PAEDIATRIC EMERGENCY:
RESPIRATORY FAILURE
By: By:
Dr Ainul
Dr. Siti Siti Ainul FarhanaBinti
Farhana Binti Sahar
Sahar
Respiratory failure
develops when the rate of gas exchange
between the atmosphere and blood is unable to
match the body's metabolic demands
ptn unable to provide sufficient oxygen to the
blood and develops hypoxemia
PaO2 < 60 mm Hg or 8 kPa
PaCO2 > 50 mm Hg or 6 kPa
Causes of hypoxaemia
Alveolar ventilation (V) and pulmonary perfusion
(Q) mismatch
Intrapulmonary shunt
Hypoventilation
Abnormal diffusion of gases at the alveolar-
capillary interface
Reduction in inspired oxygen concentration
Increased venous desaturation with cardiac
dysfunction
Type II
Type I -hypoxia
-hypoxia
(Pao2 < 8kPa)
Respiratory (PaO2 <8 kPa)
-with hypercapnia
-normal or low PaCO2 failure (CO2 > 6 kPa)
-caused by -caused by alveolar
V/Q mismatch hypoventilation with or
without V/Q mismatch
Extrathoracic airway
Respiratory pump AETIOLOGY
Central control
Intrathoracic airway and lung
Extrathoracic airway
retropharyngeal abscess
bacterial tracheitis
croup
burns
foreign-body aspiration
hypertrophic tonsils and adenoid
laryngomalacia
Respiratory pump
Diaphragmatic hernia
Flailchest
Kyphoscoliosis
Duchenne muscular dystrophy
Guillain-Barré syndrom
Myasthenia gravis
Intrathoracic airway and lung
Acute respiratory distress syndrome (ARDS)
Asthma
Aspiration
Bronchiolitis
Bronchomalacia
Pneumonia
Pulmonary edema
Pulmonary embolus
Sepsis
Central control
CNS infection
Drug overdose
Sleep apnea
Strok
Clinical features
cough, rhinorrhea, or other symptoms of an URTI
fever or signs of sepsis - infections can lead to
respiratory failure because of a systemic inflammatory
response, pulmonary edema, or ARDS
pain - suggest pleuritis or foreign-body aspiration.
bulbar dysfunction suggests myasthenia gravis.
distal weakness that progresses upward - suggests
Guillain-Barré syndrome.
apnea associated with a traumatic injury suggests a
cervical spinal cord injury
Hypoxia – dyspnea, restlessness agitation, confusion
Hypercania – headache, tachycardia, peripheral
vasodilation, drowsiness, coma
Clinical features
Respiratory rate, quality, and effort
Bradypnea - in central control abnormalities.
Tachypnea - in intrathoracic airway obstruction.
Grunting - expiratory sound made by infants as they
exhale against a closed glottis
Nasal flaring – increased effort to breath
Suprasternal and intercostal retractions - highly
negative pleural pressures are required to overcome
airway obstruction
Auscultation - for stridor, wheezing, crackles, and
decreased breath sounds (eg, alveolar consolidation,
pleural effusion).
Management for extrathoracic airway
obstruction:
Inspired humidity to liquefy secretions
Heliox (helium and oxygen gas mixture)
- to decrease work of breathing
Epinephrine 2.25%
- an aerosolized vasoconstrictor
Systemic corticosteroids
- to decrease airway edema
Airway management:
nasopharyngeal airway
- for partial upper-airway obstruction, to
provide passageway for air
oropharyngeal airway
- can be used temporarily in the
unconscious patient
endotracheal tube
- serves as an interface between the
patient and the ventilator.
Correction of hypoxemia
to assure adequate oxygen delivery to tissues,
generally achieved with a PaO2 of 60 mm Hg or
an arterial oxygen saturation (SaO2) of greater
than 90%.
Supplemental oxygen is administered via nasal
prongs or face mask;
however, in patients with severe hypoxemia,
intubation and mechanical ventilation are often
required.
Tracheal intubation
In neonates and infants younger than 6
months: 3 or 3.5 mm of inner diameter (ID)
In infants aged 6-12 months: 3.5 or 4 mm
ID
In children older than 1 year:
tube size (ID in millimeters) = (age in
years + 16)/4
Ventilate with high concentration of O2
Preparation for tracheal intubation
Monitors (heart rate, blood pressure, pulse
oximetry, capnography for CO2 detection)
Suction and catheters
Oxygenation with a bag-valve mask
Apparatus (laryngoscope, endotracheal tubes
appropriate for the patient's age and
endotracheal tubes 0.5 size smaller and larger,
stylets, oral airways)
People (respiratory therapist, nurse, a skilled set
of hands)
Lungs and respiratory pump
support
Continuous positive airway pressure (CPAP)
-indicated if lung disease results in severe
oxygenation abnormalities
Noninvasive positive-pressure ventilation
(NPPV)
-assisted ventilation provided with nasal prongs
or a face mask instead of an endotracheal or
tracheostomy tube.
THANK YOU
