From the Guidelines
The optimal treatment for croup involves a combination of supportive care and medications, with dexamethasone being the first-line medication, typically given as a single oral dose of 0.6 mg/kg (maximum 16 mg), as supported by the most recent and highest quality study 1. The treatment approach for croup should prioritize reducing airway inflammation and symptoms, while also considering the patient's overall clinical characteristics and medical history.
- For mild croup, humidified air and keeping the child calm may be sufficient, as seen in the demographic and clinical characteristics of patients with croup in the study 1.
- For moderate to severe cases, dexamethasone is the preferred medication, given its ability to reduce airway inflammation and symptoms within 1-2 hours and lasting for up to 24 hours, as implied by the implementation of a clinical guideline and orderset to reduce hospital admissions for croup 1.
- Additionally, nebulized epinephrine may be considered for children with significant respiratory distress, providing rapid but temporary relief of symptoms, and oxygen should be provided to maintain saturation above 92%, as part of the standard treatment approach.
- It is also important to note that the implementation of a clinical guideline, as seen in the study 1, can lead to improved patient outcomes and reduced healthcare costs, highlighting the importance of evidence-based treatment approaches for croup.
From the Research
Treatment Options for Croup
- Croup is a common childhood disease characterized by sudden onset of a distinctive barking cough, stridor, hoarse voice, and respiratory distress resulting from upper airway obstruction 2.
- The introduction of steroids in the treatment of croup has seen a significant reduction in hospital admissions and improved outcomes for children 2.
- In mild to moderate croup, treatment with prednisolone 1.0 mg/kg and review in 1 hour is recommended 2.
- In severe or life-threatening croup, treatment with 4 mL of adrenaline 1:1000 (undiluted) via nebuliser and immediate hospitalization via ambulance is recommended 2.
Heliox for Croup
- Heliox, a mixture of helium and oxygen, may prevent morbidity and mortality in ventilated neonates by reducing the viscosity of the inhaled air 3, 4, 5.
- Anecdotal evidence suggests that heliox relieves respiratory distress in children with croup 3, 4, 5.
- Studies have shown that heliox may be beneficial in the short term for children with moderate to severe croup treated with dexamethasone 3, 4, 5.
- However, the evidence for the effectiveness and safety of heliox is limited, and adequately powered RCTs comparing heliox with standard treatments are needed to further assess its role in the treatment of children with moderate to severe croup 3, 4, 5.
Comparison of Heliox with Other Treatments
- A study found that heliox resulted in similar improvements in croup scores compared with racemic epinephrine in patients with moderate to severe croup 6.
- Another study found that heliox may be beneficial in the short term for children with moderate croup treated with dexamethasone, but may not be more effective than 30% humidified oxygen for children with mild croup 4.
- The effect of heliox may be similar to 100% oxygen given with one or two doses of adrenaline 4, 5.