Acute respiratory failure in children

Article written by Dr. Le Van Binh – Active Resuscitation Doctor – Children's Center – Share99 Times City International Health Hub

Acute respiratory failure is a condition in which the respiratory agency suddenly does not guarantee gas exchange function, causing hypoxia, with or without carbon dioxide (CO2) of blood, which is manifested by the results of arterial blood gas measurements, with PaO2 < 60 mmHg, PaCO2 > 50 mmHg when breathing with FiO2 = 21%.

Reduce alveolar througheration:

• Complete airway obstruction: airway foreign objects ,inflammation of the petic flange, inflammation of the urye, softening of the cartilage of the purulence.
• Increase airway obstruction: HPQ, VTPQ
• Decreased pulmonary dilation: pulmonary fibrosis, pulmonaryedema , interstitial lung disease.
• Pleural cavity damage: Pleural effusion, Pneumothorax.
• Nerve damage, respiratory muscles

Increased air informed range of death:

• Increased pulmonary artery pressure
• Decreased heart flow

Increased blood CO2 production:

• Severe burns
• Use too much sugar

• Shunt in the lungs: ARDS, wet pneumonia
• Changes in the ventilation – perfussation: stool inhalation syndrome, pulmonary edema caused by the heart.
• Shunt in the heart: right shunt – left
• Reduce air absorption: upper respiratory obstruction
• Diffusion reduction: pulmonary fibrosis
• Reduce intravenous oxygen pressure: cardiac shock

Recognize the risk of acute respiratory failure

Symptoms of acute respiratory distress are assessed by the frequency of breathing (at fast times, at slow times) and exertion breathing (assessing the seriousness of the disease). Accordingly, respiratory muscle contraction in older children is a sign of severe respiratory failure.

In addition, abnormal breathing noises are also shown as follows:

• Hissing is inhaled: TQ or KQ obstruction.
• Hissing in both: heavy TQ or KQ obstruction.
• Wheezing exhales, exhales prolonged: obstruction of the lower respiratory tract
• Moaning exhales: Respiratory failure is severe in infants.

Breathing efficiency

• Listen to the lungs: Dumb lungs are very severe signs.
• Disproportionate RRPN suggests SHH cause
• SpO2< 92% không thở oxy hoặc SpO2 < 95% có thở oxy là SHH rất nặng

Consequences of respiratory failure on other agencies

As a result of respiratory failure, rapid sinus rhythm, drama, arrhythmias, may be slow rhythm, vascular rhythm. Regarding blood pressure: at first blood pressure rises to compensate but if respiratory failure persists or the final stage of blood pressure drops. In particular, respiratory failure can cause cardiac arrest due to severe hypoxia or excessive CO2 increase.

With the condition of the skin, the O2 deficiency mucosa makes the skin blue due to contraction, if cyanosis appears as a late sign, the central purple is about to stop breathing. The senses are stimulated, enveloped, coma, decreased force. Respiratory failure also affects other organs such as the bile liver and urinary kidneys.

• Arterial blood gas: Helps to determine the diagnosis, differentiate the category of respiratory failure, assess the degree of severeness, the effects of acute respiratory failure on conversion and especially help guide the treatment and management of acute respiratory failure.
• Changes in arterial blood gas in acute respiratory failure: PaO2 < 60 mmHg, SaO2 < 92% và/hoặc, PaCO2 > 50 mmHg, pH values, bicarbonate, residual alkali should be viewed
• Pulmonary X-ray: is in place for all patients with respiratory failure to help detect the cause of respiratory failure and to distinguish the type of respiratory failure with damage to the lungs, thereby guiding appropriate behavior.
• Blood bio bio bio bio bioeeration: Blood bio bio-tests often appear bio biomedical disorders, increased potassium and decreased blood calcium.
• Che is awake:Based on the indicators of leukocysis, hemolysis, thrombocyletes.
• Microorganisms: Influenza test, eria transplantation, inemanation …

The general principle of treatment of acute respiratory failure in children is to quickly normalize O2 and CO2 in the blood, enhancing the effects of the O2 transport system. At the same time, it facilitates the repair and healing of lung damage.

In addition to the general principles of treatment of upper respiratory failure, it is necessary to quickly treat the ventilation of the airways with the following measures: the right position, nasal nasal attraction,…

Oxygen supply when: The child is cyanosis and/or SaO2 < 92% và hoặc PaO2 <60mmHg khí="" máu="" động="" mạch;="" co="" rút="" lồng="" ngực="" nặng,="" thở="" nhanh="">70 times/min.</60mmHg>

Methods of oxygen supply:

• Normal oxygen supply method: Nasal oxygen (0.5 – 3 liters/min), Oxygen mask (6 – 8 liters/min), oxygen breathing through plastic cap (Hood) (5 – 8 liters/min)
• Advanced oxygen supply method: If oxygen breathing is normally rapidly breathing, severe respiratory muscle shrinkage, cyanosis, SpO2 decreases < 92% và hoặc PaO2 < 60mmHg thì cho thở Oxy qua Mask có túi dự trữ 6 – 10 l/phút mask thở lại (FiO2 60 – 80%), Mask không thở lại (FiO2 60 – 100%), Thở áp lực dương liên tục qua mũi (NCPAP). Insymed administration and mechanical ventilators when failure with O2 breathing via mask or NCPAP/ or when the patient is not breathing on his own.

Enhance the effect of O2 transport system

• Optimal Hb concentration (> 100g/l): red blood cells transmission
• Ensure heart flow: Epidemic compensation ensures sufficient money, adjusts electrolycical disorders. Taking drugs to increase myocardial contraction, hypertension: Dopamine, Dobutamin, Adrenalin … Treatment of arrhythmias (if any)
• Good oxygen supply at the organization: avoid lowering temperature, blood alkalinity (when acidosis converts to Natribicarbonate according to the formula based on blood gas results: Sodium Bicarbonate amount (mEq) = BE x P (kg) x 0.3.
• Reduce unnecessary oxygen consumption: treat fever, avoid irritation.

Facilitating the repair and healing of lung damage

• Avoid oxygen poisoning: oxygen breathing is in accordance with the in specify, method, dosage and duration of oxygen breathing.
• Adequate nutrition: Oral feeding is recommended, if it is not possible to put gastric sonde pumped with milk by the hour or a basket of gastric drops. Energy needs to increase by 30-50% of normal needs due to fast breathing
• Anti-multiple infections and hospital infections: Care must be aseptic, especially when sucking sputum through the intt management. Use antibiotics appropriately according to antibiotics.

Cause-specific intervention

• Get airway foreign objects
• Poke or pneumothorax/pneumothorax
• Ensure heart supply, blood pressure, reduce pulmonary artery pressure
• Bronchodilators

Respiratory failure can leave dangerous complications, so during transportation the child needs to pay attention to clear the airways with a safe position, provide enough oxygen, ensure body temperature and avoid hypoth glucose.

Treatment of respiratory distress syndrome in children is considered a great challenge because this condition requires the baby to be constantly monitored and cared for with the appropriate and proper method. In addition, the early hospitalization time is also a decisive factor that should be successful in treatment.

Share99 International Health Hub is the address of examination, diagnosis and treatment of respiratory failure that many customers trust. At Share99 International Health Hub, there is a team of highly skilled, skilled, experienced specialists, pediatricians, pharmacists and nurses, especially a dedicated and professional attitude.

Especially with the full support of many modern technical means, Share99 always ensures to provide the most comprehensive and effective health care.

Customers wishing to visit with modern and high-efficiency methods at Share99 please register here.

REFERENCE MATERIAL

1. Guidance on the diagnosis and treatment of a number of common diseases in children. Ministry of Health – Decision No. 3312/QD-BYT of August 7, 2015
2. Advanced Paediatric Life Support: The Practical Approach, Chapter 7 "The structured approach to the seriously ill child"Fifth Edition Australia and New Zealand 2012. , p 207-218
3. Texbook of Pediatric Emergency Medecine
4. Uptudate: Acute respiratory distress in children: Emergency evaluation and initial stabilization. This topic last updated: Dec 12, 2016.