes, but typically return after 2 hours post-treatment.<ref name="BjornsonRussell2013">{{cite journal|last1=Bjornson|first1=Candice|last2=Russell|first2=Kelly|last3=Vandermeer|first3=Ben|last4=Klassen|first4=Terry P|last5=Johnson|first5=David W|last6=Bjornson|first6=Candice|title=Nebulized epinephrine for croup in children|year=2013|doi=10.1002/14651858.CD006619.pub3}}</ref> | *Symptoms are usually alleviated within 10-30 minutes, but typically return after 2 hours post-treatment.<ref name="BjornsonRussell2013">{{cite journal|last1=Bjornson|first1=Candice|last2=Russell|first2=Kelly|last3=Vandermeer|first3=Ben|last4=Klassen|first4=Terry P|last5=Johnson|first5=David W|last6=Bjornson|first6=Candice|title=Nebulized epinephrine for croup in children|year=2013|doi=10.1002/14651858.CD006619.pub3}}</ref> | ||
*[[Epinephrine]] is usually administered as | *[[Epinephrine]] is usually administered as either of the following:<ref name="BjornsonRussell2013">{{cite journal|last1=Bjornson|first1=Candice|last2=Russell|first2=Kelly|last3=Vandermeer|first3=Ben|last4=Klassen|first4=Terry P|last5=Johnson|first5=David W|last6=Bjornson|first6=Candice|title=Nebulized epinephrine for croup in children|year=2013|doi=10.1002/14651858.CD006619.pub3}}</ref> | ||
**'''Nebulized [[racemic]] [[epinephrine]] (2.25%)''': 0.05 mL/kg (max. 0.5mL) in 3mL of normal [[saline]] for 15 minutes. | **'''Nebulized [[racemic]] [[epinephrine]] (2.25%)''': 0.05 mL/kg (max. 0.5mL) in 3mL of normal [[saline]] for 15 minutes. | ||
**'''Nebulized L-[[epinephrine]]''': 0.5mL/kg (max 5mL) for 15 minutes. | **'''Nebulized L-[[epinephrine]]''': 0.5mL/kg (max 5mL) for 15 minutes. | ||
***Repeated as necessary. | ***Repeated as necessary. | ||
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*[[Helium]] and [[oxygen]] combined into "[[heliox]]" breathing gas can be used to alleviate croup symptoms by reducing upper airway obstruction.<ref name="MoraaSturman2013">{{cite journal|last1=Moraa|first1=Irene|last2=Sturman|first2=Nancy|last3=McGuire|first3=Treasure|last4=van Driel|first4=Mieke L|last5=Moraa|first5=Irene|title=Heliox for croup in children|year=2013|doi=10.1002/14651858.CD006822.pub4}}</ref> | *[[Helium]] and [[oxygen]] combined into "[[heliox]]" breathing gas can be used to alleviate croup symptoms by reducing upper airway obstruction.<ref name="MoraaSturman2013">{{cite journal|last1=Moraa|first1=Irene|last2=Sturman|first2=Nancy|last3=McGuire|first3=Treasure|last4=van Driel|first4=Mieke L|last5=Moraa|first5=Irene|title=Heliox for croup in children|year=2013|doi=10.1002/14651858.CD006822.pub4}}</ref> | ||
**Upper airway resistance to gas flow is reduced to relieve [[respiratory distress]]. | **Upper airway resistance to gas flow is reduced to relieve [[respiratory distress]]. | ||
* | *There is evidence that [[heliox]] is as effective | ||
===Hospitalization=== | |||
*1 to 5% of children with croup will require hospitalization in addition to [[glucocorticoid]] and [[epinephrine]] therapy.<ref name="pmid23939212">{{cite journal |vauthors=Bjornson CL, Johnson DW |title=Croup in children |journal=CMAJ |volume=185 |issue=15 |pages=1317–23 |year=2013 |pmid=23939212 |pmc=3796596 |doi=10.1503/cmaj.121645 |url=}}</ref> | |||
*Hospitalization is primarily used for observation and symptom management of children with moderate and severe croup.<ref name="PetrocheilouTanou2014">{{cite journal|last1=Petrocheilou|first1=Argyri|last2=Tanou|first2=Kalliopi|last3=Kalampouka|first3=Efthimia|last4=Malakasioti|first4=Georgia|last5=Giannios|first5=Christos|last6=Kaditis|first6=Athanasios G.|title=Viral croup: Diagnosis and a treatment algorithm|journal=Pediatric Pulmonology|volume=49|issue=5|year=2014|pages=421–429|issn=87556863|doi=10.1002/ppul.22993}}</ref> | |||
*Less than 3% of admitted children will require [[intubation]].<ref name="pmid23939212">{{cite journal |vauthors=Bjornson CL, Johnson DW |title=Croup in children |journal=CMAJ |volume=185 |issue=15 |pages=1317–23 |year=2013 |pmid=23939212 |pmc=3796596 |doi=10.1503/cmaj.121645 |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 21:14, 22 February 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
The primary medical therapy used to treat croup depends on the severity of the case. For mild croup, glucocorticoid therapy is primarily used to alleviate symptoms by reducing tracheal swelling and inflammation. The main corticosteroids used are dexamethasone and/or budesonide, administered orally or, rarely, via a parenteral method. These are usually effective beginning 6 hours post-treatment. For moderate and severe croup, epinephrine is used in conjunction with glucocorticoids. The primary epinephrine therapies used are racemic epinephrine or L-epinephrine, both in nebulized form. Epinephrine alleviates symptoms within 10-30 minutes, but they usually return within 2 hours, requiring repeated dosing for long-term relief. Hospitalization is rarely required and is primarily used for observation and symptom management in children. Intubation is rare treatment necessity for hospitalized children with the most severe croup cases.
Medical Therapy
Glucocorticoids
- Corticosteroids are used to alleviate croup symptoms, effective beginning 6 hours post-treatment.[1]
- Symptom reduction is a result of reduced inflammation and swelling of the trachea.
- For croup cases of all severities, the following glucocorticoid therapies are recommended:[2]
- Dexamethasone: 0.60 mg/kg PO/IM/IV, single dose (max. 10 mg)
- Budesonide: 2mg nebulized
- Dosing is usually administered orally for mild cases, but a parenteral method may be used for severe croup.[3]
Epinephrine
- Epinephrine is indicated for moderate and severe cases of croup.[3]
- Symptoms are usually alleviated within 10-30 minutes, but typically return after 2 hours post-treatment.[4]
- Epinephrine is usually administered as either of the following:[4]
- Nebulized racemic epinephrine (2.25%): 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 minutes.
- Nebulized L-epinephrine: 0.5mL/kg (max 5mL) for 15 minutes.
- Repeated as necessary.
- Glucocorticoids are used in conjunction with epinephrine for moderate and severe croup cases.[2]
Heliox
- Helium and oxygen combined into "heliox" breathing gas can be used to alleviate croup symptoms by reducing upper airway obstruction.[5]
- Upper airway resistance to gas flow is reduced to relieve respiratory distress.
- There is evidence that heliox is as effective
Hospitalization
- 1 to 5% of children with croup will require hospitalization in addition to glucocorticoid and epinephrine therapy.[6]
- Hospitalization is primarily used for observation and symptom management of children with moderate and severe croup.[2]
- Less than 3% of admitted children will require intubation.[6]
References
- ↑ Russell, Kelly F; Liang, Yuanyuan; O'Gorman, Kathleen; Johnson, David W; Klassen, Terry P; Klassen, Terry P (2011). "Glucocorticoids for croup". doi:10.1002/14651858.CD001955.pub3.
- ↑ 2.0 2.1 2.2 Petrocheilou, Argyri; Tanou, Kalliopi; Kalampouka, Efthimia; Malakasioti, Georgia; Giannios, Christos; Kaditis, Athanasios G. (2014). "Viral croup: Diagnosis and a treatment algorithm". Pediatric Pulmonology. 49 (5): 421–429. doi:10.1002/ppul.22993. ISSN 8755-6863.
- ↑ 3.0 3.1 Everard, Mark L. (2009). "Acute Bronchiolitis and Croup". Pediatric Clinics of North America. 56 (1): 119–133. doi:10.1016/j.pcl.2008.10.007. ISSN 0031-3955.
- ↑ 4.0 4.1 Bjornson, Candice; Russell, Kelly; Vandermeer, Ben; Klassen, Terry P; Johnson, David W; Bjornson, Candice (2013). "Nebulized epinephrine for croup in children". doi:10.1002/14651858.CD006619.pub3.
- ↑ Moraa, Irene; Sturman, Nancy; McGuire, Treasure; van Driel, Mieke L; Moraa, Irene (2013). "Heliox for croup in children". doi:10.1002/14651858.CD006822.pub4.
- ↑ 6.0 6.1 Bjornson CL, Johnson DW (2013). "Croup in children". CMAJ. 185 (15): 1317–23. doi:10.1503/cmaj.121645. PMC 3796596. PMID 23939212.