Croup and Related Disorders
Joseph R. Custer MD1
1 Associate Professor of Pediatrics; Director, Pediatric Intensive Care and Stable Ventilator Units; University of Michigan Medical Center, D-1220 MPB/0718, Ann Arbor, MI
The airway of children is vital, but easily obstructed because it is narrow. Although there are many potential causes of upper airway obstruction (Table 1), a few diagnoses predominate. For example, in one study of 322 children presenting with stridor, 89% of cases were caused by croup, 8% by epiglottitis, and 2% by nonbacterial tracheitis.1 This review will cover these common airway infections as well as obstruction caused by inhalation of foreign bodies, spasmodic croup, and retropharyngeal abscess. Each of these diseases can progress to critical airway obstruction and hypoxia, causing organ damage or death.
Individuals caring for children must be prepared to diagnose and treat airway emergencies expeditiously. Appropriate management of acute upper airway obstruction tests the organization of emergency care systems. Successful management of airway emergencies requires a team approach, including the skills of the primary physician and the staff of the emergency department, radiology department, and operating room (eg, anesthesiologist, otolaryngologist). Management of these cases can be anticipated, and prospective protocols can and should be established. Regional intensive care units, transport teams, emergency room personnel, primary care physicians, anesthesiologists, and otolaryngologists can agree on a prospective management scheme such as that outlined in Table 2.
The issue of airway protection prior to or during transport to a tertiary care institution is controversial.
