Croup syndrome: historical perspective.

The management of acute croup syndrome has undergone very interesting changes in the past century. Initially a number of conditions were thought to be synonymous with croup, but with identification of the bacterial and viral etiology these have been separated into different clinical entities: viral croup which is very common and frequently self-limited; bacterial tracheitis, a condition which is infrequently encountered and which may be a complication of viral croup; and epiglottitis or supraglottitis, a disease that has been identified as most frequently due to a specific organism, H. influenzae. The management of the child with airway obstruction has also changed. Before the past decade virtually all children with epiglottitis were treated with tracheotomy and currently very few children are thus treated. Intubation has been showed to be a safe procedure in these cases. There still exists some controversy regarding the treatment of the child with laryngotracheobronchitis. In the vast majority of cases medical management has been successful and in the remainder there is controversy regarding the use of intubation or tracheotomy.