Acute laryngotracheobronchitis in children

　　1. Etiology

　　The common pathogens are viruses (mainly parainfluenza virus, adenovirus, followed by respiratory syncytial virus). However, secondary bacterial infection is easy to occur, with Haemophilus influenzae being the main pathogen, other pathogens include hemolytic streptococcus, pneumococcus, and Staphylococcus aureus, etc. Additionally, children with acute infectious diseases such as measles, influenza, scarlet fever, are also prone to this disease. Due to the narrow airways in infants and young children, severe respiratory distress is more likely to occur when there is airway inflammation.

　　2. Pathogenesis

　　Due to the weak resistance and poor coughing function of children aged 2 to 5, and the dry and cold air in winter, which is unfavorable for the movement of the respiratory tract mucus cilia system and alveolar gas exchange, secretions tend to become thick and scab, blocking the airways. In severe cases, the affected mucosa may erode, form ulcers, and fall off, further obstructing the airways and causing severe difficulty in breathing.

　　The most common is the extension of infection to other parts of the respiratory tract, such as the middle ear, terminal bronchioles, or lung parenchyma. Additionally, mediastinal emphysema and pneumothorax are common complications of tracheotomy. Air bubble rupture allows air to enter the mediastinum along the perivascular sheath surrounding the lung blood vessels, often triggered by factors such as holding the breath after inhalation and severe coughing, seen in diseases such as bronchial asthma, bronchiolitis, and whooping cough. Air bubble rupture can also cause spontaneous pneumothorax, leading to mediastinal emphysema.

　　First, medical history

　　Children are mostly 2-5 years old and often have previous infections such as viral upper respiratory tract infection, measles, influenza, scarlet fever, etc., with a prodromal period of 1-2 days.

　　Second, clinical manifestations

　　1. Symptoms

　　The onset is acute, with initial symptoms such as irritating cough and inspiratory stridor, followed by barking cough, hoarseness, and difficulty breathing. The characteristics of the symptoms are that they worsen at night. When the infection spreads downward along the bronchi and bronchioles, it can exacerbate respiratory difficulty and make expiration more laborious, and the time extends. At this point, both inspiration and expiration are difficult, and the condition becomes more severe. Most children have moderate to high fever and systemic toxic symptoms, and inspiratory respiratory difficulty occurs during rest or sleep. During activity or crying, both inspiration and expiration are difficult, and the condition further progresses. High fever, severe cyanosis, restlessness, and struggle may occur, with rapid breathing and heart rate, and the complexion changes from cyanosis to a pale gray, leading to collapse and coma. If not treated in time, death may occur due to hypoxia and systemic failure.

　　2. Signs

　　The three凹陷 signs are obvious, and respiratory sounds such as wheezing or tracheal tapping sounds can be heard, with partial or complete reduction in respiratory sounds in both lungs, interspersed with dry and wet rales. Chest X-ray examination shows bronchitis, atelectasis, or emphysema. There are symptoms of upper respiratory tract infection at the beginning, and dry cough and inspiratory stridor appear a few days later, followed by barking cough, hoarseness, sticky sputum that is difficult to cough up, inspiratory respiratory difficulty, and cyanosis.

　　Traditional treatment focuses on improving the body's physical quality and the function of internal organs, enhancing the body's disease resistance and restoring the function of the organs, so as to effectively prevent recurrence and keep away from diseases. Bronchitis is a common and frequently occurring disease, mainly characterized by cough, sputum, and asthma. Therefore, the main treatment measures include two major aspects: 1. Vaccination: Using tracheitis vaccine, generally starting before the onset season, with a weekly subcutaneous injection, starting with a dose of 0.1ml, increasing by 0.1-0.2ml each time, until 0.5-1.0ml as the maintenance dose. It should be continued for 1-2 years if effective. Nucleic acid injection (measles virus vaccine culture fluid) is injected intramuscularly or subcutaneously twice a week, with a dose of 2-4ml each time.

　　1. X-ray examination

　　It can be seen that there are signs of bronchitis, emphysema, atelectasis, and other conditions.

　　2. Bronchoscopy

　　It can be seen that the mucous membranes of the larynx, trachea, and bronchi are highly inflamed, the glottis and subglottis are narrowed, and there is thick sputum or pus crust blocking the trachea and bronchi.

　　1. Drink more vegetable and fruit juices

　　It can not only relieve cough and phlegm, but also supplement vitamins and minerals, which is very beneficial for the recovery from diseases.

　　Eat more green vegetables

　　Each meal can include more vegetables and soy products in moderation, such as white radish, carrots, and green leafy vegetables, which are light and easy to digest.

　　3. Eat more asthma-relieving foods

　　Eat more cough-suppressing, asthma-relieving, expectorant, lung-warming, and spleen-strengthening foods, such as white fungus, loquat, pomelo, pumpkin, yam, chestnut, lily, kelp, and seaweed, etc.

　　I. Treatment

　　The main principle is to maintain an unobstructed airway, control infection, maintain water and electrolyte balance, and prevent serious complications.

　　1. Maintain an unobstructed airway

　　Humidifying the airway facilitates the excretion of secretions. Provide oxygen in a timely manner, give nebulized inhalation to thin the sputum, and then promptly remove it. Observe the changes in the condition closely, and pay special attention to the symptoms of airway obstruction, among which monitoring the respiratory rate and abnormal activity of accessory respiratory muscles is a basic measure.

　　2. Antibiotic use

　　Antibiotics are ineffective for viral infections, but due to the rapid progression of the disease, most severe cases are complicated with bacterial infections. Antibiotics can generally be given, including penicillins, erythromycins, aminoglycosides, or cephalosporins. After the results of bacterial culture and drug sensitivity testing are obtained, sensitive drugs can be selected for treatment.

　　3. The use of hormones

　　There is still controversy. Opponents believe that it is detrimental to the body's production of antiviral antibodies and may cause the spread of viral infection. However, in recent years, most scholars believe that hormone therapy has a significant effect on relieving obstruction and avoiding tracheotomy. The theoretical basis is to reduce inflammation and edema, and prevent the destruction of epithelial cilia.

　　4. Tracheotomy

　　If conservative treatment is ineffective and laryngeal obstruction is still not relieved or significantly reduced, tracheotomy should be performed in a timely manner. There are reports that during the epidemic of severe measles and A type influenza virus, a higher proportion of patients with this disease require tracheotomy.

　　5. Supportive treatment

　　It includes appropriate fluid replacement to maintain water and electrolyte balance, and to avoid the drying of sputum in the trachea. In addition, small amounts of blood transfusion or plasma can be used for treatment to increase resistance. It is advisable to avoid morphine and atropine-like drugs during treatment. Antihistamines should also be used sparingly or not at all, as they inhibit the secretion of respiratory tract glands, causing mucosa and secretions to dry out, which can worsen respiratory difficulty.

　　II. Prognosis

　　Active treatment usually has a good prognosis, but if treatment is not timely or rescue is delayed, it can lead to respiratory failure and death; or it can lead to complications due to the progression of the disease.