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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).