The document discusses respiratory failure in children. It begins by listing signs of respiratory failure including increased effort of breathing seen as tachypnea, chest indrawing, and nasal flaring. Possible causes are then outlined affecting the respiratory system, circulation, nervous system, chest wall, and both upper and lower airways. Treatment principles focus on clearing the airway, treating the underlying cause, maintaining oxygen supply and transport, and providing energy. The appropriate level of oxygen support is chosen based on severity from nasal cannula to intubation.

1. RESPIRATORY FAILURE
IN CHILDREN
VIETNAM NATIONAL UNIVERSITY HCMC - SCHOOL OF MEDICINE
FACULTY OF HEALTH SCIENCE
HUNG MINH DO, M.D

2. OBJECTIVES
• Competently list down signs of respiratory failure in children
• Competently list down several possible causes of such condition
• Understand treatment of such condition

3. RECOGNITION OF
RESPIRATORY FAILURE IN CHILDREN

4. E
E
E
EFFORT OF BREATHING
EFFICACY OF BREATHING
EFFECTS OF RESPIRATORY INADEQUACY

5. • Cyanosis, SpO2 < 92%
E EFFORT OF BREATHING
• Apnea
• Irregular breathing
• Slow breathing • Agonal gasp
• Abdominal breathing
• Grunting
• Stridor at rest
• Suprasternal retraction
• Tachypnea
• Chest indrawing
• Retraction of
accessory muscles
• Flared nostrils
• Normal
NEXT

6. PEDIATRIC RESPIRATORY RATES
Ages Breathing rates
< 2-month old ≥ 60 beats/min
2-month to < 12 –month old ≥ 50 beats/min
12-month to < 5-year old ≥ 40 beats/min
≥ 5-year old ≥ 30 beats/min
BACK

7. • Chest expansion
• Air entry
• Pulse oxymetry
E EFFICACY OF BREATHING

8. • Heart rate
• Skin color
• Mental status
E EFFECTS OF RESPIRATORY INADEQUACY

9. PEDIATRIC HEART RATES
Ages Heart rates
Newborn ≥ 160 beats/min
2-month to < 2-year old ≥ 140 beats/min
2-year old to < 5-year old ≥ 120 beats/min
≥ 5-year old ≥ 100 beats/min
BACK

10. E
E
E
EFFORT OF BREATHING
EFFICACY OF BREATHING
EFFECTS OF RESPIRATORY INADEQUACY

11. CAUSES OF
RESPIRATORY FAILURE IN CHILDREN

12. Respiratory
failure
Respiratory Circulation
Nervous
system
Chest wall
Upper Airway Lower Airway
• Stridor
• Hoarse
• Suprasternal
retraction
• Wheezing
• Rales
• Past medical
history of
CHD
• PAH, HF,
Cyanotic
episodes
• Past medical
history of ND
• SMA,
Cerebral
palsy,
Encephalitis
…
• HSV,
accidents

13. CROUP EPIGLOTTITIS PHARYNGEAL
ABCESS
LARYNGEAL
DIPTHERIA
FOREIGN BODY
ASPIRATION
Onset Gradually
(1 – 3 days)
Suddenly
(a few hours)
Gradually Suddenly Suddenly
Overall condition Good Bad Bad Bad Good
Fever Mild Severe Severe Severe No
Throat pain No Yes Yes Yes 
Unable to drink No Yes
(Saliva secretion)
Yes Yes No
Specific signs Body leans
forward, head
tilts
Pseudo-
membrane
Asp. syndrome
UPPER AIRWAY OBSTRUCTION

14. PNEUMONIA BRONCHIOLITIS ASTHMA FOREIGN BODY
ASPIRATION
Age Unknown < 3yo, most < 6 mo >6 mo, most > 18mo When being able to
touch or grap things
Past medical history
of recurrent
wheezing
 < 2 times ≥ 2 times 
Significant clinical
findings
Fever, Cough,
Tachypnea, Crackles
Wheezing
Rhonchi
Wheezing
Rhonchi
Wheezing
Rhonchi
Significant laboratory
findings
Opacities Air trapping
bilaterally
Air trapping
bilaterally
Air trapping
unilaterally
Response to
bronchial
vasodilation
No No Yes No
LOWER AIRWAY

15. TREATMENT OF
RESPIRATORY FAILURE IN CHILDREN

16. PRINCIPLE
ÁNBDSJ
NFKJDF
• Airway clearance
• Treat the root cause(s)
• Energy supply
• Maintain oxygen supply
• Maintain oxygen transportation

17. Respiratory
failure
Airway clearance
Nasal cannula
Nasal cannula
Indication of
NCPAP?
NCPAP
Bag – valve –
mask
Endotracheal
intubation

18. History
• D1 – 2: 38oC, cough, runny nose, wheezing, eating
well
• D3: 38oC, increasing cough & wheezing, hard-
breathing  seeing the doctor & being admitted to
the hospital.
PMH
• 3 times admitted to the hospital for wheezing which
improved with bronchodilators.
• Mother was diagnosed with asthma from chilhood
Examination
T 38oC, BP 90/60, HR 160, RR 50
• Alert but restless
• Cyanotic, SpO2 80%
• Warm extremities, obvious pulse 160 b/m
• Obvious heart rate 160 b/m
• Suprasternal retraction (+)
• Hoarse cough (+)
• Stridor at rest (+)
• Chest indrawing (+)
1 CASE TO ILLUSTRATE
3-year old boy, admitted for breathlessness on 3rd day

19. OBJECTIVES
• Competently list down signs of respiratory failure in children
• Competently list down several possible causes of such condition
• Competently draw emergency algorithm for such condition

20. E
E
E
Tachypnea, Chest indrawing, Stridor at rest, Suprasternal retraction
Cyanosis, SpO2 80%
alert but restless, tachycardia

21. OBJECTIVES
• Competently list down signs of respiratory failure in children
• Competently list down several possible causes of such condition
• Competently draw emergency algorithm for such condition

22. Respiratory
failure
Respiratory Circulation
Nervous
system
Chest wall
Upper Airway Lower Airway
• Stridor
• Hoarse
• Suprasternal
retraction
• Wheezing
• Brhonchi
• Past medical
history of
CHD
• PAH, HF,
Cyanotic
episodes
• Past medical
history of ND
• SMA,
Cerebral
palsy,
Encephalitis
…
• HSV,
accidents

23. OBJECTIVES
• Competently list down signs of respiratory failure in children
• Competently list down several possible causes of such condition
• Competently draw emergency algorithm for such condition

24. Respiratory
failure
Airway clearance
Nasal cannula
Nasal cannula
Indication of
NCPAP?
NCPAP
Bag – valve –
mask
Endotracheal
intubation

25. PRINCIPLE
ÁNBDSJ
NFKJDF
Nasal aspiration
• Treat the root cause(s)
• Energy supply
• Maintain oxygen supply
• Maintain oxygen transportation
• Airway clearance
Nasal cannula
Blood transfusion
Food, Milk
Bronchodilation
Anti-inflammatory

26. • RECOGNITION OF RESPIRATORY FAILURE = EFFORT
EFFICACY
EFFECTS
• CAUSES OF RESPIRATORY FAILURE = DIFFERENTIAL DIAGNOSIS IF NEEDED
• TREATMENT OF RESPIRATORY FAILURE = AIRWAY CLEARANCE IS PRIOR
CHOICE OF OXYGEN SUPPLY DEVICES
MANAGEMENT OF SPECIFIC CAUSE(S)
TAKE HOME MESSAGES
ÁNBDSJ
NFKJDF

27. THANKS FOR YOUR LISTENING