2024-01-31 13:07:53
TRANSCRIPTION
Hello, I am Dominique Savary, I work in the emergency medicine department of the Angers University Hospital, and I am meeting you during this winter period to talk about a study of pediatrics which came out in Pediatrics in September 2023 and who focused on acute viral laryngotracheitis in children [ou faux croup]. [1]
This pathology is the cause of ~5% of pediatric emergency room consultations.
It is a common cause of acute upper airway obstruction in children between six months and three years of age – a rather benign disease, but which still has a strong impact on health systems, particularly because this pathology is origin of at least 5% of consultations in pediatric emergencies. The number of rehospitalizations or reconsultations after 72 hours is not negligible.
Study objectives and design
This benign pathology results in a barking cough mainly at night, with the famous seal cry, which is associated with inspiratory stridor and possibly fever. She already has a known effective treatment, which is the administration of steroids and which, roughly speaking, takes around thirty minutes to be effective. Before these 30 minutes, is there a way to improve the functional signs of these children? To find out, the study selected 118 children aged 3 months to 10 years randomized 1:1 upon their arrival at the pediatric emergency department of Geneva. These children were offered a first dose of steroids and:
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to be selected in a group placed outside the hospital or department, in a cold atmosphere, with a temperature below 10° C, of course with blankets to cover them,
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or put in another group of children who remained inside the ward with a temperature of 20°C.
The measurement of the humidity level between the exterior (70%) and the interior (30%) was significant.
Results
After 30 minutes, the two groups were compared and there was a significant reduction in symptoms at 30 minutes for roughly 50% of the children who were placed in cold air versus 23% for the children who remained inside, all this using a particular scale which is the Westley Croup Score , which measures the discomfort in the context of this false croup.
The conclusion of the author of this study (Dr. Laurence Lacroix-Ducardonnoy) is to say that the outdoor atmosphere which is more humid and colder can be useful and can be recommended early from home to parents who call the centers regulation.
Cooling the upper airways would be effective because it would increase the activity of the dilator muscles.
The explanation given for humidity is already well known to regulators, since it is often suggested to run hot water at home to aerosolize the air in the bathrooms. But beyond that, cooling the upper airways would be effective because it would increase the activity of the dilator muscles of the upper airways and thus reduce the blood flow of the mucosa by vasoconstriction, and reduce the resistance of the upper airways. . So two effects: that of cold and that of humidification.
Conclusion
It is a disease which is certainly benign, but common, and for which small measures can be effective and help to avoid a certain number of hospitalizations, or in any case consultations in pediatric emergencies.
So, of course there are always discussions around these studies. In particular, the discussion that emerges and perhaps limits these results is that we gave the steroids as soon as the patients arrived, with an evaluation that was done at 30 minutes, depending on the atmosphere, and which also corresponds to the beginning of the effectiveness of these steroids. I nevertheless wanted to share this original study which responds to needs that we may have in emergency medicine.
Thank you and see you soon on Medscape French Edition.
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