Paediatrics: Respiratory distress -Management

2021-04-15 10:50 AM

Respiratory drive: pattern and timing of breathing may reflect a central or brainstem cause.

Respiratory distress: management

Clinical assessment

Assess the patient for the following:

  • Colour: pallor or cyanosis.
  • Respiratory drive: pattern and timing of breathing may reflect a central brainstem cause.
  • Inspiration and expiration of air at the mouth and nose: upper airway obstruction produces stridor; lower airway obstruction leads to cough, wheeze, and a prolonged expiratory phase.
  • Chest wall movement: chest and abdominal wall dynamics may indicate flail-chest, diaphragmatic palsy, pneumothorax, or foreign body inhalation.
  • Position and level of agitation.
  • Mental state.
  • Heart rate and perfusion: these may reflect impending arrest.

Investigations

  • Non-invasive: pulse oximetry measurement of oxyhaemoglobin saturation, pulse oximetry measurement of oxyhaemoglobin saturation (SpO2).
  • Arterial blood gas: assessment of acid-base, PaO2, PaCO2. A capillary blood sample is a good alternative (for pH, PCO2) if the extremity is warm and the blood flows freely.
  • Blood tests: full blood count (FBC), electrolytes, glucose, and cultures.
  • CXR: for diagnosis (e.g. severe pneumonia); for assessment ofcomplications (e.g. pulmonary oedema, pneumothorax).

Monitoring

  • Pulse oximetry.
  • Continuous ECG.
  • BP.
  • Temperature.
  • Fluid balance.
  • Conscious level.

Therapy

There are specific therapies for each condition listed in the ‘Differential diagnoses’. With regard to fluid therapy, we generally restrict total volume to 80% maintenance for the following reasons.

  • Distress with retraction: high –ve intrathoracic pressure will pull fluid out of capillaries into the interstitial space and will aggravate breathing with pulmonary oedema.
  • Syndrome of inappropriate antidiuretic hormone (SIADH): this is a common problem in moderate to severe respiratory distress.
  • Diuresis is limited: in the hydrated patient consider using furosemide(0.5–1mg/kg, IV). It may help the patient with extra-interstitial water without overt oedema.