Krup Sendromları
Özet
Krup, altı aylıktan üç yaşına kadar olan çocukların %3’ünü etkileyen yaygın bir solunum yolu hastalığıdır. Beş yaşından küçük çocuklarda ateş ve/veya akut solunum yolu hastalığı nedeniyle her yıl hastaneye yatışların %7’sini oluşturur. Krup, larinks, trakea ve bronşların şişmesinden kaynaklanan üst solunum yolu tıkanıklığının bir belirtisidir. Geceleri aniden başlayan havlar tarzda öksürük, inspiratuar stridor, ses kısıklığı ve üst solunum yolu obstrüksiyonuna bağlı solunum sıkıntısı ile karakterizedir. Birçok hastada düşük dereceli ateş görülür, ancak tanı için ateş gerekli değildir. Daha az yaygın olarak, stridor akut epiglottit, bakteriyel trakeit ve yabancı cisim hava yolu tıkanıklığı ile ilişkili olabilir ve bu durumlardan ayırt edilmelidir. En sık olarak parainfluenza virüsler etkendir. Krup tanısı için laboratuvar çalışmalarına nadiren ihtiyaç duyulur. Viral kültürler ve hızlı antijen testlerinin yönetim üzerinde minimal etkisi vardır ve rutin olarak önerilmez. Radyografi ve laringoskopi, alternatif tanılardan şüphelenilen hastalar için düşünülmelidir. Randomize kontrollü çalışmalar, tek doz oral, intramüsküler veya intravenöz deksametazonun semptomları iyileştirdiğini ve herhangi bir şiddette krupu olan çocuklarda hastaneye yeniden başvuruyu ve hastanede kalış süresini azalttığını göstermiştir. Orta ila şiddetli krup hastalarında, nebülize epinefrin tedavisi semptomları iyileştirir ve hastanede kalış süresini azaltır. Semptomlar genellikle 48 saat içinde düzelir, ancak ciddi üst solunum yolu tıkanıklığı nadiren solunum yetmezliğine ve arreste yol açabilir.
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