CORUP

Croup - acute laryngotracheitis, leading to a narrowing of the lumen (stenosis) of the larynx; Characterized by the appearance of a hoarse or hoarse voice, a rough "barking" cough and difficulty breathing. It is observed mainly in children aged 6 months to 3 years, more often in the second year of life.

Croup often develops in acute respiratory infections of the viral etiology (see Acute respiratory viral infections), mainly in influenza and parainfluenza, less often in adenoviral diseases. Croup can also occur with measles (in the catarrhal period and in the period of pigmentation), aphthous stomatitis, thrush. Extremely rare croup is observed in whooping cough, scarlet fever. Diphtheria croup (diphtheria of the larynx) is one of the clinical forms of diphtheria, before it was called true as opposed to a false croup (acute stenosing laryngitis or laryngotraheobronchitis).

In the development of croup, in addition to reflex spasm of the larynx, edema of the mucous membrane is important, especially in the area of ​​the lining space (from the vocal folds to the trachea), and the accumulation of exudate in the region of the glottis. As a result, breathing becomes difficult, inspiratory dyspnea develops, nasal breathing becomes impossible, and the patient breathes through the mouth. At the same time, humidification and air heating in the upper respiratory tract are disturbed, which leads to drying of the mucous membrane of the airways, increasing the viscosity of the exudate, the formation of dry crusts, and even greater difficulty in breathing. An important role in the pathogenesis of croup in viral infections is played by the attachment of bacterial flora (especially staphylococcal), which causes severe lesions (ulcers, necrotic) of the larynx, trachea, and sometimes bronchi, accompanied by the accumulation of a large amount of mucopurulent discharge in the lumen of the upper respiratory tract .

Clinical picture . A triad of symptoms is characteristic: a coarse "barking" cough , hoarseness or hoarseness of the voice, and obstructed (stenotic) breathing.

Diphtheria croup begins gradually, sometimes against the background of normal body temperature, noisy breathing passes into an attack of suffocation. Its typical sign is the growing hoarseness of the voice, passing into aphonia at the time of stenosis of the larynx. Characteristic grayish, difficult to remove plaque on the mucous membrane of the pharynx and larynx, palatine tonsils, after removal of which the bleeding surface is exposed. The diagnosis of diphtheria is unlikely with proper vaccination.

Croup in infectious diseases of non-diphtheria etiology, as a rule, develops sharply; It is often the first manifestation of a viral infection. More often the symptoms of croup appear at night. The child suddenly wakes up, becomes restless, there is a rough "barking" cough , shortness of breath with a shortness of breath. Breathing becomes noisy. There are pallor of the skin, cyanosis of the lips. The voice during the attack is hoarse, however, when shouting, sound notes are always heard (in contrast to diphtheria croup). In children, as a rule, signs of intoxication are expressed, body temperature is raised, sometimes there is hyperemia of the throat, runny nose and other signs of the main infectious disease. When catarrh of the larynx mucosa, the symptoms usually subside or disappear a few hours after the care. However, they can repeat the next night. In cases of ulcerative or necrotic lesions of the larynx, the symptoms of croup remain long (up to 5 - 7 days, sometimes longer), periodically weakening and intensifying. Possible rapid progression of the process of stenosis, resulting in several hours to asphyxia. The severity of the croup is determined by the severity and duration of laryngostenosis.

Diagnosis in most cases is not difficult. In this case, anamnesis and typical symptomatology are taken into account. In a hospital, if necessary (for example, with suspected diphtheria of the larynx), laryngoscopy can be used. The diagnosis of diphtheria is confirmed by bacteriological examination of smears from throat and films from the larynx. It must be remembered that bouts of shortness of breath can be caused by laryngospasm in children with rickets and spasmophilia, and noisy breathing with a special sound on inspiration can be noted in children with congenital stridor. The voice with laryngospasm and stridor always remains ringing, there is no "barking" cough . Difficulty breathing can also be caused by the retropharyngeal abscess, in which case the patient's voice is inarticulate with a nasal tinge, there is no aphonia and no coarse cough, and when viewed from the pharynx, a protrusion of its posterior wall is detected. In young children, the cereal may sometimes resemble an attack of bronchial asthma, but in the latter case there is a difficulty in exhaling, the voice is not changed, there is no "barking" coughing.

Treatment . All patients with cereal, regardless of its etiology and severity of stenosis of the larynx (due to the possibility of its sudden amplification) are subject to urgent hospitalization after emergency care. During transportation the patient must be accompanied by a doctor or paramedic. It is advisable to hospitalize children of an early age with their mother.

Emergency care is aimed at restoring the patency of the airways, relieving spasm of the muscles of the larynx and swelling of the mucous membrane. The amount of treatment is determined by the degree of respiratory failure. With a slight degree of stenosis, it is necessary. To rest the child, to provide access to fresh (but not cold) air into the room. If the body temperature is low, a general bath with a duration of 5-10 minutes is recommended with an initial water temperature of 37 ° C and a gradual increase to 39 ° C. Give a warm drink (briar infusion, tea with honey, lemon, milk with butter, honey and baking soda), expectorant potion. Effective steam inhalations, the effect of which increases when adding baking soda (1 teaspoon per 1 liter of water), chamomile, sage, immortelle, eucalyptus. Steam inhalations can be administered every 3 hours. Intramuscular injection of 2% solution of suprastin (in a single dose to children under 1 year - 0.25 ml, 1-4 years - 0.3 ml, 5 - 6 years - 0.4 ml). Dimedrol and pipolfen can only be used once in the absence of suprastin, since they, with atropine-like action, delay exudation and increase the viscosity of sputum (a single dose of 1% solution of dimedrol for children of the first 6 months of life - 0.2 ml, in the second half - 0, 2 - 0,5 ml, 1-2 years - 0,5 - 0,7 ml, 3 - 6 years -1,0 ml, 2,5% solution of pipolfen for children under 2 years - 0,2 ml, 3- 4 years - 0.3 ml, 5 - 6 years - 0.4 ml). With the expressed concern of the child, the risk of seizures, intramuscularly injected 0.5% solution of seduksen (children under 1 year - in a single dose of 0.3-1 ml, children 1-6 years - 1 -1.5 ml), 0.25% Solution of droperidol (in a single dose of 0.1-0.2 ml / kg) or 20% solution of sodium oxybutyrate (in a single dose of 0.5 ml / kg, the drug can be given inside with a mixture of fruit juice). Children with severe stenotic phenomena in addition to the above measures intramuscularly administered prednisolone hemisuccinate at a rate of 1 mg / kg. If necessary, use antipyretic, cardiac agents.

In the hospital, prolonged inhalation of warm and humid air ("tropical atmosphere") in combination with oxygen therapy is carried out. For this purpose, steam-oxygen tents are used in which the temperature is maintained at 30 ° C, humidity 100%, oxygen content 40-50%, and aerosols of medicinal products (sodium bicarbonate, euphyllin, suprastin, hydrocortisone) are created using a special device. Widely used are inhalations of moistened oxygen. If the conservative treatment is ineffective, if respiratory failure increases, nasotracheal intubation or tracheostomy is indicated. When diphtheria croup is very important early introduction of antidiphtheria serum by the method of Bezredki. With croup, due to a virus-bacterial infection, antibiotics are prescribed.

The prognosis with timely and adequate therapy is favorable in most cases. An unfavorable outcome is associated with the development of severe hypoxia.

Prevention of diphtheria croup is the active immunization of children, early detection, isolation and treatment of patients with diphtheria and carriers that release toxigenic strains of the pathogen. Prevention of croup arising in infectious diseases of non-diphtheria etiology is the timely and adequate treatment of acute respiratory viral and other infectious diseases.