Radiographic tracheal diameter measurements in acute infectious croup: an objective scoring system

Corkey, C. W. B.; Barker, Geoffrey; Edmonds, John F.; Mok, P.M.; Newth, Christopher J. L.

doi:10.1097/00003246-198108000-00007

Cited by 41 publications

(10 citation statements)

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“…Various proposed methods for objective assessment of respiratory distress in children with croup are either impractical or insensitive to change across the full range of disease severity. 23,[57][58][59] Consequently, in clinical trials of treatment eff ectiveness, outcome measures have mainly included clinical scores and health-care use. 60,61 Although such scores are useful for research studies, none has been shown to enhance routine clinical care, at least in part, because they are not reliable when used by a wide range of clinicians.…”

Section: Assessment Of Severitymentioning

confidence: 99%

Croup

2008

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Most children who present with acute onset of barky cough, stridor, and chest-wall indrawing have croup. 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. Epinephrine delivered via a nebuliser is effective for temporary relief of symptoms of airway obstruction. Corticosteroids are the mainstay of treatment, and benefit is seen in children with all levels of severity of croup, including mild cases.

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Section: Assessment Of Severitymentioning

confidence: 99%

Croup

2008

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“…This is particularly important when grading stridor and re- http://www.pediatrics.org/cgi/content/full/107/6/e96tractions, because both have been fluroscopically shown to inversely correlate with the diameter of the trachea. 9 Twenty-five patients who were eligible for the study were not enrolled, and it is possible that this group may have responded differently to treatment. However, initial CSs of study patients were similar to those children who were not enrolled because of parental refusal.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Comparison of Helium–Oxygen Mixture (Heliox) and Racemic Epinephrine for the Treatment of Moderate to Severe Croup

et al. 2001

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ABSTRACT. Objective. To compare the additive effect of a helium-oxygen mixture (Heliox) or racemic epinephrine (RE) on croup scores (CSs) in children with moderate to severe croup treated with humidified oxygen and steroids.Design. A prospective, randomized, double-blind trial.Setting. Emergency department and pediatric intensive care unit of an urban level I trauma center.Participants. Randomly assigned, consecutive children ages 6 months to 3 years presenting with moderate to severe croup (CS: >5).Interventions. After cool humidified oxygen and 0.6 mg/kg of intramuscular dexamethasone, patients were randomized to receive either Heliox or RE. Vital signs, oxygen saturation, and CSs were recorded at regular intervals.Outcome/Analysis. Reductions in CSs were compared using repeated-measures analysis of variance.Results. Thirty-three patients were enrolled. Three were excluded because of protocol violations, and 1 was excluded because of lack of documentation, leaving 29 patients for final analysis. The average age was 24.2 months, 20 were male (68.8%). Both Heliox and RE were associated with improvement in CSs over time. There were no significant differences in mean CS, oxygen saturation, respiratory rate, or heart rate between groups at baseline or at the end of the treatment period.Conclusion. In patients with moderate to severe croup, the administration of Heliox resulted in similar improvements in CS compared with patients given RE. Pediatrics 2001;107(6). URL: http://www.pediatrics.org/ cgi/content/full/107/6/e96; helium-oxygen mixture, croup.ABBREVIATIONS. RE, racemic epinephrine; CS, croup score; ED, emergency department. L aryngotracheobronchitis, or croup, is a common respiratory illness in children. Most cases of croup are mild and require only supportive care with humidified oxygen. However, in moderate to severe cases, aggressive therapy may be necessary to avoid exhaustion and subsequent respiratory failure. Although steroids have gained widespread acceptance as a means of attenuating subglottic edema, racemic epinephrine (RE) has long been considered the mainstay of acute therapy for moderate to severe croup. 1 Helium is a biologically inert gas that possesses a very low specific gravity (density) and is one third the viscosity of air. 2 These properties result in a decreased resistance to airflow (lower Reynolds number), and suggest that a helium-oxygen mixture may be a useful adjunct to improve ventilation via enhanced laminar airflow in the face of moderate to severe croup. Recently, mixtures of helium and oxygen have been used successfully in the pediatric intensive care unit setting for treatment of both refractory viral and postextubation croup. [3][4][5] Although both Heliox (AGA Gas, Flint, MI) and RE have been independently shown to decrease the work of breathing and lower croup scores (CSs), 3,4,6 no study to date has compared these modalities in the management of moderate to severe croup. Therefore, the purpose of this study was to compare the relative effect of Heliox and RE on CSs in pe...

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“…Many initial studies demonstrated significant improvements in croup symptom scores compared to placebo at 10 and 30 minutes after administration, with waning effects by 120 minutes after treatment [82–87]. In addition to changes in clinical scores, inhaled epinephrine significantly reduces tracheal diameter [88], and improves breathing mechanics [89] in children with stridor from viral croup.…”

Section: Clinical Evidence Of the Use Of α-Ar Agonists And Gc In Tmentioning

confidence: 99%

Scientific Rationale for the Use of Alpha-Adrenergic Agonists and Glucocorticoids in the Therapy of Pediatric Stridor

Niño

Baloğlu

Gutiérrez

et al. 2011

International Journal of Otolaryngology

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Purpose. The most common pharmacological therapies used in the treatment of stridor in children are glucocorticosteroids (GC) and alpha-adrenergic (αAR) agonists. Despite the long-standing reported efficacy of these medications, there is a paucity of data relating to their actual mechanisms of action in the upper airway. Summary. There is compelling scientific evidence supporting the use of αAR-agonists and GCs in pediatric stridor. αAR signaling and GCs regulate the vasomotor tone in the upper airway mucosa. The latter translates into better airflow dynamics, as delineated by human and nonhuman upper airway physiological models. In turn, clinical trials have demonstrated that GCs and the nonselective αAR agonist, epinephrine, improve respiratory distress scores and reduce the need for further medical care in children with stridor. Future research is needed to investigate the role of selective αAR agonists and the potential synergism of GCs and αAR-signaling in the treatment of upper airway obstruction and stridor.

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Radiographic tracheal diameter measurements in acute infectious croup: an objective scoring system

Cited by 41 publications

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Croup

Croup

A Randomized Comparison of Helium–Oxygen Mixture (Heliox) and Racemic Epinephrine for the Treatment of Moderate to Severe Croup

Scientific Rationale for the Use of Alpha-Adrenergic Agonists and Glucocorticoids in the Therapy of Pediatric Stridor

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