Laryngotracheobronchitis II

Laryngotracheobronchitis II

PATHOLOGICAL FINDINGS:

• Inflammatory reaction of respiratory mucosa
• Loss of epithelial cells
• Thick mucoid secretions

SPECIAL TESTS:

Rapid antigen tests are available in some centers

IMAGING:

• PA and lateral neck films show funnel-shaped subglottic region with normal epiglottis - steeple sign or pencil-point sign (present in 40% of children with LTB)
• Patient should be monitored during imaging - progression of airway obstruction may be rapid

DIAGNOSTIC PROCEDURES:

• Direct laryngoscopy - if child is not in acute distress
• Fiberoptic laryngoscopy - procedure of choice where available
• Bronchoscopy

TREATMENT

APPROPRIATE HEALTH CARE:

• Outpatient in mild cases only
• Intensive care unit for patients with tachypnea, tachycardia, hypoxia, cyanosis, reactions, pneumonia, or congestive heart failure

GENERAL MEASURES:

• Humidification - croup tent
• Intravenous fluids
• Electrocardiographic monitoring and pulse oximetry

SURGICAL MEASURES:

• Intubation required in 6-10% for 3-5 days; use smallest tube possible
• Tracheotomy - rarely

ACTIVITY:

Must keep patient quiet; crying may exacerbate symptoms

DIET:

• NPO with IV fluids for severe cases
• Frequent small feedings with increased fluids for mild cases

PATIENT EDUCATION:

• Educate parents about when to seek emergency care if mild cases progress
• Emotional support and reassurance for the patient

MEDICATIONS

DRUG(S) OF CHOICE:

• Dexamethasone: 1-1.5 mg/kg up to 20 mg every 8-12 hours for 8 doses
• Racemic epinephrine (Vaponefrin): 0.2-0.5 mL of 2.25 percent racemic epinephrine delivered in 2-3 mL of normal saline - one dose per 30 minutes, monitoring for side effects and rebound
• Antibiotics controversial in this viral illness
• Oxygen as needed

Contraindications: Refer to manufacturer's literature
Precautions: Avoid over sedation
Significant possible interactions: Refer to manufacturer's literature

ALTERNATIVE DRUGS:

• Budesonide 2 mg nebulized; a topical glucocorticoid
• Ribavirin for respiratory syncytial virus
• Amantadine for influenza A

FOLLOW UP

PATIENT MONITORING:

Severe cases require ICU care with respiratory monitoring for hypoxemia and hypercapnia

PREVENTION/AVOIDANCE:

N/A

POSSIBLE COMPLICATIONS:

• Subglottic stenosis in intubated patients
• Bacterial tracheitis
• Cardiopulmonary arrest
• Pneumonia

EXPECTED COURSE AND PROGNOSIS:

• Upper respiratory infection prodrome of 1-7 days
• If required, intubation is maintained for 3-5 days
• If required, tracheotomy is maintained for 3-7 days
• Recovery is usually full, without lasting effects

MISCELLANEOUS

ASSOCIATED CONDITIONS:

If recurrent, search for underlying anatomic abnormality such as subglottic stenosis or consider foreign body

AGE-RELATED FACTORS:

Pediatric: Common in children under the age of three
Geriatric: N/A
Others: N/A

PREGNANCY:

N/A

SYNONYMS:

• Croup
• Infectious croup
• Viral croup
• LTB

ICD-9-CM:

464.20 Acute
464.21 With obstruction
476.1 Catarrhal, chronic, atrophic

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Medical Diagnosis » L » Laryngotracheobronchitis II