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Treatment of Croup

PAUL S. BERGESON, MD
Am J Dis Child. 1976;130(3):336. doi:10.1001/archpedi.1976.02120040114026.
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Sir.—It has now been five years since the Utah group began publishing its data regarding intermittent positive-pressure breathing (IPPB) and racemic epinephrine for the treatment of laryngotracheobronchitis1,2 and six years since they showed "before and after" films at the American Academy of Pediatrics meetings in Chicago documenting their spectacular results. Yet, the pediatric community still does not comprehend the use of this relatively simple procedure, as evidenced by the recent article by Taussig et al in the Journal (129:790-793, 1975).

The authors state that in their controlled study the natural history of the disease is not drastically altered by this treatment, but they have deviated significantly from the original well-defined technique. Adair's group uses a higher pressure (15 to 20 cm of water), respirator sensitivity setting at near maximal, and a longer treatment period (15 minutes or more); a prolonged inspiratory time is not used until a child

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