Management tactics of patients with acute stenosing laryngotracheitis (a review of the guidelines of medical communities)

Acute stenosing laryngotracheitis (croup) is a clinical syndrome manifested by a barking cough, inspiratory stridor, hoarseness of voice and is accompanied by difficulty breathing. After establishing the diagnosis, it is necessary to carefully determine the degree of its severity in order to prescribe optimal therapy. The aim of this article is to generalize and analyze the management tactics of patients with acute stenotic laryngotracheitis (croup). Modern publications, clinical guidelines, national and international protocols were analyzed. Literature was searched in scientific databases: PubMed, Scopus, Web of Science, and Google Scholar. The main approach to the medical treatment of croup is the use of agents that effectively reduce swelling of the mucous membrane of the subligamentous space and increase the lumen of the respiratory tract. To achieve this goal, systemic corticosteroids, inhaled corticosteroids, and racemic epinephrine are prescribed. In the treatment of croup, systemic corticosteroids can be used in different forms: orally, intramuscularly, intravenously, or rectally. Oral administration is the preferred method of systemic corticosteroid administration, especially in the age group of 6 months to 3 years. According to the guidelines, budesonide, which is used through a nebulizer, is an effective method of treating croup in children, especially in cases where oral administration of drugs is not possible due to repeated episodes of vomiting. The use of racemic epinephrine or epinephrine by nebulizer is the recommended first step in the treatment of a child with persistent inspiratory stridor at rest and marked chest wall retraction. Conclusions. The main aspects of the tactics of managing patients with croup in the ward are timely diagnosis and adequate medical intervention in order to prevent complications. Effective treatment of croup requires a comprehensive approach that includes the integration of systemic and inhaled corticosteroids along with epinephrine for immediate relief of symptoms. Scientific studies point to the need for continuous improvement of clinical protocols in order to optimize the treatment of this serious medical problem related to croup. No conflict of interests was declared by the authors.