From the Guidelines
Croup management should prioritize outpatient treatment with a clinical guideline, limiting hospital admission until 3 doses of racemic epinephrine are needed, as this approach has been shown to reduce hospital admissions by 37% without increasing revisits or readmissions 1. Croup is a common viral respiratory infection in children characterized by a barking cough, hoarseness, and stridor. Most cases can be managed at home with supportive care including humidified air from a cool-mist humidifier or steaming bathroom, adequate hydration, and fever control with acetaminophen or ibuprofen. Key considerations for managing croup include:
- Using a clinical guideline to standardize treatment and reduce unnecessary hospital admissions 1
- Limiting hospital admission until 3 doses of racemic epinephrine are needed, as this approach has been shown to be effective in reducing hospital admissions without increasing revisits or readmissions 1
- Administering a single dose of oral dexamethasone (0.15-0.6 mg/kg, maximum 10 mg) for moderate to severe cases to reduce airway inflammation and improve symptoms
- Monitoring for signs of severe respiratory distress, including blue-tinged lips, drooling, difficulty swallowing, or struggling to breathe, and seeking immediate medical attention if these symptoms occur. The use of clinical guidelines and evidence-based treatment approaches can help improve outcomes for children with croup, reducing the need for hospital admissions and minimizing the risk of complications 1.
From the Research
Definition and Diagnosis of Croup
- Croup is a common childhood disease characterized by sudden onset of a distinctive barking cough, usually accompanied by stridor, hoarse voice, and respiratory distress resulting from upper airway obstruction 2.
- A careful history and physical examination is the best method to confirm the diagnosis and to rule out potentially serious alternative disorders such as bacterial tracheitis and other rare causes of upper-airway obstruction 3.
- Laboratory studies are seldom needed for diagnosis of croup, and viral cultures and rapid antigen testing have minimal impact on management 4.
Treatment of Croup
- The introduction of steroids in the treatment of croup has seen a significant reduction in hospital admissions and improved outcomes for children 2.
- Corticosteroids are the mainstay of treatment, and benefit is seen in children with all levels of severity of croup, including mild cases 3.
- A single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity 4.
- In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization 4.
- Nebulized epinephrine provides effective additional therapy for more severe cases, and L-epinephrine appears to be comparable to racemic epinephrine 5.
Management of Croup
- The assessment of airway, breathing and circulation, focusing on airway, is paramount in treating croup 2.
- In mild to moderate croup, give prednisolone 1.0 mg/kg and review in 1 hour 2.
- In severe or life threatening croup, give 4 mL of adrenaline 1:1000 (undiluted) via nebuliser and send immediately to hospital via ambulance 2.
- Heliox and humidified oxygen may also be effective in the short-term management of refractory croup, although further study is warranted 5.