Acute laryngotraheobronchitis in young children
Last reviewed: 23.04.2024
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Acute laryngotraheobronchitis in young children (1-2 years) is one of the most serious diseases complicating influenza infection, often despite all the measures taken, resulting in death. In older children, this disease occurs less frequently. Acute laryngotraheobronchitis can occur sporadically, but it is especially frequent during epidemics of influenza. As the etiologic factor, a group of myxovirus parainfluenza in association with a coccal infection is most often advocated. The most severe is acute laryngotraheobronchitis caused by hemolytic streptococcus.
[Pathological anatomy
The mucous membrane of the respiratory tract is hyperemic, bright red in color, covered with copious, excruciate exudate, at the onset of the disease with a liquid, then thickening and forming pseudomembranous fibrinous films, fused to the underlying tissue. In other cases, with green streptococcus and staphylococcus, yellowish-green crusts are formed that fill the airways and cause the phenomena of their obstruction. These pathoanatomical changes often lead to more or less common pulmonary edema and atelectasis.
Symptoms and clinical course of acute laryngotraheobronchitis in children
The disease debuts with an increase in body temperature to 38-39 ° C, accompanied by chills and signs of severe endogenous intoxication. At the same time, a breathing disorder progresses. These phenomena are manifested by an earthy complexion, rapid breathing, widening of the wings of the nose in time to the respiratory movements of the chest. Respiratory noises, heard above, on and under the sternum testify that the stenosis covers both the larynx and the underlying airways. The main cause of airway obstruction is profuse exudation and difficulty in expe- riation (exhalation), which contributes to the accumulation of pathological contents in the lumen of the larynx, trachea and bronchi and its inability to cough and expectorate. With laryngotracheal surgery, the tube of the laryngoscope "sinks" in abundant mucopurulent discharge, and its end is covered with purulent crusts, making it difficult to examine. The stage of initial excitation is quickly replaced by a state of prostration, and the child often dies between 24 and 48 hours from the onset of the disease. The cause of death is bronchopneumonia, hypoxia and toxic myocarditis.
The diagnosis is made on the basis of acute onset, rapidly growing apnea, hypoxia, signs of cardiac dysfunction, severe general condition.
Differentiation of acute laryngotraheobronchitis follows from liningitis, diphtheria, banal bronchopneumonia, asthmatic state and especially from radiopaque foreign bodies of plant origin, which are often complicated by acute tracheobronchitis.
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Treatment of acute laryngotraheobronchitis in children
Treatment of acute laryngotraheobronchitis in children is performed in a specialized pediatric department and in the intensive care unit. From the very beginning, based on the clinical picture described above, massive doses of broad-spectrum antibiotics are prescribed with transitions after receiving an antibiotic image for "targeted" application of the corresponding antibiotic drugs. Treatment with antibiotics is complemented by the administration of elevated doses of corticosteroids in injections and per os. Assign also aerosol inhalation mucolytic agents in a mixture with hydrocortisone and antibiotics under the "cover" of inhaling oxygen or carbogen. At the same time, they use drugs that normalize the cardiac and respiratory activity, as well as antihistamines, decongestants and other drugs aimed at combating toxicosis. In connection with these, the principles of intensive and detoxification therapy are used.
Intensive therapy is a type of specialized treatment for patients and victims who, due to a serious illness, trauma, surgical intervention or intoxication, develop or may develop "life-threatening functional or metabolic disorders of the cardiovascular system, respiratory, excretory and other body systems. One of the tasks of caring for patients with intensive care is the prevention of complications that can develop in a seriously ill patient due to a fixed position (bedsores, hypostasis), the inability to eat, defecate and urinate, the presence of fistula, etc. Intensive therapy includes intensive observation and use according to the indications of a complex of medical measures. Intensive monitoring consists in constant monitoring of the patient's consciousness, the most important hemodynamic parameters, the number of breaths, the rate of intravenous infusions, the observance of the order of medical prescriptions, and other processes important for intensive care. Intensive observation is more effective when using monitors that provide automatic visual and signal-acoustic recording of the patient's vital activity parameters. Actually therapeutic intensive care measures include intravenous infusion, including puncture catheterization of veins, for example subclavian, prolonged ventilation, methods of restoring and maintaining airway patency (intubation of the trachea), oxygen therapy, barotherapy.
HBO, oxygen therapy, peritoneal in extracorporeal dialysis, the use of artifical kidney, hemosorption, means of pacing, the introduction of various drugs, parenteral nutrition. In the process of realization of intensive observation, there may be a need to revitalize the organism when a sudden death of a clinical death characterized by a reversible phase of dying occurs, in spite of the absence of blood circulation in the body and the cessation of oxygen supply to its tissues, the viability of all tissues and organs remains for a certain time, primarily the brain and its cortex. Thanks to this, it is possible to restore the vital functions of the body through resuscitation and subsequent intensive therapy. The duration of clinical death in a person depends on the cause of the development of the terminal state, duration of dying, age, etc. Under normal temperature conditions, clinical death lasts 3-5 minutes, after which it is impossible to restore normal CNS activity.
Detoxication therapy - therapeutic measures aimed at stopping or reducing the effect of toxic substances on the body. The scope and methods of detoxification therapy are determined by the causes, severity and duration of intoxication. In exogenous intoxications, detoxification therapy depends on the path of entry into the body, the nature of the action and the physico-chemical properties of the toxin, as well as the rate of its neutralization in the body and isolation from it. With endogenous intoxications characteristic of all infectious diseases, as well as accumulation of toxic substances (catabolites) in the body with hepatic or renal failure, detoxification therapy is necessary as an adjunct to the treatment of the underlying disease. Reduction of the concentration of toxins in the blood is achieved by the introduction of a large amount of liquid (1.5 liters and more) in the form of drinking, intravenous infusion of isotonic sodium chloride solution, 5% glucose solution. Simultaneously, high-speed diuretics are injected (Lasix 80-100 mg intravenously). To prevent loss of urine of potassium ions and other obligatory metabolic processes in the body and the functioning of vital organs of substances after administration of diuretics, it is necessary to introduce a solution of electrolytes (lactasol, 400-500 ml). An essential antitoxic property is haemodesis, reopolyglucin, administered intravenously. Effective oral administration of enterodesis (1 teaspoon per 100 ml of water 3-4 times a day). For detoxication, the exchange blood transfusion is also used and the method of dialysis is the removal of low molecular weight and medium molecular toxic compounds by their diffusion through special membranes.
In some cases, to prevent asphyxia, a tracheostomy is applied to the child, which is used in the following days to introduce various medications (mucolytic and fibrinolytic agents, hydrocortisone, antibiotic solutions) through the tracheotomy tube. Before the tracheotomy, it is advisable to perform bronchoscopy for sucking the pathological contents from the trachea and bronchi and introducing appropriate medications into the lower respiratory tract, after which the lower tracheotomy is produced in more or less tranquil conditions. Decanulation of the patient is carried out some time after the normalization of breathing and the disappearance of inflammatory phenomena in the entire respiratory system. In complex treatment, the use of immunoprotectors should not be overlooked, since acute laryngotraheronkitis usually occurs in weakened children, often with signs of congenital immunodeficiency.
Prognosis for acute laryngotraheal bronchitis in children
The prognosis even in the conditions of application of the most modern methods of treatment remains extremely serious, since children most often ill with these diseases at the age of 1-2 years do not possess the acquired immunity, but have only innate immunity, the tension of which is insufficient to withstand such a terrible disease, what is acute laryngotraheronhitis. According to the famous French pediatrician and otorhinolaryngologist J. Lemarie, the prognosis is heavily weighted as a result of complications that occur with urgent interventions performed with asphyxia, as well as due to secondary complications from the lungs and Rubtsov stenoses of the larynx. According to the author's statistics, mortality in this disease reaches 50% in children under 2 years old.