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Paediatric Considerations in Critical Care 689

TABLE 25.4 Endotracheal tube (ETT) and nasogastric tube (NG) sizes for infants and children

Age Weight (kg) ETT size (mm ID) At lip (cm) At nose (cm) Suction catheter (FG) NG tube (FG)
0 <3.0 2.5 6 7.5 5 8
0 3.0 3.0 8.5 10.5 6 8
0–3 months 3.5–5 3.5 9 11 6–8 10
3–12 months 6–9 3.5 10 12 6–8 10
1 year 10–12 4.0 11 14 8 10
2 years 13–14 4.5 12 15 8 12
3 years 14–15 4.5 13 16 8 12
4–5 years 16–19 5.0 14 17 8–10 12
6–7 years 20–23 5.5 15 19 10 14
8–9 years 24–29 6.0 16 20 10–12 14
10–11 years 30–37 6.5 17 21 12 14
12–13 years 38–49 7.0 18 22 12 16
14+ years 50–60 7.5 19 23 12 16
Adult >60 8–9 20–21 24–25 12 16
FG = French gauge; ID = internal diameter. Adapted from (91).

Epiglottitis is now rarely seen since immunisation against intubation. Possible complications of croup include
Haemophilus influenzae type b (Hib) was introduced into respiratory failure, respiratory arrest, hypoxic damage,
the immunisation schedule for all Australian and New secondary bacterial infection, acute pulmonary oedema,
Zealand children. However, it is important to distinguish persistence or recurrence. 84
epiglottitis from croup in order to initiate appropriate
management. Other less common infectious causes of Clinical manifestations
upper airway obstruction seen in young children include Croup is characterised by a barking or seal-like cough,
bacterial tracheitis and retropharyngeal abscess, while inspiratory stridor and hoarse voice. The severity of
97
diseases thought to have disappeared, such as Lemierre’s croup is assessed based on increased respiratory rate,
syndrome and diphtheria have not been completely increased heart rate, altered mental state, work of breath-
eradicated. 94 ing and stridor. Stridor at rest is noted in moderate to
Infection of the lymphoid tissue around the nodes drain- severe croup and is often quite loud. If a child’s stridor
ing the nasopharynx, sinuses and eustachian tubes may becomes softer but the work of breathing remains
cause pus to accumulate in the retropharyngeal space, increased, it should be treated as an emergency as the
98
leading to a retropharyngeal abscess. Presenting symp- obstruction may become more severe. The symptoms of
toms include history of upper respiratory tract infection croup are listed and compared with those of epiglottitis
(URTI), sore throat, fever, toxic appearance, meningis- in Table 25.5. Diagnosis is made on physical assessment
mus, stridor, dysphagia, and difficulty handling secre- and the history of the illness.
94
tions. Diagnosis is usually made on bronchoscopy.
Treatment involves surgical drainage and antibiotic Management
administration. Short-term intubation may be required Management of croup depends on the severity of the
until swelling has resolved following surgery. upper airway obstruction and close cardiorespiratory
observation and monitoring is essential. Children with
Croup moderate to severe croup should be given face-mask
Croup (laryngotracheobronchitis) is used to describe a oxygen and allowed to adopt the position which they find
most comfortable. Strategies such as positioning the child
set of symptoms caused by acute swelling causing obstruc- in a parent’s lap and holding the face-mask close to their
tion in the upper airway (larynx, trachea and bronchi) face may limit their distress and can have beneficial effects
from inflammation and oedema, caused mostly by the on oxygenation. 97
parainfluenza or influenza viruses. 84,95 Croup occurs in
approximately 2% of Australian children, generally aged The use of steroids in combination with nebulised adren-
96
1–4 years, and in winter months. Recent advances in aline is responsible for significant improvement of symp-
croup management have been responsible for a fall in toms in children within 12 hours of administration,
the number of children requiring hospitalisation and abating the need for intubation in the vast majority of