direct=true&db=mnh&AN=30138522&site=eds-live&scope=siteJohnson, D. W. (2016). Croup. American Family Physician, 94(6), 476–478. Retrieved from ?direct=true&db=mnh&AN=27637124&site=eds-live&scope=site
If a patient is not responding to medical management for presumed croup, the otolaryngology team is occasionally consulted for direct laryngoscopy and bronchoscopy (DLB) to rule out tracheitis or another airway pathology.. Comorbidities, complications, and level of care were also analyzed. Five patients (28%) had gastrointestinal reflux disease (GERD), and 4 had previously undergone intubation (22%). Eleven patients(61%) had concurrent airway pathology, 7 of whom (39%) required operative intervention. Preoperative mean body temperature and the increase in mean temperature were significantly higher in tracheitis patients than in the non-tracheitis patients. Our study found that performing inpatient DLB in patients hospitalized with croup is reasonably safe and provides a sufficient yield for identifying tracheitis or other airway pathology in selected populations. Preoperative vital signs can be suggestive of tracheitis or additional unexpected airway pathology. Recurrent croup, a history of GERD or previous intubation, and preoperative admission to the ICU increase the yield of DLB.Tracheitis is a potentially life-threatening superinfection characterized by the formation of thick, purulentsecretions that are difficult to clear. In its classic manifestation, tracheitis causes patients to appear toxic and febrile with leukocytosis.2 In contrast, patients with croup are nontoxic, and fever and white blood cell counts are variable.3 Tracheitis is usually acute, but it also can be insidious. When patients do not respond to medical management for presumed croup, the otolaryngology team is occasionally asked to perform direct laryngoscopy and bronchoscopy (DLB) to rule out tracheitis or another airway pathology. However, there are risks involved in performing DLB during acute croup; they include worsening the respiratory status by administering general anesthesia, and instrumentation of an already edematous subglottis. This can result in the need for intubation or transfer to a higher level of care, which increases the risk of complications, length of hospital stays, and costs. While the benefits of diagnosing tracheitis outweigh the risksLevel of care and complications. All 4 patients who were intubated during DLB had been placed in the ICU setting preoperatively, and only 1 patient required ICU admission during the immediate postoperative period. We believe this finding is important when having a preoperative discussion of DLB
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- Spring '15
- cough, Gastroesophageal reflux disease, croup, acute bronchitis