Monitoring
Clinical Response Evaluation
Patients with mild croup who can tolerate oral fluids and have not received nebulized Epinephrine may be discharged with instructions about symptoms to watch out for and when to seek help.
Please see Nonpharmacological section.
Patients with moderate to severe croup who remain well after 2-4 hours of observation (after the first or second dose of nebulized Epinephrine) may be discharged home if the following criteria are met:
- No stridor at rest
- Normal pulse oximetry
- Good air exchange
- Normal color and level of consciousness
- Able to tolerate oral fluids
- Caregivers understand the indications for return to care and would be able to do so, if necessary
Hospital admission should be considered in case of severe croup with poor air entry, altered consciousness, impending respiratory failure, moderate or severe croup symptoms that recur or persist after initial treatment, an appearance or clinical picture suggesting potential serious secondary bacterial infection, the need for supplemental O₂, and severe dehydration.
Complications
Recurrent or Atypical Croup
Recurrent episodes of croup or croup-like symptoms, croup-like illness occurring outside the typical age range, and croup-like symptoms that do not respond to standard therapies may indicate the presence of an underlying airway or digestive tract condition. Congenital or acquired airway abnormalities (eg, laryngomalacia, laryngeal cleft, subglottic hemangioma, subglottic stenosis, and other lesions), gastroesophageal reflux disease, eosinophilic esophagitis, or atopic conditions may result in significant narrowing of the upper airway and predispose the patient to croup. Patients who have recurrent or atypical croup should be referred to an otolaryngologist for further evaluation.