What are the indications for nebulised adrenaline in the management of croup?

Indications for the use of nebulised adrenaline in the management of croup include children presenting with moderate to severe croup or impending respiratory failure. Nebulised adrenaline is recommended as part of the treatment for these cases, often alongside corticosteroids. It is particularly indicated when hospital admission is required due to the severity of illness. Children with severe respiratory distress or those too unwell to take oral medication may receive nebulised adrenaline as an alternative or adjunct to corticosteroids. Nebulised adrenaline is not routinely used in mild croup but is reserved for more severe presentations to rapidly reduce airway swelling and improve breathing.

Specifically, children with features of moderate or severe illness, or signs of impending respiratory failure, should receive nebulised adrenaline. This includes those with a respiratory rate over 60 breaths per minute, high fever, or a toxic appearance. Nebulised adrenaline may also be considered in children who cannot tolerate oral corticosteroids due to vomiting or severe respiratory distress, where inhaled budesonide or intramuscular dexamethasone are alternatives. Oxygen supplementation is also given alongside nebulised adrenaline in severe cases.