Virtual Pediatric Hospital: ElectricAirway: Upper Airway Problems in Children
ElectricAirway: Upper Airway Problems in Children: Croup Syndromes
Answer to 18
Donna M. Santer, M.D., Michael P. D'Alessandro, M.D.
Peer Review Status: Externally Peer Reviewed by Lauren D Holinger, MD, Robert J. Winter, MD and the AMA
The answer is A. Treatment of these children needs to be aggressive, because the stenosis is usually more severe than with congenital subglottic stenosis. If the child has respiratory difficulty within a few hours of extubation as with this child, racemic epinephrine nebulization may be all that is needed (Procedure A). If the child shows progressive symptoms, reintubation may be necessary and a course of corticosteroids should be used before the next attempt to extubate (Procedure C). For those children who fail this second attempt at extubation, a surgical procedure is indicated. A cricoid split tracheoplasty or laser surgery (Procedure H) may be used to avoid tracheotomy, depending on the individual clinical indications.
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