tailieunhanh - Evidence based pediatrics - part 5

Bình thường (bao gồm cả giấc ngủ) bị mất phương hướng xanh tím tím tái Không tím tái, cổ động tại Không tím còn lại Khi kích động Tại Air nhập còn lại bình thường Giảm rõ rệt giảm Retractions 0 Không nhẹ vừa phải nặng | 180 Evidence-Based Pediatrics Table 9-1 Westley Croup Score Level of consciousness Normal including sleep 0 Disoriented 5 Cyanosis None 0 Cyanosis with agitation 4 Cyanosis at rest 5 Stridor None 0 When agitated 1 At rest 2 Air entry Normal 0 Decreased 1 Markedly decreased 2 Retractions None 0 Mild 1 Moderate 2 Severe 3 widely used and more recently oral dexamethasone or inhaled budesonide have become treatment options. Humidification The presumed beneficial effects of mist therapy are mediated through the reduction of inflammation caused by mucosal drying and the reduction of the viscosity of airway Steam kettle and steam bath treatments have long been recommended for outpatients with croup. However reports of children presenting with scalds30 have led most advocates of humidity treatment to recommend cool mist therapy. Mist tents may be upsetting to infants make it difficult for the health-care providers to see the child require separation of mother and child and incur some equipment expenditure. High humidity can be delivered by mist sticks simple tubing held to the child s face which may be less distressing. Sasaki and colleagues reported improved airflow in kittens with partial airway obstruction when they breathed increased In children however only one study32 has compared high humidity with room air in a controlled trial. Unfortunately the sample size was inadequate n 9 the method of randomization unclear and the outcome measured by unblinded observers. This study did not demonstrate any benefit to mist therapy. Clearly at present there is poor evidence to include or exclude the use of mist therapy in the treatment of croup and decisions to use this treatment should be based on other grounds. Inhaled Epinephrine Only one RCT has failed to demonstrate improved croup scores among children with croup who are treated with inhaled epinephrine. This study showed a trend toward improvement but lacked a sufficient sample size to draw .