PAEDS

Question 1

2 types of NIV

Answer 1

CPAP
BiPAP

Question 2

Benefits of BiPAP

Answer 2

Treats hypoventilation of whatever cause- Pressure to support respiratory failure- May be used to improve airway clearance- Rate to overcome lack of central drive

Question 3

HFNC

Answer 3

Humidified High flow nasal cannula

Question 4

what does HFNC administer

Answer 4

Humidified High flow nasal cannula
heated and humidified blend of air and oxygen higher than pts inspiratory flow
generally 6ml/min

Question 5

signs of respiratory distress of WOB in children

Answer 5

Tachypnoea
Nasal flare
Tracheal tug
Recession
intercostal, subcostal, substernal
Mild / moderate/ severe
Grunting (adduction of laryngeal muscles to try and increase auto PEEP & FRC)

Question 6

paradoxical breathing

Answer 6

lower ribs sucked in during inspiration as the diaphragm pull on non
compliant lungs)

Question 7

normal peak cough flow in adults

Answer 7

> 400L/min

Question 8

interpret peak cough flow of <270ml

Answer 8

Unable to clear secretions during LRTI

Question 9

interpret peak cough of <160L/min

Answer 9

Unable to clear secretions on a daily basis

Question 10

expulsive flow - normal cough mechanism

Answer 10

irritation trigger
deep inspiration - 80-90% normal capacity
0.2 s of glottis closure with simultaneous contraction to generate pressure ~ 190cm H2O
Opening of glottis
effective contraction of expiratory muscles

Question 11

list the physiological difference of child vs adult lung

Answer 11

↑ Compliance in chest wall, ↓ compliance of lungs
↓ % of type 1 (Fatigue resistant) muscle fibres in diaphragm (Child 30% vs. adult 50-60%)
Poorly developed intercostal muscles
↑metabolic rate of 02 consumption
Preferential ventilation of upper lung when positioned in side lying
reduced diameter of airway
preferential nasal breathers
proportionally larger tonsils and tongue
floppy cartilage

Question 12

what is implied if the child has ↑ Compliance in chest wall, ↓ compliance of lungs

Answer 12

↓ FRC and ↑ work of breathing

Question 13

what is implied if the child has ↓ % of type 1 (Fatigue resistant) muscle fibres in diaphragm (Child 30% vs. adult 50-60%)

Answer 13

Diaphragm more prone to fatigue → less able to withstand respiratory distress

Question 14

what is implied if the child has poorly developed intercostal muscles

Answer 14

Near solely reliant on diaphragm for respiration

Question 15

what is implied if the child has ↑metabolic rate of 02 consumption

Answer 15

Hypoxia develops more rapidly

Question 16

what is implied if is child has Preferential ventilation of upper lung when positioned in side lying

Answer 16

Ensure Sa02 maintenance when repositioning

Question 17

what is implied with reduced airway diameter

Answer 17

↑ airway resistance → ↑respiratory difficulties with any inflammation of airways

Question 18

what is implied with preference of nasal breathing

Answer 18

NG tubes etc. narrows diameter and ↑ WOB. Ensure nasal passages are cleared of secretions

Question 19

what is implied with proportionally larger tonsils and tongue

Answer 19

increased airway obstruction

Question 20

what is implied with floppy cartilage

Answer 20

predispose to airway collapse

Question 21

Airway resistance is inversely proportional to the fourth power of the radius of the airway - Poiseuilles law
Halving the internal diameter of the trachea will increase the resistance (reduce air flow) by __

Answer 21

16

Question 22

anatomical difference in children lungs

Answer 22

Immature cilia
↓alveolar surface area (24 million vs. 300 million at 8 years)
↑ heart size in infants
More horizontal ribs and more cylindrical
Poor collateral ventilation in infancy

Question 23

implication for cilia

Answer 23

↑ accumulation of secretions, mucus plugging

Question 24

implication for reduced alveolar surface area

Answer 24

reduced space for gas exchange

Question 25

implication for increased heart size

Answer 25

less room for lung expansion

Question 26

implication for horizontal ribs and more cylindrical

Answer 26

Lack of bucket handle and pump handle movement, unable to increase lung volumes

Question 27

implication of poor collateral ventilation in infancy

Answer 27

increased risk of atelectasis of RTI

Question 28

Pores of Kohn

Answer 28

inter alveolar

Question 29

Canals of Lamber

Answer 29

brionchar-alveolar

Question 30

channels of martin

Answer 30

interbronchiolar

Question 31

benefits of sidelying positioning

Answer 31

Ventilation better in non dependent lung but still receives blood flow Dependent lung is compromised due to compliant chest wall Head up reduces pressure from abdominal contents so diaphragm can move more freely

Question 32

benefits of prone positioning

Answer 32

Less compression of lung tissue from heart Helps with drainage of secretions and redistribution of oedema

Question 33

benefits of supine positioning

Answer 33

Ventilation best anteriorly, with perfusion best posteriorly V/Q mismatch Avoid head down tip as risk of reflux and aspiration

Question 34

contrindications of manual techniques

Answer 34

Undrained pneumothorax Raised intracranial pressure Rib fractures Osteopenia/Osteoporosis Platelets of <40 Pulmonary haemorrhage

Question 35

benefits of manual hyperinflation

Answer 35

Prevent atelectasis and recruit areas of collapsed lung Improve lung compliance and gas exchange Increases movement of pulmonary secretions toward central airways Prevent airway mucus plugging

Question 36

how is manual hyperinflation performed

Answer 36

2 breaths at PIP/PEEP on ventilator, 3rd breath 10% above PIP Followed by end inspiratory hold with quick release to increase expiratory air flow

Question 37

indications of manual assisted cough

Answer 37

Secretions causing respiratory compromise that patient is unable to effectively clear * Reduced PCF Considerations: * Position dependant, requires skill * Risk of abdominal trauma and reflux * Need to time with cough

Question 38

contraindications of manual assisted cough

Answer 38

Rib fractures Raised ICP Undrained pneumothorax Osteopenia / Osteoporosis

Question 39

how oropharyngeal suctioning meaured

Answer 39

Measure corner of mouth to ear lobe and add approx 2 cms

Question 40

how is nasopharyngeal suctioning measured

Answer 40

Measure tip of nose to ear lobe to thyroid cartilage

Question 41

benefits of beta 2 agonists

Answer 41

Bronchodilates airways Reduces inflammation Improve mucocillary clearance

Question 42

effects of mucolytics

Answer 42

Rehydrate secretions - Improve mucocilliary clearance - Stimulate cough

Question 43

benefits of pulmozyme

Answer 43

Targets and cleaves the extracellular DNA to ↓mucus viscosity and ↑ sputum clearance

Question 44

reasons for paediatric trache

Answer 44

Airway Congenital or acquired e.g tracheomalacia Breathing Respiratory muscle weakness CLD Chest wall deformities Circulation Ongoing cardiac support required Disability/Neuro Congenital or acquired injury e.g high SCI, severe TBI Central hypoventilation syndrome

Question 45

aims of long term ventilation

Answer 45

Maintain airway patency Maintain adequate lung recruitment Reverse hypoventilation Reduced WOB Reduce frequency of respiratory infections Promote clinical stability Transition to home environment Allow neurodevelopmental progress

Question 46

GDD

Answer 46

Global developmental delay