Pediatric emergency medicine trisk 690
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Impending respiratory failure must be promptly recognized and
managed. Effective early intervention can limit progression, morbidity,
and mortality.
A systematic approach to prioritizing assessment and support of
airway, breathing, and circulation should be employed.
Emergency management of acute respiratory failure often involves both
diagnostic testing and lifesaving therapeutic maneuvers.
After stabilization, attention must be given to treating the underlying
condition.
Current Evidence
While many cases of respiratory distress are benign and self-limited, requiring
minimal or no intervention, pulmonary diseases contribute to significant
morbidity and mortality in pediatrics, including 3% to 5% of deaths; some of
these deaths may be preventable. Importantly, respiratory failure often precedes
cardiopulmonary arrest in children; unlike adults for whom primary cardiac
disease is often responsible. Therefore, careful assessment of cardiopulmonary
status and anticipation of and preparation for deterioration are important aspects
of care. Prompt recognition and treatment of impending respiratory failure can be
lifesaving and may reduce morbidity and mortality.
By definition, there are two components to respiratory failure—inability of the
respiratory system to (1) provide sufficient oxygen for metabolic needs (hypoxic
respiratory failure) and (2) excrete the carbon dioxide (CO2 ) produced by the
body (hypercapnic or ventilatory respiratory failure). Both are often present
simultaneously, but to varying degrees.
TABLE 99.1
CAUSES OF ACUTE RESPIRATORY FAILURE IN CHILDREN
Pulmonary diseases
Airway obstruction
Upper
Airway obstruction
Lower
Infectious pneumonia (bacterial, viral,
fungal, and other)
Tuberculosis
Pertussis, parapertussis syndrome
Cystic fibrosis
Drug-induced pulmonary disease
Vasculitis, collagen vascular disease
Pulmonary dysgenesis
Pulmonary edema
Pneumothorax, hemothorax, chylothorax
Drowning/near drowning
Bronchopulmonary dysplasia
Bronchiolitis
Asthma
Pulmonary hemorrhage
Acute epiglottitis
Laryngotracheobronchitis (croup)
Bacterial tracheitis
Foreign-body aspiration
Adenotonsillar hypertrophy
Retropharyngeal abscess
Subglottic stenosis, web, or hemangioma
Laryngomalacia
Laryngeal edema
Congenital neck anomalies (e.g., cystic
hygroma, bronchial cleft abnormalities)
Static encephalopathy
Reactive airway disease (asthma)
Bronchiolitis
Foreign-body aspiration
Cystic fibrosis
Bronchiectasis
Tracheobronchomalacia
Chest wall deformity disorders
Neurologic disease
Central nervous system
Spinal/anterior horn cell
Neuromuscular junction
Other diseases
Bronchopulmonary dysplasia
α1 -Antitrypsin deficiency
Hydrocarbon aspiration, aspiration
syndromes
Congenital lobar emphysema
Diaphragmatic hernia
Kyphoscoliosis (severe)
Restrictive lung disease secondary to chest
deformity
Status epilepticus
Severe static encephalopathy
Acute meningoencephalitis
Brain abscess, hematoma, tumor
Brain stem insult
Arnold–Chiari crisis
Drug intoxication
Transverse myelitis
Poliomyelitis
Polyradiculitis (Guillain–Barré)
Spinal muscle atrophy type 1 (Werdnig–
Hoffmann syndrome)
Myasthenia gravis
Botulism (e.g., infantile, food-borne,
wound)
Tetanus
Myopathy
Neuropathy
Drugs (e.g., succinylcholine, curare,
pancuronium, organophosphates)
Cardiac disease
Anemia (severe)
Acidemia (e.g., renal failure, diabetic
ketoacidosis, hepatic disease)
