Croup/Laryngotracheobronchitis

 

 

Considerations

 

  • Pediatric patient considerations

  • Possible airway difficulty & complications:  

    • Consider double set-up, rigid bronchoscope, spontaneously breathing patient

    • Obstruction, laryngospasm

    • Respiratory fatigue/failure

    • Super infection with bacterial trachietis possible

  • Dehydration, need for volume replacement 

  • PICU & extubation plan

 

 

Treatment

 

  • Nebulized epinephrine 0.5 ml/kg of 1:1000 to max 5 ml q15-20 min

  • Dexamethasone 0.6 mg/kg PO or 0.15-0.3 mg/kg IV

  • Budesonide 2 mg via neb (2 ml)

  • Humidified O2

  • Heliox 

  • Approach to intubation:

    • Perform in OR with difficult airway cart & ENT +/- rigid bronchoscopy 

    • Use small endotracheal tube, cuffed & stylet