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==Overview==
==Overview==
[[Tracheitis]] is a [[bacterial infection]] of the [[trachea]]. It results in [[airway]] [[inflammation]] with [[mucosal]] [[edema]], [[Trachea|tracheal]] [[ulceration]] and thick membranous [[Exudate|exudates]]. It is most commonly caused by a superimposed [[bacterial infection]] following a [[viral]] [[upper respiratory tract infection]]. Common [[bacterial]] [[pathogens]] include [[Staphylococcus aureus|Staphylococcus Aureus]], [[Haemophilus Influenzae B|Haemophilus Influenza]], [[Streptococcus Group A|Streptococcus Viridans]] and [[Moraxella catarrhalis|Moraxella Catarrhalis]]. It is a disease most commonly encountered in [[pediatric]] age group, between 2-10 years of age. However, [[mechanical ventilation]] can also cause [[tracheitis]] as it allows colonization of the [[trachea]] through [[Endotracheal tube|endotracheal]] [[Endotracheal intubation|tube]].  Clinical features include [[cough]], [[Hoarseness|hoarseness,]] [[stridor]] which can rapidly progress into [[respiratory distress]] within 36 to 72 hours. Acute [[airway obstruction]] can also develop due to rapid formation of tracheal [[Exudate|exudates]]. Securing airway by [[endotracheal intubation]] is therefore crucial in management of [[tracheitis]] along with early initiation of [[Antibiotics|empiric antibiotics]]. Rigid [[endoscopy]] is performed to remove thick membranous [[Exudate|exudates]], known to cause significant tracheal lumen obstruction. Complications of [[tracheitis]] include [[airway obstruction]], [[acute respiratory distress syndrome]], [[toxic shock syndrome]], [[septic shock]] and multi organ failure.
[[Tracheitis]] is a [[bacterial infection]] of the [[trachea]]. It results in [[airway]] [[inflammation]] with [[mucosal]] [[edema]], [[Trachea|tracheal]] [[ulceration]] and thick membranous [[Exudate|exudates]]. It is most commonly caused by a superimposed [[bacterial infection]] following a [[viral]] [[upper respiratory tract infection]]. Common [[bacterial]] [[pathogens]] include [[Staphylococcus aureus|Staphylococcus Aureus]], [[Haemophilus Influenzae B|Haemophilus Influenza]], [[Streptococcus Group A|Streptococcus Viridans]] and [[Moraxella catarrhalis|Moraxella Catarrhalis]]. It is a disease most commonly encountered in [[pediatric]] age group, between 2-10 years of age. However, [[mechanical ventilation]] can also cause [[tracheitis]] as it allows colonization of the [[trachea]] through [[Endotracheal tube|endotracheal]] [[Endotracheal intubation|tube]].  Clinical features include [[cough]], [[Hoarseness|hoarseness,]] [[stridor]] which can rapidly progress into [[respiratory distress]] within 36 to 72 hours. Acute [[airway obstruction]] can also develop due to rapid formation of tracheal [[Exudate|exudates]]. Securing airway by [[endotracheal intubation]] is therefore crucial in management of [[tracheitis]] along with early initiation of [[Antibiotics|empiric antibiotics]]. Rigid [[endoscopy]] is performed to remove thick membranous [[Exudate|exudates]], known to cause significant tracheal lumen obstruction. Complications of [[tracheitis]] include [[airway obstruction]], [[acute respiratory distress syndrome]], [[toxic shock syndrome]], [[septic shock]] and multi organ failure.
==Treatment==
===Medical Therapy===
Treatment of [[tracheitis]] involves prompt intiation of [[Antibiotic|antibiotics]] and clinical assessment of [[airway]]. Signs of impending [[respiratory failure]] include i[[Intercostal|ntercostal]] [[Retraction|retractions]], [[Cyanosis|cyanosis,]] [[lethargy]] and [[confusion]]. [[Endotracheal intubation]] is performed in impending [[respiratory failure]] to maintain airway, perform frequent [[pulmonary toilet]] and manage acute [[respiratory failure]]. Operative [[bronchoscopy]] can be performed for direct visualisation of [[trachea]], confirmation of the diagnosis and removal of [[pseudomembranes.]]  [[Endotracheal intubation]] rate has been reported between 38% to 100%  and the mean duration of [[intubation]] is 3.2 days.  It is therefore a crucial part of management of [[tracheitis]] which requires judicious assessment of the [[airway]] patency and the urgent availability of skills and expertise required for immediate [[airway intubation]]. Empiric broad spectrum [[Antibiotic|antibiotics]] are initially used to control the [[Infection|infection.]] As the [[Trachea|tracheal]] [[Culture medium|culture]] result becomes available the [[Antibiotic|antibiotics]] can be changed according to the [[organism]] isolated. Most commonly isolated [[Organism|organisms]] include [[Staphylococcus aureus|Staphylococcus Aureus]], [[Streptococcus Penumoniae Infection|Streptococcus Pneumonia]] and [[Moraxella catarrhalis|Moraxella Catarrhalis]]. [[Cephalosporins|Third generation cephalosporin]] combined with an anti staphylococcal [[antibiotic]] e.g [[Nafcillin]], [[Vancomycin]] , [[Clindamycin]] are included in the initial [[antibiotic]] regimen. Current guidelines have outlined a total treatment duration of 10 to 14 days.
Supportive respiratory care is provided in less severe clinical presentation. This includes supplemental [[oxygen]] ( Sp02=94%)and [[bronchodilators]] ([[Epinephrine (patient information)|Epinephrine]] or [[Albuterol]]). [[Anti-pyretics]] can be used for [[Fever|fever.]] [[Corticosteroids]] have not proven benefit but are still used nonetheless.


==References==
==References==

Revision as of 21:28, 28 April 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Dushka Riaz, MD

Overview

Tracheitis is a bacterial infection of the trachea. It results in airway inflammation with mucosal edema, tracheal ulceration and thick membranous exudates. It is most commonly caused by a superimposed bacterial infection following a viral upper respiratory tract infection. Common bacterial pathogens include Staphylococcus Aureus, Haemophilus Influenza, Streptococcus Viridans and Moraxella Catarrhalis. It is a disease most commonly encountered in pediatric age group, between 2-10 years of age. However, mechanical ventilation can also cause tracheitis as it allows colonization of the trachea through endotracheal tube. Clinical features include cough, hoarseness, stridor which can rapidly progress into respiratory distress within 36 to 72 hours. Acute airway obstruction can also develop due to rapid formation of tracheal exudates. Securing airway by endotracheal intubation is therefore crucial in management of tracheitis along with early initiation of empiric antibiotics. Rigid endoscopy is performed to remove thick membranous exudates, known to cause significant tracheal lumen obstruction. Complications of tracheitis include airway obstruction, acute respiratory distress syndrome, toxic shock syndrome, septic shock and multi organ failure.

References

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