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Revision as of 21:20, 22 February 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

The treatment for croup depends on the severity of symptoms. The main stem for the treatment is the use of corticosteroids, especially dexamethasone or budesonide, given orally for mild cases and parenteral for more severe cases. Nebulized epinephrine is administered for moderate to severe cases, and it is effective in alleviating the intensity of symptoms related to upper airway obstruction, improvement is seen within 10-20 minutes since administration and last for approximately for 2 hours. There is no significant difference between using racemic and L-epinephrine^[1]^[2], being the latter less expensive and available in most countries. Oxygen may be needed if hypoxia develops. Children with moderate or severe croup are typically hospitalized for observation, usually for less than a day. Intubation is rarely needed (less than 1% of hospitalized patients).

Medical Therapy Based on the MedicationAdapted from Lancet. 2008;371(9609):329–339. ^[3]

▸ Click on the following categories to expand treatment regimens.

Croup Medical Therapy

▸ Glucocorticoids

▸ Epinephrine

▸ Oxygen

▸ Antibiotics

▸ Heliox

Glucocorticoids
Mild to Moderate Croup
▸ Dexamethasone 0.60 mg/kg PO/IM/IV, single dose (max. 10 mg) OR ▸ Budesonide 2mg nebulized
Severe Croup
▸ Dexamethasone 0.60 mg/kg IM/IV, single dose OR ▸ Budesonide 2mg nebulized

Epinephrine
Mild Croup
There are no indications for nebulized epinephrine in mild croup
Moderate to Severe Croup
▸ Nebulized racemic epinephrine (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min OR ▸ Nebulized L-epinephrine 0.5mL/kg (max 5mL) for 15 min Repeat as needed

Oxygen
▸ Humidified oxygen should be given to patients with hypoxia or severe respiratory distress

Antibiotics
▸ Antibiotic are not indicated to treat viral croup ▸ Antibiotics are use for complications, such as bacterial tracheitis or epiglottitis

Heliox
▸ There is no sufficient data that recommends the general use of heliox in patients with croup.^[4]^[5]^[6]
▸ Some studies have shown a short-term benefit of heliox inhalation in children with moderate to severe croup.^[7]^[8]

Medical Therapy Based on the Severity Adapted from Pediatric Pulmonology 49:421–429 (2014) ^[9]

▸ Click on the following categories to expand treatment regimens.

Disease Severity

▸ Mild

▸ Moderate

▸ Severe

Mild
▸ Dexamethasone 0.60 mg/kg PO single dose (max. 10 mg) OR ▸ Budesonide 2mg nebulized

Moderate
▸ Nebulized racemic epinephrine (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min OR ▸ Nebulized L-epinephrine 0.5mL/kg (max 5mL) for 15 min Repeat as needed
PLUS
▸ Dexamethasone 0.60 mg/kg PO/IM single dose (max. 10 mg) OR ▸ Budesonide 2mg nebulized

Severe
▸ Nebulized racemic epinephrine (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min OR ▸ Nebulized L-epinephrine 0.5mL/kg (max 5mL) for 15 min Repeat as needed
PLUS
▸ Dexamethasone 0.60 mg/kg IM/IV single dose (max. 10 mg)
AND
▸ Hospital admission

References

↑ Candice Bjornson, Kelly Russell, Ben Vandermeer, Terry P. Klassen & David W. Johnson (2013). "Nebulized epinephrine for croup in children". The Cochrane database of systematic reviews. 10: CD006619. doi:10.1002/14651858.CD006619.pub3. PMID 24114291.
↑ Candice Bjornson, Kelly F. Russell, Ben Vandermeer, Tamara Durec, Terry P. Klassen & David W. Johnson (2011). "Nebulized epinephrine for croup in children". The Cochrane database of systematic reviews (2): CD006619. doi:10.1002/14651858.CD006619.pub2. PMID 21328284.
↑ Bjornson, Candice L; Johnson, David W (2008). "Croup". The Lancet. 371 (9609): 329–339. doi:10.1016/S0140-6736(08)60170-1. ISSN 0140-6736.
↑ Weber, J. E.; Chudnofsky, C. R.; Younger, J. G.; Larkin, G. L.; Boczar, M.; Wilkerson, M. D.; Zuriekat, G. Y.; Nolan, B.; Eicke, D. M. (2001). "A Randomized Comparison of Helium-Oxygen Mixture (Heliox) and Racemic Epinephrine for the Treatment of Moderate to Severe Croup". PEDIATRICS. 107 (6): e96–e96. doi:10.1542/peds.107.6.e96. ISSN 0031-4005.
↑ Beckmann, Kathleen R.; Brueggemann, William Martin (2000). "HELIOX TREATMENT OF SEVERE CROUP". The American Journal of Emergency Medicine. 18 (6): 735–736. doi:10.1016/S0735-6757(00)90309-7. ISSN 0735-6757.
↑ Gupta, Vineet K.; Cheifetz, Ira M. (2005). "Heliox administration in the pediatric intensive care unit: An evidence-based review". Pediatric Critical Care Medicine. 6 (2): 204–211. doi:10.1097/01.PCC.0000154946.62733.94. ISSN 1529-7535.
↑ Irene Moraa, Nancy Sturman, Treasure McGuire & Mieke L. van Driel (2013). "Heliox for croup in children". The Cochrane database of systematic reviews. 12: CD006822. doi:10.1002/14651858.CD006822.pub4. PMID 24318607.
↑ Sarah Kline-Krammes, Christina Reed, John S. Jr Giuliano, Hamilton P. Schwartz, Michael Forbes, John Pope, James Besunder, Michael D. Gothard, Kerry Russell & Michael T. Bigham (2012). "Heliox in children with croup: a strategy to hasten improvement". Air medical journal. 31 (3): 131–137. doi:10.1016/j.amj.2011.08.004. PMID 22541348. Unknown parameter |month= ignored (help)
↑ 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.

Template:WH Template:WS

[1] Candice Bjornson, Kelly Russell, Ben Vandermeer, Terry P. Klassen & David W. Johnson (2013). "Nebulized epinephrine for croup in children". The Cochrane database of systematic reviews. 10: CD006619. doi:10.1002/14651858.CD006619.pub3. PMID 24114291.

[2] Candice Bjornson, Kelly F. Russell, Ben Vandermeer, Tamara Durec, Terry P. Klassen & David W. Johnson (2011). "Nebulized epinephrine for croup in children". The Cochrane database of systematic reviews (2): CD006619. doi:10.1002/14651858.CD006619.pub2. PMID 21328284.

[BjornsonJohnson2008-3] Bjornson, Candice L; Johnson, David W (2008). "Croup". The Lancet. 371 (9609): 329–339. doi:10.1016/S0140-6736(08)60170-1. ISSN 0140-6736.

[WeberChudnofsky2001-4] Weber, J. E.; Chudnofsky, C. R.; Younger, J. G.; Larkin, G. L.; Boczar, M.; Wilkerson, M. D.; Zuriekat, G. Y.; Nolan, B.; Eicke, D. M. (2001). "A Randomized Comparison of Helium-Oxygen Mixture (Heliox) and Racemic Epinephrine for the Treatment of Moderate to Severe Croup". PEDIATRICS. 107 (6): e96–e96. doi:10.1542/peds.107.6.e96. ISSN 0031-4005.

[BeckmannBrueggemann2000-5] Beckmann, Kathleen R.; Brueggemann, William Martin (2000). "HELIOX TREATMENT OF SEVERE CROUP". The American Journal of Emergency Medicine. 18 (6): 735–736. doi:10.1016/S0735-6757(00)90309-7. ISSN 0735-6757.

[GuptaCheifetz2005-6] Gupta, Vineet K.; Cheifetz, Ira M. (2005). "Heliox administration in the pediatric intensive care unit: An evidence-based review". Pediatric Critical Care Medicine. 6 (2): 204–211. doi:10.1097/01.PCC.0000154946.62733.94. ISSN 1529-7535.

[7] Irene Moraa, Nancy Sturman, Treasure McGuire & Mieke L. van Driel (2013). "Heliox for croup in children". The Cochrane database of systematic reviews. 12: CD006822. doi:10.1002/14651858.CD006822.pub4. PMID 24318607.

[8] Sarah Kline-Krammes, Christina Reed, John S. Jr Giuliano, Hamilton P. Schwartz, Michael Forbes, John Pope, James Besunder, Michael D. Gothard, Kerry Russell & Michael T. Bigham (2012). "Heliox in children with croup: a strategy to hasten improvement". Air medical journal. 31 (3): 131–137. doi:10.1016/j.amj.2011.08.004. PMID 22541348. Unknown parameter |month= ignored (help)

[PetrocheilouTanou2014-9] 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.

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@@ Line 4: / Line 4: @@
 ==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.
+The treatment for [[croup]] depends on the severity of symptoms.  The main stem for the treatment is the use of [[corticosteroids]], especially [[dexamethasone]] or [[budesonide]], given orally for mild cases and parenteral for more severe cases.   Nebulized [[epinephrine]] is administered for moderate to severe cases, and it is effective in alleviating the intensity of symptoms related to [[upper airway obstruction]], improvement is seen within 10-20 minutes since administration and last for approximately for 2 hours.   There is no significant difference between using racemic and L-[[epinephrine]]<ref>{{Cite journal
+ | author = [[Candice Bjornson]], [[Kelly Russell]], [[Ben Vandermeer]], [[Terry P. Klassen]] & [[David W. Johnson]]
+ | title = Nebulized epinephrine for croup in children
+ | journal = [[The Cochrane database of systematic reviews]]
+ | volume = 10
+ | pages = CD006619
+ | year = 2013
+ | month =
+ | doi = 10.1002/14651858.CD006619.pub3
+ | pmid = 24114291
+}}</ref><ref>{{Cite journal
+ | author = [[Candice Bjornson]], [[Kelly F. Russell]], [[Ben Vandermeer]], [[Tamara Durec]], [[Terry P. Klassen]] & [[David W. Johnson]]
+ | title = Nebulized epinephrine for croup in children
+ | journal = [[The Cochrane database of systematic reviews]]
+ | issue = 2
+ | pages = CD006619
+ | year = 2011
+ | month =
+ | doi = 10.1002/14651858.CD006619.pub2
+ | pmid = 21328284
+}}</ref>, being the latter less expensive and available in most countries.  [[Oxygen]] may be needed if [[Hypoxia (medical)|hypoxia]] develops.  Children with moderate or severe croup are typically hospitalized for observation, usually for less than a day. [[Intubation]] is rarely needed (less than 1% of hospitalized patients).
-==Medical Therapy==
+==Medical Therapy Based on the Medication<SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Lancet. 2008;371(9609):329–339. <ref name="BjornsonJohnson2008">{{cite journal|last1=Bjornson|first1=Candice L|last2=Johnson|first2=David W|title=Croup|journal=The Lancet|volume=371|issue=9609|year=2008|pages=329–339|issn=01406736|doi=10.1016/S0140-6736(08)60170-1}}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
-===[[Glucocorticoids]]===
-*[[Corticosteroids]] are used to alleviate croup symptoms, effective beginning 6 hours post-treatment.<ref name="RussellLiang2011">{{cite journal|last1=Russell|first1=Kelly F|last2=Liang|first2=Yuanyuan|last3=O'Gorman|first3=Kathleen|last4=Johnson|first4=David W|last5=Klassen|first5=Terry P|last6=Klassen|first6=Terry P|title=Glucocorticoids for croup|year=2011|doi=10.1002/14651858.CD001955.pub3}}</ref>
-**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:<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>
-**[[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.<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]]===
-*[[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>
-*[[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 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.<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>
-===[[Heliox]]===
+<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-*[[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]].
+{|
-*There is evidence that [[heliox]] is as effective
+| valign=top |
+<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
+<font color="#FFF">
+'''Croup Medical Therapy'''
+</font>
+</div>
+<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
+<font color="#FFF">
+&nbsp;&nbsp;▸&nbsp;&nbsp;'''Glucocorticoids'''
+</font>
+</div>
+<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
+<font color="#FFF">
+&nbsp;&nbsp;▸&nbsp;&nbsp;'''Epinephrine'''
+</font>
+</div>
+<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
+<font color="#FFF">
+&nbsp;&nbsp;▸&nbsp;&nbsp;'''Oxygen'''
+</font>
+</div>
+<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
+<font color="#FFF">
+&nbsp;&nbsp;▸&nbsp;&nbsp;'''Antibiotics'''
+</font>
+</div>
+<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
+<font color="#FFF">
+&nbsp;&nbsp;▸&nbsp;&nbsp;'''Heliox'''
+</font>
+</div>
+| valign=top |
+{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
+| valign=top |
+{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Glucocorticoids}}
+|-
+| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Mild to Moderate Croup
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dexamethasone]] 0.60 mg/kg PO/IM/IV, single dose  (max. 10 mg)''''' <br> OR <br> ▸ '''''[[Budesonide]] 2mg nebulized'''''
+|-
+| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Severe Croup
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dexamethasone]] 0.60 mg/kg IM/IV, single dose''''' <br> OR <br> ▸ '''''[[Budesonide]] 2mg nebulized'''''
+|-
+|}
+|}
+{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
+| valign=top |
+{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Epinephrine}}
+|-
+| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Mild Croup
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | There are no indications for nebulized epinephrine in mild croup
+|-
+| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Moderate to Severe Croup
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Nebulized racemic [[epinephrine]] (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min''''' <br> OR <br>   ▸ '''''Nebulized L-[[epinephrine]] 0.5mL/kg (max 5mL) for 15 min'''''  <br>                ''Repeat as needed''
+|-
+|}
+|}
+{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
+| valign=top |
+{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Oxygen}}
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ Humidified oxygen should be given to patients with hypoxia or severe respiratory distress
+|-
+|}
+|}
+{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
+| valign=top |
+{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Antibiotics}}
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Antibiotic are not indicated to treat viral croup''''' <br> ▸ '''''Antibiotics are use for complications, such as bacterial tracheitis or epiglottitis'''''
+|-
+|}
+|}
+{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
+| valign=top |
+{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Heliox}}
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ There is no sufficient data that recommends the general use of heliox in patients with croup.<ref name="WeberChudnofsky2001">{{cite journal|last1=Weber|first1=J. E.|last2=Chudnofsky|first2=C. R.|last3=Younger|first3=J. G.|last4=Larkin|first4=G. L.|last5=Boczar|first5=M.|last6=Wilkerson|first6=M. D.|last7=Zuriekat|first7=G. Y.|last8=Nolan|first8=B.|last9=Eicke|first9=D. M.|title=A Randomized Comparison of Helium-Oxygen Mixture (Heliox) and Racemic Epinephrine for the Treatment of Moderate to Severe Croup|journal=PEDIATRICS|volume=107|issue=6|year=2001|pages=e96–e96|issn=0031-4005|doi=10.1542/peds.107.6.e96}}</ref><ref name="BeckmannBrueggemann2000">{{cite journal|last1=Beckmann|first1=Kathleen R.|last2=Brueggemann|first2=William Martin|title=HELIOX TREATMENT OF SEVERE CROUP|journal=The American Journal of Emergency Medicine|volume=18|issue=6|year=2000|pages=735–736|issn=07356757|doi=10.1016/S0735-6757(00)90309-7}}</ref><ref name="GuptaCheifetz2005">{{cite journal|last1=Gupta|first1=Vineet K.|last2=Cheifetz|first2=Ira M.|title=Heliox administration in the pediatric intensive care unit: An evidence-based review|journal=Pediatric Critical Care Medicine|volume=6|issue=2|year=2005|pages=204–211|issn=1529-7535|doi=10.1097/01.PCC.0000154946.62733.94}}</ref>
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ Some studies have shown a short-term benefit of heliox inhalation in children with moderate to severe croup.<ref>{{Cite journal
+ | author = [[Irene Moraa]], [[Nancy Sturman]], [[Treasure McGuire]] & [[Mieke L. van Driel]]
+ | title = Heliox for croup in children
+ | journal = [[The Cochrane database of systematic reviews]]
+ | volume = 12
+ | pages = CD006822
+ | year = 2013
+ | month =
+ | doi = 10.1002/14651858.CD006822.pub4
+ | pmid = 24318607
+}}</ref><ref>{{Cite journal | author = [[Sarah Kline-Krammes]], [[Christina Reed]], [[John S. Jr Giuliano]], [[Hamilton P. Schwartz]], [[Michael Forbes]], [[John Pope]], [[James Besunder]], [[Michael D. Gothard]], [[Kerry Russell]] & [[Michael T. Bigham]] | title = Heliox in children with croup: a strategy to hasten improvement | journal = [[Air medical journal]] | volume = 31 | issue = 3 | pages = 131–137 | year = 2012 | month = May-June | doi = 10.1016/j.amj.2011.08.004 | pmid = 22541348 }}</ref>
+|-
+|}
+|}
+|}
+==Medical Therapy Based on the Severity <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Pediatric Pulmonology 49:421–429 (2014) <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> </SMALL></SMALL></SMALL></SMALL></SMALL>==
+<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
+{|
+| valign=top |
+<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
+<font color="#FFF">
+'''Disease Severity'''
+</font>
+</div>
+<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
+<font color="#FFF">
+&nbsp;&nbsp;▸&nbsp;&nbsp;'''Mild'''
+</font>
+</div>
+<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
+<font color="#FFF">
+&nbsp;&nbsp;▸&nbsp;&nbsp;'''Moderate'''
+</font>
+</div>
+<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
+<font color="#FFF">
+&nbsp;&nbsp;▸&nbsp;&nbsp;'''Severe'''
+</font>
+</div>
+| valign=top |
+{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
+| valign=top |
+{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Mild}}
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dexamethasone]] 0.60 mg/kg PO single dose  (max. 10 mg)''''' <br> OR <br> ▸ '''''[[Budesonide]] 2mg nebulized'''''
+|-
+|}
+|}
+{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
+| valign=top |
+{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Moderate}}
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Nebulized racemic [[epinephrine]] (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min''''' <br> OR <br>   ▸ '''''Nebulized L-[[epinephrine]] 0.5mL/kg (max 5mL) for 15 min'''''  <br>                ''Repeat as needed''
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dexamethasone]] 0.60 mg/kg PO/IM single dose  (max. 10 mg)''''' <br> OR <br> ▸ '''''[[Budesonide]] 2mg nebulized'''''
+|-
+|}
+|}
+{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
+| valign=top |
+{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Severe}}
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Nebulized racemic [[epinephrine]] (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min''''' <br> OR <br>   ▸ '''''Nebulized L-[[epinephrine]] 0.5mL/kg (max 5mL) for 15 min'''''  <br>                ''Repeat as needed''
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dexamethasone]] 0.60 mg/kg IM/IV single dose  (max. 10 mg)'''''
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | AND
+|-
+| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ Hospital admission
+|-
+|}
+|}
+|}
-===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==
 {{Reflist|2}}

Sandbox:Croup medical therapy: Difference between revisions

Revision as of 21:20, 22 February 2016

Overview

Medical Therapy Based on the MedicationAdapted from Lancet. 2008;371(9609):329–339. [3]

Medical Therapy Based on the Severity Adapted from Pediatric Pulmonology 49:421–429 (2014) [9]

References

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Medical Therapy Based on the MedicationAdapted from Lancet. 2008;371(9609):329–339. ^[3]

Medical Therapy Based on the Severity Adapted from Pediatric Pulmonology 49:421–429 (2014) ^[9]