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[Bacterial tracheitis in children]
Insights
Bacterial tracheitis (BT) is a severe complication of croup in children, often requiring intubation and intensive care. Suspecting BT when intubation is needed for croup is crucial for timely management and improved outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Otolaryngology
Context:
- Croup is a common pediatric respiratory illness.
- Bacterial tracheitis (BT) is a rare but serious complication of croup.
- This study examines the incidence and characteristics of BT in children admitted with croup.
Purpose:
- To determine the incidence of bacterial tracheitis in children admitted with croup.
- To describe the clinical features and management of bacterial tracheitis.
- To highlight the importance of suspecting BT in croup cases requiring intubation.
Summary:
- Bacterial tracheitis occurred in 1.3% of children admitted with croup.
- Children with BT often presented with typical croup symptoms but required intubation due to tracheal pus.
- Intubated patients needed frequent suctioning; antibiotic therapy was administered, with one fatality from secondary complications.
Impact:
- Bacterial tracheitis should be suspected in croup cases necessitating intubation.
- Close pediatric intensive care unit (PICU) monitoring and tracheal suctioning are vital post-intubation.
- Prompt antibiotic therapy may be beneficial in managing bacterial tracheitis.
Abstract:
Bacterial tracheitis (BT) was found in 10 of 748 children (1.3%) admitted with croup during 1983-1990. 9.9% of all the 748 croup cases seen (74) were admitted to the pediatric intensive care unit (PICU) and 16 of the 74 required intubation. 10 of those intubated (62.5%) were found to have BT and had typical features of croup, including inspiratory stridor, hoarseness and cough. Airway obstruction resulted mainly from accumulated tracheal pus. After endotracheal intubation all required frequent suctioning of thick purulent secretions. In 2 children causative microorganisms were cultured from the blood, and in all 10 from the tracheal pus. All children were given antibiotic therapy but a 7 month-old girl died of secondary complications (respiratory syncytial virus infection, pneumonia and adult respiratory distress syndrome). The others recovered and were discharged from the PICU within 3-14 days. BT should be suspected when tracheal intubation is required in croup. In such cases close monitoring in a PICU and frequent tracheal suctioning after intubation is necessary; antibiotic therapy should be considered.