Pediatrics 5: Bacterial Tracheitis Portal
PEDS: Because this entire portal pertains only to pediatric patients, the convention of underlining has been omitted.
Bacterial tracheitis occasionally follows a viral respiratory infection such as croup. The child may have a bark-like cough that is typical of croup but develop toxic symptoms such as high fevers, severe respiratory distress, and respiratory failure. Bacterial tracheitis usually occurs in children < 3 years old. Aggressive airway management and anitbiotics are necessary. The child may appear toxic but does not exhibit classic evidence of epiglottitis.
Etiology
Staphylococcus
aureus is the most common causative agent. Occasionally Moraxella
catarrhalis or Hemophilus influenza may be identified as causative
agents.
Diagnosis and Treatment
To manage the airway, orotracheal intubation ( Vol II—AIR SKILLS 3 Orotracheal Intubation) or tracheostomy ( Vol II—AIR SKILLS 14 Tracheotomy) may be necessary. As in epiglottitis, avoid agitating the patient. Administer oxygen by holding an oxygen mask near the face. When ready to intubate, lay the child down and perform orotracheal intubation.
If the child is too agitated and alert to allow this, administer ketamine 2 mg/kg, atropine 0.02 mg/kg (0.1 mg minimum), and midazolam (Versed) 0.1 mg/kg, all IM. These three medications can be combined in the same syringe. Confirm correct placement with an esophageal intubation detector (Vol II—AIR SKILLS 1 Aids to Intubation) or in infants, a CO2 detector.
Obtain blood cultures and culture the tracheal secretions.
Appropriate IV antibiotic therapy includes anti-staphylococcal agents plus agents active against Hemophilus influenza and Streptococcus infections.