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Respiratory failure ped
- 1. CASE CONFERENCEEXTERN AKECHANOKWATCHARAPUNJAMART
- 2. RESPIRATORY FAILURE IN PEDIATRICSEXTERNAKECHANOK WATCHARAPUNJAMART
- 3. DEFINITION āWhen oxygenation andventilation are insufficient to meet the metabolic demands of the bodyā Reference: Traditionally defined as respiratory dysfunction resulting in PaO2 <60 mmHg (room air) PaCO2 > 50 mmHg (acidosis)
- 4. Why does RESPIRATORY FAILURE tendto occur more in Children than Adult?
- 5. Pediatric Airway Anatomy 1.Obligate nose breather 2. Small airway 3.Disproportionally bigger tongues
- 6. Pediatric Airway Anatomy 4.Long, floppy epiglottis, Larynx is higher in neck
- 7.
- 8. Pediatric Airway Anatomy 5.Cone shaped, Cricoid ring is the narrowest point of the pediatric airway
- 9. Pediatric Airway Anatomy 6.Childrenhave large tonsils and adenoids
- 10. Pediatric Airway Anatomy 7.Theprocess of alveolization continues beyond the infant age 20-50 million alveoli at birth in a term infant 300 million by the age of 8 years
- 11. Pediatric Airway Anatomy 8.Collateralventilation through the pores of Kohn and Lambertās canal are not well developed in the early years
- 12.
- 13. Pediatric Airway Anatomy 10.Ossificationof the rib cage, calcification of the costal cartilage, and development of muscular mass develops progressively until adulthood
- 14. Pediatric Airway Anatomy 11.developmentof Respiratory center Apnea Irregular Respiration
- 15.
- 16. Causes of Respiratory Failure? 1.Upper & Lower airway obstruction 2.Alveolar-Interstitial lung disease 3. Ventilatory pump failure Reference:
- 17.
- 19. Acute respiratory failurein childhoood Preterm infant Hyaline membrane disease = infant RDS Lung immaturity Congenital pneumonia acquired lung diseases: nosocomial pneumonia bronchiolitis sepsis Newborn (at term) Congenital pneumonia Meconium aspiration Malformations: Lung hypoplasia, CDH acquired lung diseases: nosocomial pneumonia bronchiolitis sepsis
- 20. Acute respiratory failurein childhoood Infant (1- 12 months) sepsis-syndrome infectious pneumonia (RSV-bronchiolitis) non infectious pneumonia - inhalational injury circulatory arrest Preschool age sepsis-syndrome infectious pneumonia (RSV-bronchiolitis) non infectious pneumonia - foreign body aspiration - inhalational injury - drowning trauma circulatory arrest
- 21. How do weknow if the patient has RESPIRATORY FAILURE?
- 22. Signs & Symptomsof Respiratory Failure Reference : http://depts.washington.edu/uwgenped/outpatient-clinical-guidelines (26/11/2015)
- 24.
- 25. ąøąø³ąø¢ą¹ąø ąøąø³ąøąøąø“ąøąø³ąø¢ R RespiratoryRate (ąø«ąø³ąø¢ą¹ąøą¹ąø£ą¹ąø§ąøąø¶ą¹ąø) R Retraction (Work of Breathing) (ą¹ąøą¹ą¹ąø£ąøąø”ąø³ąøąøąø¶ą¹ąøąøąø³ąø£ąø«ąø³ąø¢ą¹ąø ąø«ąøąø ąø«ąøą¹ąø³ąøąøąøąøøą¹ąø”) C Color (Cyanosis) (ąø”ąøµąøąø³ąøąø³ąø£ą¹ąøąøµąø¢ąø§) C Conscious Change (ąø£ąø°ąøąø±ąøąøąø³ąø£ąø£ąø¹ą¹ąøŖąøąø“ą¹ąøąø„ąøµą¹ąø¢ąøą¹ąøąø„ąø) A Air Entry (ą¹ąøŖąøµąø¢ąøąø„ąø”ą¹ąøą¹ąø³ąøąøąøąø„ąøąø„ąø) Impending respiratory failure : Reference
- 26.
- 27. Blood Gas Abnormalities inRespiratory Failure oTraditionally defined as respiratory dysfunction resulting in PaO2 <60 mmHg (room air) PaCO2 > 50 mmHg (acidosis) and Arterial Oxygen saturation, SaO2 < 90% o The patientās general state, respiratory effort, and potential for impending exhaustion are more important indicators than blood gas values.
- 28. ā¢ PaO2 Low,PaCO2 Normal ā¢ PaO2 Low ,PaCO2 High Blood Gas Abnormalities in Respiratory Failure āNon ventilatory or Normocapnic or Type I Respiratory Failureā āVentilatory or Hypercapnic or Type II Respiratory Failureā : Reference
- 29. Pathophysiology Most Common!! Reference :Kevin E J Gunning, Pathophysiology of Respiratory Failure and Indications for Respiratory Support ,page 6
- 30. Range of V/QRelationships Intrapulmonary Shunt
- 31. The effects ofalveolarācapillary leak and positive end-expiratory pressure (PEEP) on pulmonary gas exchange.
- 32. Pathophysiology Reference : KevinE J Gunning, Pathophysiology of Respiratory Failure and Indications for Respiratory Support ,page 6
- 33.
- 34. How Is Respiratory Failure Management? TreatUnderlying cause and pathophysiology Adequate Oxygenation : Reference
- 35. Adequate Oxygenation Oxygen delivery,DO2ąøąø¶ą¹ąøąøąø±ąø cardiacoutput (Q), hemoglobin (Hb) , oxygen saturation ą¹ąøą¹ąø„ąø·ąøąøą¹ąøąø(SaO2) ą¹ąø„ąø°ąøą¹ąø³ PaO2
- 36. Oxygen Administration ā¢ Leastinvasive and most easily tolerated therapy for hypoxic respiratory failure ā¢ Oxygen nasal cannula 2-4 L/min ā¢ Simple face mask 5-10 L/min, FiO2 0.35-0.65 ā¢ Partial rebreathing mask ā¢ Non-rebreathing mask
- 37.
- 38. Positive-Pressure Respiratory support ā¢ High-flownasal cannula (4-16 L/min) ā¢ Continuous positive airway pressure (CPAP) ā¢ Bilevel Positive Airway Pressure (BiPaP)
- 39. ąøą¹ąøąøą¹ąøąøąøµą¹ą¹ąøąøąø³ąø£ą¹ąøą¹ NIPPV ą¹ąøąøąø³ąøąøąøąø“ąøąø±ąøąø“ ā¢ąøąø±ąøąø£ąø³ąøąø³ąø£ąø«ąø³ąø¢ą¹ąøą¹ąø£ą¹ąø§ąø«ąø£ąø·ąøąø«ąø³ąø¢ą¹ąøą¹ąø£ą¹ąø§ ą¹ąøąø“ą¹ąø”ąøąø¶ą¹ąø ā¢ ą¹ąøą¹ąøąø„ą¹ąø³ąø”ą¹ąøąø·ą¹ąø Accessory ą¹ąøąøąø³ąø£ ąø«ąø³ąø¢ą¹ąø ā¢ ąø”ąøµąøąø³ąø£ąø«ąø³ąø¢ą¹ąøą¹ąøąø Paradox ā¢ PaCO2 >45 mm Hg, pH <7.35 ąøą¹ąøąø«ą¹ąø³ąø”ą¹ąøąøąø³ąø£ą¹ąøą¹ NIPPV 1.ąøŖąø±ąøąøąø³ąøąøąøµąøą¹ąø”ą¹ąøąøąøąøµą¹ 2.ąø”ąøµą¹ąøŖąø”ąø«ąø°ąøąø£ąø“ąø”ąø³ąøąø”ąø³ąø 3.ą¹ąø”ą¹ąøŖąø³ąø”ąø³ąø£ąøąøŖąø±ąøą¹ąøąøąøąø³ąøąø³ąø£ąøąøąø Upper airway Obstruction ą¹ąøą¹ ąøąø¢ą¹ąø³ąøą¹ąøąø„ą¹ąøąø“ąø : Reference
- 40. ąøą¹ąøąøą¹ąøąøąøµą¹ą¹ąøąøąø³ąø£ą¹ąøą¹ IPPV ą¹ąøą¹ąø§ąøąøąøąø“ąøąø±ąøąø“ 1.ąø ąø³ąø§ąø°ąøąø³ąø£ąø«ąø³ąø¢ą¹ąøąø„ą¹ąø”ą¹ąø«ąø„ąø§(Impending Respiratory failure) 2.Circulatory Instability 3.Increase intracranial pressure,ICP 4.Pulmonary Hypertension Reference
- 41. Other Management ā¢ ąøąø³ąø£ą¹ąø«ą¹ą¹ąø„ąø·ąøąø ā¢ąøąø³ąø£ąø„ąøąøąø§ąø³ąø”ąøą¹ąøąøąøąø³ąø£ąøąøąøąøąøąøąøąø“ą¹ąøąø ą¹ąøą¹ąø ą¹ąø«ą¹ąø¢ąø³ąø„ąøą¹ąøą¹ ą¹ąøą¹ąøąøąø±ąø§ąø„ąøą¹ąøą¹ ą¹ąø«ą¹ąø¢ąø³ ąøąøąøąø«ąø„ąø±ąø ąø¢ąø³ąøąø„ąø³ąø¢ąøąø„ą¹ąø³ąø”ą¹ąøąø·ą¹ąø ą¹ąøą¹ąøąøą¹ąø ā¢ ąøąø³ąø£ą¹ąøąø“ą¹ąø” cardiac output ą¹ąøąø¢ąøąø³ąø£ą¹ąø«ą¹ąøŖąø³ąø£ąøą¹ąø³ąøąø³ąøąø«ąø„ąøąøą¹ąø„ąø·ąøąøąøąø³ ą¹ąø«ą¹ąø¢ąø³ ąøąø£ąø°ąøąøøą¹ąøąøąø³ąø£ąøąø³ąøąø³ąøąøąøąøąø«ąø±ąø§ą¹ąø ą¹ąøą¹ąøąøą¹ąø ā¢ ąøąø³ąø£ą¹ąøąø„ąøµą¹ąø¢ąøąøąøµą¹ąøąøąø ā¢ ąøąø³ąø£ą¹ąø«ą¹ąø¢ąø³ąøąø¢ąø³ąø¢ąø«ąø„ąøąøąø„ąø” ąø«ąø£ąø·ąøąø¢ąø³ąøą¹ąø³ąøąøąøøąø„ąøąøµąøą¹ąø”ąø·ą¹ąøąø”ąøµąøą¹ąøąøą¹ąøąøąøµą¹ : Reference