16. Respiratory insufficiency in childhood. Flashcards
Bag/mask ventilation initiated for patients with ________
apnoea
High flow nasal cannula (HFNC)
delivering a warm and humidified oxygen or a mixture of room air and oxygen at a flow rate higher than patient’s inspiratory flow rate usually 2 L/kg/min, >6 L/min in children.
Non-invasive positive-pressure ventilation (NPPV)
is a method of mechanical support of breathing without endotracheal intubation, which is valuable alternative to invasive mechanical ventilation (IMV) in selected patients. This method is much safer than IMV and allows many complications associated to endotracheal intubation to be avoided ( injury of upper airways, laryngeal oedema, post-extubation vocal cord dysfunction, hospital acquired infections like pneumonia, and lung injuries associated with endotracheal intubation)
Invasive mechanical ventilation (IMV)
is the next therapeutic method in respiratory failure. Criteria for mechanical ventilation are PaCO, >60-65 mmHg in newborns, >55-60 mmHg in older children, or rapid increase >5 mmHg/h; PAO, <45-50 mmHg in newborns, <50-60 mmHg in older children.
→ Non-ventilatory methods for support of the respiration are also used in the treatment of acute respiratory failure in children: permissive hypercarbia, inhalation of nitric oxide, extracorporeal membrane oxygenation (ECMO).
Acute respiratory failure can develop faster in small children due to:
- Increased metabolism
- Increased risk of apnoea
- Increased breathing resistance
- Decreased lung volume
- Decreased efficiency and endurance of the respoiratory muscles
Obvious symtoms of respiratory failure in the pediatric population:
Tachypnoea
Chest retraction
Thoraco-abdominal asynchronism
Nostril breathing
Head shaking in infants
Use of accessory muscles (jugular, epigastral and intercostal retraction)
Moaning
Pulsus paradoxus
Bradycardia and hypotension are signs of upcoming cardiac arrest
