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Tracheitis, Bacterial

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  • True pediatric emergency
  • Admission to ICU
  • Maintain airway: often difficult due to copious secretions Endotracheal or nasotracheal intubation usually needed, especially in infants and children <4 years of age Much less likely to need intubation if child >8 years of age Advantage of intubation is the ability to clear trachea and bronchi of secretions and pseudomembranes.
  • Vigorous pulmonary toilet to clear airway of secretions
  • Hydration, humidification, antibiotics

Admission Criteria/Initial Stabilization

  • Suspected or confirmed diagnosis of tracheitis
  • Respiratory distress
  • Artificial airway

Nursing

  • Provide calm, quiet environment for child once endoscopy and cultures are done.
  • Airway monitoring
  • Frequent suctioning
  • Monitor fluid balance.
  • Establish and maintain open lines of communication with child and parents.

Discharge Criteria

No longer in need of acute care

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Children with artificial airways will require ongoing follow-up.

DIET

Varies with clinical situation

PATIENT EDUCATION

Keep immunizations up to date.

PROGNOSIS

  • Intubation generally 3 to 11 days
  • Usually requires 3 to 7 days of hospitalization
  • With effective early recognition and management, complete recovery can be expected.
  • Cardiopulmonary arrest and death have occurred.

COMPLICATIONS

  • Cardiopulmonary arrest
  • Hypotension
  • Acute respiratory distress syndrome (ARDS)
  • Pneumonia
  • Formation of pseudomembranes

REFERENCES

11 Kuo CY, Parikh SR. Bacterial tracheitis. Pediatr Rev. 2014;35(11):497 " 499.22 Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis. 2009;41(8):548 " 557.33 American Academy of Pediatrics. Pediatric Pulmonology. Elk Grove Village, Illinois, IL: American Academy of Pediatrics; 2011:955.

ADDITIONAL READING

  • Hopkins A, Lahiri T, Salerno R, et al. Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics. 2006;118(4):1418 " 1421.
  • Huang YL, Peng CC, Chiu NC, et al. Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int. 2009;51(1):110 " 113.
  • Loftis L. Acute infectious upper airway obstructions in children. Semin Pediatr Infect Dis. 2006;17(1):5 " 10.
  • Shah S, Sharieff GQ. Pediatric respiratory infections. Emerg Med Clin North Am. 2007;25(4):961 " 979.
  • Vorwerk C, Coats T. Heliox for croup in children. Cochrane Database Syst Rev. 2010;(2):CD006822.

SEE ALSO

Croup (Laryngotracheobronchitis); Epiglottitis

CODES

ICD10

  • J04.10 Acute tracheitis without obstruction
  • J04.11 Acute tracheitis with obstruction
  • J05.0 Acute obstructive laryngitis [croup]
  • J04.1 Acute tracheitis
  • J04.1 Acute tracheitis

ICD9

  • 464.10 Acute tracheitis without mention of obstruction
  • 464.11 Acute tracheitis with obstruction
  • 464.4 Croup

SNOMED

  • 62994001 Tracheitis (disorder)
  • 26650005 Acute tracheitis
  • 64369009 acute tracheitis without obstruction (disorder)
  • 8519009 acute tracheitis with obstruction (disorder)
  • 71186008 Croup (disorder)

CLINICAL PEARLS

  • Bacterial tracheitis is an acute, potentially life-threatening, infraglottic bacterial infection following a primary viral infection that accounts for 5 " 14% of upper airway obstructions in children requiring critical care services.
  • Children with suspected or actual bacterial tracheitis should be cared for in a pediatric ICU.
  • Endoscopy provides a definitive diagnosis (2).
  • Initial treatment of choice for bacterial tracheitis is broad-spectrum antibiotic coverage, aggressive airway protection, and supportive care (2).