In severe croup, which noninvasive support may be employed?

• A. Place on a T-piece CPAP
• B. Administer high-flow nasal cannula only
• C. Immediate intubation without prior stabilization
• D. Chest physiotherapy

Answer: (A)

Severe croup tightens the upper airway and makes breathing work harder, so the goal is to provide noninvasive support that splints the airway and reduces the effort of breathing. Placing the child on continuous positive airway pressure delivered through a T-piece CPAP setup keeps the airway open during spontaneous breaths, improves ventilation, and can improve oxygenation without immediate invasive airway control. This approach is favored when the child is still able to breathe on their own but needs airway stabilization and closer monitoring. High-flow nasal cannula can help some patients, but it doesn’t consistently provide the airway splinting CPAP offers in severe obstruction. Immediate intubation without stabilization bypasses noninvasive options and is reserved for deteriorating or high-risk situations. Chest physiotherapy is not appropriate for croup and can worsen airway irritation.