One child in each group needed a second dose of epinephrine within one hour; subsequently, 3 children in the racemic epinephrine group required endotracheal intubation, compared with none in the other group. These results suggest that the L-form of epinephrine is at least as effective as the racemic form in treating croup in children. But because of epinephrine's transient effect and possible rebound phenomenon, patients with moderate to severe croup should be monitored closely.
Waisman Y et al. Prospective randomized double-blind study comparing L- epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis croup.
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Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. Ten-year experience with IPPB in the treatment of acute laryngotracheobronchitis. Anesth Analg. Treatment of laryngotracheobronchitis croup : use of intermittent positive-pressure breathing and racemic epinephrine. Am J Dis Child. Inhalation of racemic adrenaline in the treatment of mild and moderately severe croup. Clinical symptom score and oxygen saturation measurements for evaluation of treatment effects.
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Am Rev Respir Dis. Racemic epinephrine in the treatment of croup: nebulization alone versus nebulization with intermittent positive pressure breathing. Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis croup. The disposition of children with croup treated with racemic epinephrine and dexamethasone in the emergency department. J Emerg Med. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Acute Rhinosinusitis in Adults. Next: Urticaria: Evaluation and Treatment. May 1, Issue. Croup: An Overview. Croup is a common illness responsible for up to 15 percent of emergency department visits due to respiratory disease in children in the United States.
A 25 — 27 Treatment of croup with corticosteroids is beneficial, even with mild illness. A 28 , 29 A single dose of an oral corticosteroid is effective in patients with mild croup.
B 29 Nebulized epinephrine improves outcomes in patients with moderate to severe croup. Enlarge Print Table 1. Table 1. Enlarge Print Table 2. Differential Diagnosis of Children with Severe Respiratory Symptoms Condition History Physical examination Workup Common etiologies Angioedema Detailed questioning to identify the offending antigen Swelling of face and neck Epicutaneous skin testing or radioallergosorbent testing may be performed later Allergic reaction Bacterial tracheitis Mild to moderate presentation, then rapid decomposition in three to seven days High-grade fever, toxic appearance, copious secretions, productive cough, retractions; no drooling or odynophagia Lateral neck radiography may be helpful, bacterial culture of tracheal secretions after intubation, WBC count elevated Staphylococcus aureus , Haemophilus influenzae , group A streptococci Epiglottitis Rapid onset of symptoms, sore throat, muffled voice, drooling High-grade fever, toxic appearance, child sitting or leaning forward Lateral neck radiography if clinical diagnosis unclear, WBC count elevated H.
Table 2. Algorithm for the outpatient management of croup in children. Outpatient Management of Croup in children Figure 1. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! In general, children included in the studies were young average age less than two years in the majority of included studies.
Severity of croup was described as moderate to severe in all included studies. Six studies took place in the inpatient setting, one in the ED and one setting was not specified. Six of the eight studies were deemed to have a low risk of bias and the risk of bias was unclear in the remaining two studies.
Nebulized epinephrine was associated with croup score improvement 30 minutes post-treatment three RCTs, standardized mean difference SMD This effect was not significant two and six hours post-treatment. Nebulized epinephrine was associated with significantly shorter hospital stay than placebo one RCT, MD
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