An acute viral inflammation of the upper and lower respiratory tracts characterised by inspiratory stridor, subglottic swelling and respiratory distress (most pronounced on inspiration). Infection produces inflammation of larynx, trachea, bronchi, bronchioles and lung parenchyma. Obstruction caused by swelling and inflammatory exudate is most severe in the subglottic region and leads to increased work of breathing, hypercapnia and at times atelectasis.
Clinical Features
A “barking” often spasmodic cough (following a URTI) and hoarseness may mark the onset of respiratory stridor commonly at night. Respiratory distress, tachypnoea, supraclavicular, suprasternal, substernal and intercostal inspiratory retractions. In severe cases cyanosis occurs; Fever in 50% of children. Auscultation Prolonged inspiration and stridor. Some expiratory rhonchi and wheezes, and diminished breath sounds if atelectasis is present. The illness lasts 3-4 days and during this period may improve in the morning and worsen at night.
Management
• Admit to hospital and prepare equipment for intubation and/or tracheostomy
• Administer humidified O2 (at 30-40% concentration)
• Nasotraeheal intubation if signs of severe obstruction occur: Severe chest indrawing, agitation, anxiety (air-hunger) and cyanosis
• Tracheostomy may be done if intubation is impossible.
