Humidification in viral croup: a controlled trial

Abstract

Sixteen children (mean age 1.9 years)admitted to hospital with viral croup were assigned randomly toeither a high humidity atmosphere or room air. No other treatment was given. During the initial 12 h both groups of patients showed a similar rate of recovery as measured by pulse rate, respiration rate, transcutaneous oxygen (Tc02), transcutaneous carbon dioxide (TcC02) and a clinical rating. No therapeutic benefit was demonstrated from the provision of a high humidity atmosphere. The widespread use of humidification in the management of croup requires reappraisal.

Management of Croup

“…A small randomized controlled trial involving 16 children did not demonstrate any benefit in using a humidified atmosphere when compared with room air. [17] Similarly, a large tertiary pediatric hospital in Australia stopped using mist tents and mist therapy in 1985, and this did not result in a deterioration of outcome. [18] Children in mist tents can become wet and cold and are not easily consoled by parents during isolation.…”

Humidified air inhalation for treating croup: a systematic review and meta-analysis

“…Two of the studies 19,20 compared cool humidified air with no treatment, while the third 18 compared warmed humidified air fed into a perspex cot with no treatment. There were no trials in primary care settings and none involving warm mist delivered more directly to infants.…”

“…Moreover, the trend in admissions favoured control although none of these results reached statistical significance and this variation may reflect the play of chance. Two of the studies were methodologically weak 18,20 while the more rigorous Neto study 19 included initial treatment of all children with oral dexamethasone probably limiting the potential for improvement. It is questionable therefore whether there is sufficiently robust evidence to rule in or rule out any beneficial effect of humidified air.…”

“…Additional analyses were completed using combined data at 20-30 minutes 19,20 and data from time point 60 and 120 minutes. 18,19 Data from 20 to 30 minutes favoured mist therapy -0.40 (-0.82 to 0.02) although it should be noted that this includes the unblinded assessment from Jamshidi et al (2001). Assessment data at 60 minutes favoured no treatment 0.2 (-0.64 to 1.05).…”

“…Bourchier et al (1984) 18 is widely cited. In this study, 16 consecutive inpatients with croup (age range 0.4-4.5 years) were allocated using a random process not described to one of two groups.…”