Синдром крупа у детей: предрассудки и доказательная медицина


DOI: https://dx.doi.org/10.18565/pharmateca.2018.1.15-22

А.С. Полякова (1, 2), М.Д. Бакрадзе (1, 2), В.К. Таточенко (1)

1) ФГАУ «Национальный научно-практический центр здоровья детей» Минздрава РФ, Москва, Россия; 2) ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
Среди острых респираторных заболеваний важную роль в детской популяции играют состояния, сопровождающиеся обструкцией верхних дыхательных путей. Из них бóльшая часть приходится на синдром крупа, который представляет собой отек слизистой оболочки подскладочного пространства гортани, сопровождающийся характерной клинической симптоматикой: инспираторный стридор, осиплость, грубый «лающий» кашель. Выделяется вирусный и спастический (рецидивирующий) круп – патогенетически разные состояния с одинаковой симптоматикой. Препаратом выбора для купирования острого стеноза гортани являются глюкокортикостероиды – оральные, парентеральные или ингаляционные. В статье описаны возможные состояния, проявляющиеся рецидивами крупа, а также основные препараты, часто применяющиеся, но неэффективные при стенозе гортани.
Ключевые слова: круп у детей, стеноз гортани, ларинготрахеит, глюкокортикостероиды, адреналин

Литература


1. Pawelczyk M., Kowalski M.L. The Role of Human Parainfluenza Virus Infections in the Immunopathology of the Respiratory Tract. Curr. Allergy Asthma Rep. 2017;17(3):16.

2. Pfleger A., Eber E. Management of acute severe upper airway obstruction in children. Pediatr. Respir. Rev. 2013;14(2):70–7.

3. Куличенко Т.В., Байбарина Е.Н., Баранов А.А., Намазова-Баранова Л.С., Пискунова С.Г., Беседина Е.А., Садовщикова А.Н., Юлдашев О.Р., Мухортова С.А., Артемова И.В., Черников В.В., Харькин А.В., Чистякова Е.Г., Вологдина Е.Л., Капутская Т.Н., Кирипова Р.Ф. Оценка качества стационарной помощи детям в регионах Российской Федерации. Вест. Рос. академии мед. наук. 2016;71(3):214–23.

4. Lee M.N., Kang K.A., Park S.J., Kim S.J. Effects of pre-education combined with a simulation for caring for children with croup on senior nursing students. Nurs. Health Sci. 2017 Apr 24.

5. Cherry J.D. Clinical practice: croup. N. Engl. J. Med. 2008;358:384–91.

6. Cutrera R., Baraldi E., Indinnimeo L., Miraglia Del Giudice M.,Piacentini G., Scaglione F., Ullmann N., Moschino L., Galdo F., Duse M. Management of acute respiratory diseases in the pediatric population: the role of oral corticosteroids. Ital. J. Pediatr. 2017;43(1):31.

7. Toward Optimized Practice (TOP) Working Group for Croup. Guideline for the diagnosis and management of croup. Alberta, Canada: Edmonton (AB);2003, 1–17 (revised 2008).

8. Bjornson C.L., Johnson D.W. Croup in children. CMAJ. 2013;185(15):1317–23.

9. Tran D.N., Trinh Q.D., Pham N.T., Vu M.P., Ha M.T., Nguyen T.Q., Okitsu S., Hayakawa S., Mizuguchi M., Ushijima H. Clinical and epidemiological characteristics of acute respiratory virus infections in Vietnamese children. Epidemiol. Infect. 2016;144(3):527–36.

10. Abedi G.R., Prill M.M., Langley G.E., Wikswo M.E., Weinberg G.A., Curns A.T., Schneider E. Estimates of Parainfluenza Virus-Associated Hospitalizations and Cost Among Children Aged Less Than 5 Years in the United States, 1998–2010. J. Pediatric Infect. Dis Soc. 2016;5(1):7–13.

11. Branche A.R., Falsey A.R. Parainfluenza Virus Infection. Semin. Respir. Crit. Care Med. 2016;37(4):538–54.

12. Johnson D.W. Croup. BMJ. Clin. Evid. 2014;2014:pii: 0321.

13. Miller E.K., Gebretsadik T., Carroll K.N., Dupont W.D., Mohamed Y.A., Morin L.L., Heil L., Minton P.A., Woodward K., Liu Z., Hartert T.V., Williams J.V. Viral etiologies of infant bronchiolitis, croup and upper respiratory illness during 4 consecutive years. Pediatr. Infect. Dis. J. 2013;32:950–55.

14. Бакрадзе М.Д. Новые лечебно-диагностические и организационные технологии ведения детей с острыми лихорадочными заболеваниями. Дисс. докт. мед. наук. М., 2009.

15. Lee D.R., Lee C.H., Won Y.K., Suh D.I., Roh E.J., Lee M.H., Chung E.H. Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in Korea. Korean J. Pediatr. 2015;58(10):380–85.

16. Rosychuk R.J., Klassen T.P., Metes D., Voaklander D.C., Senthilselvan A., Rowe B.H. Croup presentations to emergency departments in Alberta, Canada: a large population-based study. Pediatr. Pulmonol. 2010;45(1):83–91.

17. Gelbart B., Parsons S., Sarpal A., Ninova P., Butt W. Intensive care management of children intubated for croup: a retrospective analysis. Anaesth. Intensive Care. 2016;44(2):245–50.

18. Narayanan S., Funkhouser E. Inpatient hospitalizations for croup. Hosp. Pediatr. 2014;4(2):88–92.

19. Darras K.E., Roston A.T., Yewchuk L.K. Imaging Acute Airway Obstruction in Infants and Children. Radiographics. 2015;35(7):2064–79.

20. Tyler A., McLeod L., Beaty B., Juarez-Colunga E., Birkholz M., Hyman D., Kempe A., Todd J., Dempsey A.F. Variation in Inpatient Croup Management and Outcomes. Pediatrics. 2017:pii: e20163582.

21. Mandal A., Kabra S.K., Lodha R. Upper Airway Obstruction in Children. Indian J. Pediatr. 2015;82(8):737–44.

22. Ibrahimov M., Yollu U., Akil F., Aydin F., Yener M. Laryngeal foreign body mimicking croup. J. Craniofac. Surg. 2013;24(1):e7–8.

23. Nasirmohtaram S., Shabani N. Esophageal Foreign Body: A Case Report of a Refractory Croup in a 20-Month-Old Boy. J. Otorhinolaryngol. 2016;28(89):435–37.

24. Greifer M., Santiago M.T., Tsirilakis K., Cheng J.C., Smith L.P. Pediatric patients with chronic cough and recurrent croup: the case for a multidisciplinary approach. Int. J. Pediatr. Otorhinolaryngol. 2015;79(5):749–52.

25. Joshi V., Malik V., Mirza O., Kumar B.N. Fifteen-minute consultation: structured approach to management of a child with recurrent croup. Arch. Dis. Child. Educ. Pract. Ed. 2014;99(3):90–3.

26. Wall S.R., Wat D., Spiller O.B., Gelder C.M., Kotecha S., Doull I.J. The viral aetiology of croup and recurrent croup. Arch. Dis. Child. 2009;94(5):359–60.

27. Duval M., Tarasidis G., Grimmer J.F., Muntz H.R., Park A.H., Smith M., Asfour F., Meier J. Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study. Clin. Otolaryngol. 2015;40(3):227–33.

28. Hiebert J.C., Zhao Y.D., Willis E.B. Bronchoscopy findings in recurrent croup: A systematic review and meta-analysis. Int. J. Pediatr. Otorhinolaryngol. 2016;90:86–90.

29. Delany D.R., Johnston D.R. Role of direct laryngoscopy and bronchoscopy in recurrent croup. Otolaryngol. Head Neck Surg. 2015;152(1):159–64.

30. Rankin I., Wang S.M., Waters A., Clement W.A., Kubba H. The management of recurrent croup in children. J. Laryngol. Otol. 2013;127(5):494–500.

31. Hodnett B.L., Simons J.P., Riera K.M., Mehta D.K., Maguire R.C. Objective endoscopic findings in patients with recurrent croup: 10-year retrospective analysis. Int. J. Pediatr. Otorhinolaryngol. 2015;79(12):2343–47.

32. Westley C.R., Cotton E.K., Brooks J.G. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am. J. Dis. Child. 1978;132(5):484–87.

33. Eghbali A., Sabbagh A., Bagheri B., Taherahmadi H., Kahbazi M. Iran. Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study. Fundam. Clin. Pharmacol. 2016;30(1):70–5.

34. Pitluk J.D., Uman H., Safranek S. Clinical inquiries. What’s best for croup? J. Fam. Pract. 2011;60(11):680–81.

35. Moore M., Little P. Humidified air inhalation for treating croup: a systematic review and meta-analysis. Fam. Pract. 2007;24:295–301.

36. Scolnik D., Coates A.L., Stephens D., Da Silva Z., avine E., Schuh S. Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. JAMA. 2006;295(11):1274–80.

37. Бакрадзе М.Д., Дарманян А.С., Таточенко В.К.. Рациональная терапия крупа у детей. Вопр. современ. педиатрии. 2007;6(5):32–6.

38. Moraa I., Sturman N., McGuire T., van Driel M.L., Editorial group: Cochrane acute respiratory infections group published online: 2013 Dec 7: Assessed as up-to-date: 2013 Nov 12.

39. D’Angelo A.F., McGillivray D., Kramer M. Will my baby stop breathing? A study of parental concerns and family impact in mild croup. Pediatr. Res. 2001;49:83A.

40. Moraa I., Sturman N., McGuire T., van Driel M.L. Heliox for croup in children. Cochrane Database Syst. Rev. 2013;(12):CD006822.

41. Gupta V.K., Cheifetz I.M. Heliox administration in the pediatric intensive care unit: an evidence-based review. Pediatr. Crit. Care Med. 2005;6:204–11.

42. Russell K.F., Liang Y., O’Gorman K., Johnson D.W., Klassen T.P. Glucocorticoids for croup. Cochrane Database Syst. Rev. 2011;(1):CD001955.

43. Bjornson C.L., Klassen T.P., Williamson J., Brant R., Mitton C.., Plint A., Bulloch B., Evered L., Johnson D.W. A randomized trial of a single dose of oral dexamethasone for mild croup. N. Engl. J. Med. 2004;351:1306–13.

44. Sasidaran K., Bansal A., Singhi S. Acute upper airway obstruction. Indian. J. Pediatr. 2011;78(10):1256–61.

45. Garbutt J.M., Conlon B., Sterkel R., Baty J., Schechtman K.B., Mandrell K., Leege E., Gentry S., Stunk R.C. The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial. Clin. Pediatr. (Phila). 2013;52(11):1014–21.

46. Bjornson C., Russell K., Vandermeer B., Klassen T.P., Johnson D.W. Nebulized epinephrine for croup in children. Cochrane Database Syst. Rev. 2013;10:CD006619.

47. Kilic A., Unuvar E., Sutgu M., Suleyman A., Tamay Z., Yildiz I., Oguz F., Sidal M., Guler N. Acute obstructive respiratory tract diseases in a pediatric emergency unit: evidence-based evaluation. Pediatr. Emerg. Care. 2012;28(12):1321–27.

48. Dobrovoljac M., Geelhoed G.C. How fast does oral dexamethasone work in mild to moderately severe croup? A randomized doubleblinded clinical trial. Emerg. Med. Australas. 2012;24:79–85.

49. Thompson M., Vodicka T.A., Blair P.S., Buckley D.I., Heneghan C., Hay A.D. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ. 2013;347:f7027.

50. Fifoot A.A., Ting J.Y. Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized, double-blinded clinical trial. Emerg. Med. Australas. 2007;19:51–8.

51. Chub-Uppakarn S., Sangsupawanich P. A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup. Int. J. Pediatr. Otorhinolaryngol. 2007;71:473–77.

52. Klassen T.P., et al. Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial. JAMA. 1998;279:1629–32.

53. Duggan D.E., et al. Bioavailability of oral dexamethasone. Clin. Pharmacol. Ther. 1975;18:205–9.

54. Petrocheilou A., Tanou K., Kalampouka E., Malakasioti G., Giannios C., Kaditis A.G. Viral croup: diagnosis and a treatment algorithm. Pediatr. Pulmonol. 2014;49(5):421–29.

55. Fernandes R.M., Oleszczuk M., Woods C.R., Rowe B.H., Cates C.J., Hartling L. The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: an overview of reviews. Evid. Based Child. Health. 2014;9(3):733–47.

56. Butte M.J., et al. Pediatric myocardial infarction after racemic epinephrine administration. Pediatrics. 1999;104:e9.

57. Reena K.A., Singh S.K., Agrawal V. Unsuspected subglottic web in a child managed for severe respiratory obstruction. Saudi J. Anaesth. 2017;11(1):99–101.

58. Siegel B., Thottam P., Mehta D. The role of larygotracheal reconstruction in the management of recurrent croup in patients with subglottic stenosis. Int. J. Pediatr. Otorhinolaryngol. 2016;82:78–80.

59. Munson P.D. Recurrent croup and persistent laryngomalacia: Clinical resolution after supraglottoplasty. Int. J. Pediatr. Otorhinolaryngol. 2016;84:94–6.


Об авторах / Для корреспонденции


Автор для связи: А.С. Полякова – к.м.н., врач-педиатр отделения диагностики и восстановительного лечения ФГАУ ННПЦЗД Минздрава России, ассистент кафедры факультетской педиатрии № 1 ФГБОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России, Москва, Россия; тел. 8 (495) 967-14-21, e-mail: darmanyan@nczd.ru


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