In most cases, acute stenosing laryngotracheitis in children develops between the ages of 2 and 7 years. An infectious and inflammatory disease is characterized by damage to several parts of the upper respiratory tract at once. Edema of the vocal cords, spasm of the pharyngeal muscles and hypersecretion of mucus lead to the development of stenosis and, accordingly, respiratory failure.
Untimely provision of prehospital care to a patient can cause an acute violation of the patency of the respiratory tract in the larynx region and the development of acute asphyxia.
Features of the disease
Acute stenosing laryngotracheitis (OSLT) is a dangerous infectious disease that develops in 97% of cases against the background of ARVI, influenza, chronic tonsillitis, laryngitis, bronchitis, etc. With the development of the disease, the mucous membranes of the trachea and larynx are affected, which leads to severe tissue edema. It is these parts of the respiratory tract that are responsible for transporting air from the nasal and oral cavity to the lungs. In addition, the larynx and trachea produce a special secret that prevents the mucous membranes from drying out.
If a small child falls ill, the tissues of the airways become inflamed and the blood vessels dilate greatly, which leads to an increase in the permeability of their walls. Over time, this leads to the accumulation of intercellular fluid in the mucous membranes of the trachea and pharynx, as a result of which the lumen in the airways is greatly narrowed.
In childhood, laryngotracheitis can cause the so-called false croup. Inflammation of the larynx leads to obstruction of the respiratory tract and impaired ventilation. In the event of laryngospasm, parents should act in concert until the arrival of the ambulance team. Otherwise, spasm of the pharyngeal muscles and stenosis of the larynx can lead to asphyxia and hypoxic coma.
Patients under the age of 7 are at risk for the development of ASLT, and the disease is 3 times more likely to be diagnosed in boys.
How does croup syndrome manifest?
The first clinical manifestations of stenosing laryngotracheitis are identical to those of the common cold. Children complain of nasal congestion, runny nose, fever, lethargy, and intermittent coughing. If the problem is ignored and there is no treatment, after 2-3 days, specific signs are added to the above symptoms, indicating the development of false croup:
- hoarseness and nasalness of the voice;
- dry barking cough;
- inspiratory dyspnea;
- whistling when exhaling and inhaling;
- nervous overexcitement.
As a rule, laryngospasm occurs in children in the evening before bedtime. The child becomes whiny and restless, breathing heavily, tossing and turning and coughing often.
Against the background of a lack of oxygen in the body, the skin becomes very pale, cyanosis (blue discoloration) of the lips occurs. Rapid shallow breathing is a good reason for calling the ambulance team home.
First aid
Laryngeal stenosis is the main cause of seizures in a young child. Regardless of the stage of development of the disease, when the first symptoms of false croup appear, you need to call a doctor at home. Only he will be able to adequately assess the patient's condition and prescribe treatment on an outpatient or inpatient basis. How to help a child before an ambulance arrives?
Parents are not always able to timely identify the symptoms of stenosing laryngotracheitis and consult a specialist. If an attack occurs, the patient should be provided with competent prehospital assistance. In an extreme situation, parents should remain absolutely calm so as not to scare the child and aggravate his condition.
What's the first thing to do? In the event of laryngospasm, you need to act according to a clear algorithm:
- provide bed rest;
- ventilate the room;
- use the means of distraction therapy;
- give antipyretic drugs;
- drip vasoconstrictor drops into the nose;
- provide an abundant drink.
Important! With a spastic cough, mucolytics should not be given to children, as they stimulate the production of mucus, which the child will not be able to cough up due to stenosis of the larynx.
In most cases, stenosing laryngotracheitis in children is fairly easy to treat. However, the first attack of a suffocating cough can greatly scare not only the child, but also his parents. Therefore, before the arrival of the ambulance, you must clearly follow the instructions and correctly perform all the necessary manipulations.
Help in the first minutes
In the first minutes after the onset of an attack, it is undesirable to force the child to perform any procedures. Physical activity will only worsen the child's well-being and make breathing difficult. How to act in such a situation? First of all, you need to lay the child and put a blanket or several pillows under his back.
To prevent the child from panic due to lack of oxygen, try to calm him down. Fear only intensifies the spasm of the muscles of the larynx, stimulates increased breathing and thereby prolongs the attack.
Explain to your child that at rest, the shortness of breath will go away quickly and that his breathing will return to normal.
A barking cough appears due to dryness and irritation of the mucous membrane. Provide fresh air to reduce symptoms. If signs of false croup increase, open windows, doors and humidify the air. If a special humidifier is not available, spray the room with saline or mineral water. It is desirable that the air temperature in the room does not exceed 20 degrees.
Distraction therapy
Means of distracting therapy can reduce the swelling of the laryngeal mucosa and thereby restore normal airway patency. Foot baths promote the expansion of blood vessels in the limbs and the outflow of intercellular fluid from the respiratory system. Gradually, the temperature of the water in the basin should be increased by adding hot water from the kettle to it.
The child should not breathe hot steam, as this will stimulate the secretion of phlegm, which he will not be able to cough up effectively.
Inhalation with an ultrasonic nebulizer allows minimizing the manifestations of stenosing (sub-lining) laryngotracheitis. It is recommended to use corticosteroids "Budenite Steri-Neb" or "Pulmicort" as a decongestant drug. Inhalation is performed for 10-15 minutes several times a day. If you do not have a nebulizer, you can take the child to the bathroom and open the tap with warm water. The steam-saturated air will prevent irritation of the laryngopharyngeal mucosa and help eliminate barking coughs.
If laryngotracheitis was triggered by a viral infection, a semi-alcohol compress can be placed on the chest to eliminate the attack. Warming procedures help to relax smooth muscles, in particular the muscles of the larynx. However, it should be borne in mind that with subfebrile or febrile fever, thermotherapy cannot be used, since this will only aggravate the patient's well-being.
Antipyretic drugs
The high temperature stimulates sweating and dehydration of the mucous membranes.In addition, subfebrile condition provokes increased breathing, which leads to drying of the mucous ENT organs and exacerbation of respiratory failure. If the body temperature exceeds 38-38.5 degrees, it is recommended to use antipyretic drugs.
In pediatric practice, “Nurofen for Children”, “Ibuprofen”, “Paracetamol”, “Vibrukol” are used to lower the temperature. If the barking cough does not stop, it is advisable to use antipyretics in the form of rectal suppositories. The safest drugs include Panadol, Efferalgan and Tsefekon.
If a child develops febrile seizures, an ambulance should be called immediately. It should be remembered that any antipyretic drugs that contain acetylsalicylic acid should not be given to children under 12 years of age. Failure to comply with this rule can lead to the development of Reye's syndrome, in which the patient develops cerebral edema and liver failure.
Vasoconstrictor drops
Stenosing laryngotracheitis very often develops against the background of viral, bacterial or allergic rhinitis. To facilitate nasal breathing in a child, it is recommended to use vasoconstrictor drugs. They will reduce the permeability of the blood vessels and thereby eliminate the swelling in the airways.
As a vasoconstrictor, you can use:
- Tizin Xylo;
Otrivin Baby;- "Nazivin";
- "Advance spray";
- Adrianol.
Otrivin Baby;Important! It is undesirable to instill vasoconstrictor drops in the nose with severe tachycardia and atrophic rhinitis.
After eliminating the symptoms of false croup, you need to seek help from a specialist. It should be understood that without adequate treatment, the symptoms of the disease will only worsen, which can cause acute respiratory failure and hypoxic coma.
Alternative therapy
The main task of emergency care is to reduce swelling of the mucous membranes and restore normal patency of the respiratory tract. In many ways, the principles of providing first aid depend on the stage of laryngeal stenosis. It should be noted that with stenosis at stages 3 and 4 of development, treatment is carried out only in stationary conditions with the use of oxygen therapy.
Emergency prehospital care, taking into account the stage of development of laryngeal stenosis:
| Laryngeal stenosis stage | Clinical manifestations | The drugs used |
|---|---|---|
| 1 (compensated stenosis) |
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| 2 (subcompensated stenosis) |
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| 3 (decompensated stenosis) |
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| 4 (terminal stenosis) |
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In the absence of effect from the use of drugs, tracheal intubation may be required. During the transportation of the child to the intensive care unit, doctors carry out infusion therapy, which involves the intravenous administration of medicinal solutions that support the patient's vital functions.
Emergency hospital care
Within the walls of the hospital, the specialists continue the emergency therapy begun in the ambulance car. To restore the patency of the respiratory tract, the airways are sanitized using an electric suction. Subsequent inhalations with alkaline solutions stimulate the liquefaction and removal of mucus from the pharynx and trachea, thereby facilitating the child's breathing.
Oxygen therapy helps prevent irreversible processes in the brain that can occur due to lack of oxygen. To do this, a special catheter is inserted into the child's nasal cavity, through which humidified and oxygen-enriched air is supplied. After eliminating the symptoms of acute respiratory failure, the patient is prescribed adequate drug treatment of the underlying disease that provoked the development of stenosing laryngotracheitis.
