Elsevier

Critical Care Clinics

Volume 29, Issue 2, April 2013, Pages 167-183
Critical Care Clinics

Acute Respiratory Failure

https://doi.org/10.1016/j.ccc.2012.12.004Get rights and content

Section snippets

Key points

  • •

    Acute respiratory failure is common in critically ill children.

  • •

    Monitoring for respiratory failure includes commonly used invasive tests, such as blood gas analysis, but noninvasive monitoring has recently grown in importance and proven reliable.

  • •

    Recent advancements in therapeutic options for respiratory failure have improved the overall outcome of critically ill children, but much more rigorous investigation is still needed.

Epidemiology

As a common end point to multiple clinical conditions, the incidence of respiratory failure in the pediatric population is difficult to ascertain. In one study, 17.1% of patients admitted to a PICU at several large children’s hospitals required mechanical ventilation, with acute respiratory conditions as the culprit in 62.4% of these patients. In this cohort of patients, bronchiolitis (26.7%) and pneumonia (15.8%) were the leading etiologies for respiratory failure.9

Acute lung injury (ALI)

Monitoring

Monitoring respiratory function appropriately will help identify the development of respiratory failure as well as guide therapy based on response, and can predict outcome.17 The fundamental and most important assessment of respiratory function is the clinical examination. Respiratory rate and pattern are indicative of the physiologic status of the respiratory system. Tachypnea is often the first sign of respiratory compromise.18, 19 Dys-coordinate, paradoxic movement of the chest during

Therapy

Specific aspects of the therapy for respiratory failure vary depending on the underlying cause. In all cases, however, the goal of therapy is to supplement the patient’s gas exchange. Initial measures should include steps to ensure airway patency and clearance. Supplemental oxygen may be administered via facemask or nasal cannula.

The use of noninvasive positive pressure ventilation (NPPV), in the form of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), has

Prognosis and outcome

Overall, the mortality from ALI is relatively high (22%–27%) compared with the general PICU population, although lower than in adults (35%–45%).37, 83 Fortunately, mortality for ALI continues to improve in children, recently reported as low as 8%,56 although higher for recipients of stem cell transplantation.84 Interestingly, children with ARDS secondary to RSV have a significantly lower mortality rate of approximately 5% compared with ARDS from other causes.80 The degree of hypoxemia, as

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    The authors do not have any financial conflict of interest to disclose.

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