Acute Respiratory Failure In Children Research Articles

Clinical Profile and Outcome of Acute Respiratory Failure in Children: A Prospective Study in a Tertiary Care Hospital

Background : It was to study the clinical pattern of acute respiratory failure in children from 1 month to 15 years of age and to determine the outcome of respiratory failure in relation to underlying etiology and associated factors. Methods : A hospital-based prospective study was conducted on 115 children in the age group from 1 month to 15 years. The duration of the study was 18 months. Acute respiratory failure was identified in any patient presenting with respiratory arrest or respiratory distress with SpO 2 < 90%. The arterial blood gas (ABG) was done in all the patients showing signs of respiratory distress/altered respiratory pattern, and were included in the study if PaO 2 < 50 mm Hg  and/or PaCO 2 > 60 mm Hg. Results: Maximum patients (56.52%) were observed in the age group of 1 month to 1 year and majority was males. Pulmonary diseases accounted for majority (62.60%) of cases, followed by nervous system (23.50%), sepsis (9.56%) and cardiovascular system diseases (4.34%). The respiratory failure was classified into three types based on ABG analysis, of which hypoxic respiratory failure (type 1) was the commonest (74.78%). The commonest cause of respiratory failure and mortality was bronchopneumonia (42.60%). About one-third of the patients (33.91%) required ventilation support. Overall mortality rate was 14.14%. Among the malnourished children maximum number had grade IV malnutrition, and the mortality rate increased with the grade of malnutrition. Conclusion : The commonest type of respiratory failure was hypoxic type, and bronchopneumonia was the commonest cause of mortality. Int J Clin Pediatr. 2014;3(2):46-50 doi: http://dx.doi.org/10.14740/ijcp145w

Efficiency of oxygen therapy by head box for acute respiratory failure in infants

Oxygen therapy is the main treatment method for acute respiratory failure in children. The method consisting in the administration of oxygen therapy by head box to infants is frequently used in pediatric practice. Objectives. To evaluate the efficiency of oxygen therapy administered by head box to infants suffering from pneumonic acute respiratory failure by comparing two methods for measuring hemoglobin oxygen saturation: in arterialized capillary blood and by pulse oximetry. Material and method. 30 infants suffering from pneumonic acute respiratory failure were studied. We used a clinical appraisal score for acute respiratory failure, which appraises respiratory rate, nasal flaring, recession, cyanosis, sensorial, before and after oxygen therapy. In arterialized capillary blood we measured partial pressure of oxygen and hemoglobin oxygen saturation, and we used an Automatic Blood Gas System analyzer. We also measured hemoglobin oxygen saturation using a pulse oximeter. Determinations were made before the initiation of oxygen therapy, and 30 minutes and 60 minutes after the initiation of oxygen therapy. Results. As compared to the baseline values, determined before the initiation of oxygen therapy, we recorded a statistically significant improvement in the clinical score both after 30 minutes and 60 minutes from the initiation of oxygen therapy (p<0.001). The improvement was greater after 60 minutes. The increase in the partial pressure of oxygen was statistically significant both at the 30 minute and 60 minute determination (p<0.001). Both methods of SaO2 measurement recorded statistically significant increases (p<0.001) in this variable after 30 and 60 minutes, respectively. Conclusions. Oxygen therapy administered by head box improves acute respiratory failure appraised by clinical score. The administration of oxygen therapy by head box to infants significantly increases the values of partial pressure of oxygen and hemoglobin oxygen saturation measured in capillary blood, as well as the values of hemoglobin oxygen saturation determined by pulse oximeter both after 30 minutes and after 60 minutes. The increases in the three parameters are larger after 60 minutes. There is statistically significant concordance between the values of hemoglobin oxygen saturation determined in capillary blood and by pulse oximetry at all determinations.

Acute respiratory failure in children

Acute respiratory failure is the most common medical emergency in children. One aim of this review is to discuss the physiologic peculiarities that explain the increased vulnerability of infants and children to any pathology affecting the respiratory tract. The other aim is to highlight the importance of history taking and correct physical examination for early recognition of an impending catastrophic progression of respiratory failure. Under most circumstances, correct physical examination alone allows one to pinpoint the cause to a particular part of the respiratory system and to make the appropriate decisions for a proactive and life-saving management of the critically ill child.

Adenovirus Serotype 3 and 7 Infection with Acute Respiratory Failure in Children in Taiwan, 2010–2011

ObjectiveIncreased incidence of adenovirus infection in children was noticed since September 2010 in Taiwan and severe cases requiring intensive care were noted later. We did this study to find the clinical characteristics and risk factors associated with severe adenovirus infection.Patients and MethodsWe collected cases of severe adenovirus infection between November 2010 and June 2011 to analyze their clinical characteristics in two medical centers in northern Taiwan. Severe adenovirus infection was defined as laboratory-confirmed adenovirus cases with required intensive care. Hexon gene sequencing was performed for molecular genotyping.Results45 patients were included, 22 cases (49%) were infected with serotype 7, 19 (42%) with serotype 3, and 4 with serotype 2. The median age (range) was 2.75 years (0.08–15.43 years); 87% were below 5 years. Male to female ratio was 1.65 (28 to 17). Of these patients, 56% had underlying neurological diseases, 50% experienced fever higher than 40°C and 69% suffered fever longer than one week. The clinical diagnosis included pneumonia in 40 (89%) patients, bronchopneumonia in 5 (11%), and encephalitis in 7 (16%). At least 22 patients had pleural effusion. They had complications of respiratory failure (53%), acute respiratory distress syndrome (24%), hypotension (40%), and 6 (13%) patients needed extracorporeal membranous oxygenation. Ten (22%) patients died, all with underlying major systemic diseases and 7 (70%) infected with serotype 7.ConclusionsAdenovirus serotype 7 and 3 can cause severe disease–even death–in children, especially those with underlying neurological diseases. Patients infected with adenovirus serotype 7 tended to have a higher case-fatality rate.

Assessment and initial management of acute respiratory failure in children

Diseases of the respiratory system are some of the leading causes of child care in emergency services, with severity ranging from mild and self-limiting to life-threatening. Undetected acute respiratory failure is the main cause of cardiac arrest in children. The ability to recognize, produce an early diagnosis, and properly manage respiratory impairments in children are essential skills for doctors working in emergency services. The purpose of this article is to present an approach to systematic evaluation so as to enable early diagnosis and initial management of acute respiratory failure in children in emergency services.

Non-invasive ventilation in acute respiratory failure in children.

The aim of this paper is to assess the clinical efficacy of non-invasive ventilation (NIV) in avoiding endotracheal intubation (ETI), to demonstrate clinical and gasometric improvement and to identify predictive risk factors associated with NIV failure. An observational prospective clinical study was carried out. Included Patients with acute respiratory disease (ARD) treated with NIV, from November 2006 to January 2010 in a Pediatric Intensive Care Unit (PICU). NIV was used in 151 patients with acute respiratory failure (ARF). Patients were divided in two groups: NIV success and NIV failure, if ETI was required. Mean age was 7.2±20.3 months (median: 1 min: 0,3 max.: 156). Main diagnoses were bronchiolitis in 102 (67.5%), and pneumonia in 44 (29%) patients. There was a significant improvement in respiratory rate (RR), heart rate (HR), pH, and pCO2 at 2, 6, 12 and 24 hours after NIV onset (P<0.05) in both groups. Improvement in pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) was verified at 2, 4, 6, 12 and 24 hours after NIV onset in the success group (P<0.001). In the failure group, significant SpO2/FiO2 improvement was only observed in the first 4 hours. NIV failure occurred in 34 patients (22.5%). Risk factors for NIV failure were apnea, prematurity, pneumonia, and bacterial co-infection (P<0.05). Independent risk factors for NIV failure were apneia (P<0.001; odds ratio 15.8; 95% confidence interval: 3.42–71.4) and pneumonia (P<0.001, odds ratio 31.25; 95% confidence interval: 8.33–111.11). There were no major complications related with NIV. In conclusion this study demonstrates the efficacy of NIV as a form of respiratory support for children and infants with ARF, preventing clinical deterioration and avoiding ETI in most of the patients. Risk factors for failure were related with immaturity and severe infection.

Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review

Noninvasive positive pressure ventilation (NPPV) refers to the delivery of mechanical respiratory support without the use of endotracheal intubation (ETI). The present review focused on the effectiveness of NPPV in children > 1 month of age with acute respiratory failure (ARF) due to different conditions. ARF is the most common cause of cardiac arrest in children. Therefore, prompt recognition and treatment of pediatric patients with pending respiratory failure can be lifesaving. Mechanical respiratory support is a critical intervention in many cases of ARF. In recent years, NPPV has been proposed as a valuable alternative to invasive mechanical ventilation (IMV) in this acute setting. Recent physiological studies have demonstrated beneficial effects of NPPV in children with ARF. Several pediatric clinical studies, the majority of which were noncontrolled or case series and of small size, have suggested the effectiveness of NPPV in the treatment of ARF due to acute airway (upper or lower) obstruction or certain primary parenchymal lung disease, and in specific circumstances, such as postoperative or postextubation ARF, immunocompromised patients with ARF, or as a means to facilitate extubation. NPPV was well tolerated with rare major complications and was associated with improved gas exchange, decreased work of breathing, and ETI avoidance in 22-100% of patients. High FiO2 needs or high PaCO2 level on admission or within the first hours after starting NPPV appeared to be the best independent predictive factors for the NPPV failure in children with ARF. However, many important issues, such as the identification of the patient, the right time for NPPV application, and the appropriate setting, are still lacking. Further randomized, controlled trials that address these issues in children with ARF are recommended.

Noninvasive ventilation for acute respiratory failure in children - a systematic review.

To assess the role of noninvasive ventilation in the treatment of children with acute respiratory failure. A systematic review of literature on noninvasive ventilation in MEDLINE, LILACS, EMBASE, and Cochrane databases, besides references in articles. The outcomes evaluated were responses in blood oxygenation and ventilation, and patient survival. A total of 120 studies on noninvasive ventilation were found as of May, 2010. Of these, only 19 were about noninvasive ventilation in children. On the other hand, there are prospective and cohort clinical trials leading to a level II quality of evidence concerning the use of noninvasive ventilation in children. There is scientific evidence for proposing the use of noninvasive ventilation, with a B-II degree of recommendation.

Ventilación de Alta Frecuencia en Infección Respiratoria Grave por VRS

High frequency oscillatory (HFOV) has been progressively useful in children with severe hypoxemic and Iry-percapnic respiratory insufficiency, at Pediatric Intensive Care Units. Objectives: To describe our experience in treatment of children with severe RSV infection unresponsive to conventional ventilation (CV), to describe effectiveness in gas exchange and to evaluate the safety of the method. A descriptive and prospective study set at two paediatric intensive care units, in Hospital Roberto del Rio and Clinica Santa Maria of Santiago, Chile between January 2001 and December 2004. Results: 36 patients between 0.5 and 10 months of age with severe RSV infection and respiratory failure unresponsive to mechanical ventilation were connected to HFOV after an average time of conventional ventilation of 2.6 days. Arterial pH improved during the first hour in HFOV from 7.18 to > 7.3. Initial PaO 2 /FiO 2 in average was 104.8, there was a slow and progressive improvement until 72 hours (138). FiO 2 diminished since an average of 74% till 63.6% at 72 hours pCO 2 went down from an average of 88 mm de Hg pre HFOV to 50 mmHg at 12 hours, remaining low. Oxygenation Index, preHFOV, was in average 18 and it maintained in 17 at 72 hours, with a FiO 2 < 60%. Patients were hold in HFOV between 2-18 days. 3/36 patients died after 1.5, 4 and 18 days of HFOV. 8,3% presented air leak. One of these patients is oxygen dependent after 12 months of foliowing. Conclusions: High frequency oscillatory ventilation is a useful method in the management of acute respiratory failure in children with severe infection for RSV unresponsive to conventional ventilation. It can improve gas exchange slowly and progressively with a low risk of air leak, secuelae and death.

The effect of biphasic extrathoracic cuirass ventilation for acute respiratory failure in children

The effect of biphasic extrathoracic cuirass ventilation for acute respiratory failure in children

The treatment of bronchiolitis

Bronchiolitis is the commonest reason for hospital admission in infancy and the most frequent cause of acute respiratory failure in children admitted to paediatric intensive care units in the UK...

Surfactant therapy for acute respiratory failure in children: a systematic review and meta-analysis

IntroductionExogenous surfactant is used to treat acute respiratory failure in children, although the benefits and harms in this setting are not clear. The objective of the present systematic review is to assess the effect of exogenous pulmonary surfactant on all-cause mortality in children mechanically ventilated for acute respiratory failure.MethodsWe searched the MEDLINE, EMBASE, CINAHL and Ovid Healthstar databases, the bibliographies of included trials and review articles, conference proceedings and trial registries. We included prospective, randomized, controlled trials of pulmonary surfactant that enrolled intubated and mechanically ventilated children with acute respiratory failure. We excluded trials that exclusively enrolled neonates or patients with asthma. Two reviewers independently rated trials for inclusion, extracted data and assessed the methodologic quality. We quantitatively pooled the results of trials, where suitable, using a random effects model.ResultsSix trials randomizing 314 patients were included. Surfactant use reduced mortality (relative risk = 0.7, 95% confidence interval = 0.4 to 0.97, P = 0.04), was associated with increased ventilator-free days (weighted mean difference = 2.5 days, 95% confidence interval = 0.3 to 4.6 days, P = 0.02) and reduced the duration of ventilation (weighted mean difference = 2.3 days, 95% confidence interval = 0.1 to 4.4 days, P = 0.04).ConclusionSurfactant use decreased mortality, was associated with more ventilator-free days and reduced the duration of ventilation. No serious adverse events were reported.

Surfactant for acute respiratory failure in children: where should it fit in our treatment algorithm?

In a recent meta-analysis, surfactant administration in paediatric acute respiratory failure was associated with improved oxygenation, reduced mortality, increased ventilator-free days and reduced duration of ventilation. Surfactant is expensive, however, and its use involves installation of large volumes into the lungs, resulting in transient hypoxia and hypotension in some patients. Many questions also remain unanswered, such the as optimum dosage and the timing of administration of surfactant. The merits of surfactant administration should therefore still be decided on an individual case-by-case basis.

O papel da ventilação líquida no tratamento da insuficiência respiratória aguda em crianças - uma revisão sistemática

Liquid Ventilation consists of partially or completely filling the lungs with a fluid (perfluorcarbon). This brings about elimination of the air-liquid interface and reduction of the surface tension in lungs with surfactant deficiency. This article focuses on the role of liquid ventilation in the treatment of acute respiratory failure in children. A systematic review of literature was conducted using MEDLINE, LILACS and COCHRANE LIBRARY databases and references of articles. Match terms were: Liquid Ventilation, Respiratory Distress Syndrome, Meconium Aspiration Syndrome, Congenital Diaphragmatic Hernia and Acute Respiratory Distress Syndrome. Randomized clinical trials, cohort studies and case control studies were searched for. Blood oxygenation, respiratory mechanics and survival were the outcomes evaluated. Two hundred eighty four publications related to liquid ventilation were selected during the study period: 19 (7.5%) were clinical trials and only six of them focused on the use of Liquid Ventilation in children. All six publications were characterized as phase I and II clinical trials and analyzed separately. Upon analysis of these trials it was concluded that, because of the lack of controlled and randomized clinical trials, liquid ventilation cannot be recommended as a therapy for children with acute respiratory failure.

The role of high-frequency oscillatory ventilation in paediatric intensive care

Mechanical ventilation during acute respiratory failure in children is associated with development of ventilator-induced lung injury. Experimental models of mechanical ventilation that limit phasic changes in lung volumes and prevent alveolar overdistension appear to be less damaging to the lung. High-frequency oscillatory ventilation, using very small tidal volumes and relatively high end-expiratory lung volumes, provides a safe and effective means of delivering mechanical ventilatory support with the prospect of reducing the development of ventilator-induced lung injury. Despite theoretical advantages and convincing laboratory data, however, the use of high-frequency oscillatory ventilation in the paediatric population has not yet been associated with significant improvements in clinically significant outcome measures.

Inhaled Nitric Oxide for Acute Respiratory Failure in Children and Adults

Inhaled Nitric Oxide for Acute Respiratory Failure in Children and Adults

Approaches in the management of acute respiratory failure in children.

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are conditions that are associated with significant morbidity and mortality in children. There have been no advances in preventing ARDS, but this review highlights strategies directed at minimizing ventilator-induced lung injury and other new adjunctive therapies in the care of these patients. High-frequency oscillatory ventilation, airway pressure release ventilation, and partial liquid ventilation are potential protective ventilatory modes for children with ALI or ARDS. Recruitment maneuvers, prone positioning, and kinetic therapy are all reported to improve oxygenation by opening the lung while positive end-expiratory pressure maintains functional residual capacity. Inhaled nitric oxide and surfactant are used to reduce inspired oxygen concentration and facilitate gas exchange, but their efficacy in ARDS continues to be investigated. Also, early investigations suggest that a specialized enteral formula can be a useful adjunctive therapy by reducing lung inflammation and improving oxygenation. When mechanical ventilation and adjunctive therapies fail, extracorporeal life support continues to be used as a rescue therapy. It is likely that a combination of these therapies will maximize treatment and clinical outcomes in the future, but the only way that will be proven is through large controlled clinical trials in pediatric patients.

Terapia com surfactante pulmonar exógeno em pediatria

OBJETIVO: Revisar o estagio atual do conhecimento sobre a utilizacao do surfactante exogeno nas diferentes doencas pulmonares que levam a insuficiencia respiratoria aguda em criancas. FONTES DOS DADOS: Este manuscrito baseia-se na experiencia clinica dos autores sobre o assunto e na revisao da literatura recente atraves de consulta aos bancos de dados ONIA, Mdconsult, Medline e Cochrane Database Library. SINTESE DOS DADOS: Apesar do sucesso obtido com a utilizacao do surfactante exogeno na sindrome de desconforto respiratorio do recem-nascido, questoes permanecem indefinidas, como o momento do seu emprego, muito precoce (profilatico), baseado na idade gestacional ou em testes rapidos de maturidade pulmonar, ou entao mais tardiamente, apos o quadro clinico instalado. Em outras patologias graves que levam a insuficiencia respiratoria grave com necessidade de suporte ventilatorio, o seu uso ainda e controverso, e os dados da literatura sao limitados e conflitantes. Porem, relatos de uso clinico em varias destas situacoes, com sucesso, tem sido frequentes. A pesquisa em surfactante tem-se centrado ultimamente na sua inativacao por varias substâncias que podem estar presentes na via aerea. Nas patologias em que a inativacao parece ser um fator importante, novos surfactantes com adicao de adjuvantes para reverter a tendencia a inativacao (por exemplo: polietilenoglicol) estao atualmente em fase de testes. CONCLUSOES: A terapia com surfactante exogeno ainda nao e um tema esgotado, nem mesmo na SDR. Os surfactantes podem ser ainda aperfeicoados, sobretudo para resistir a inibicao, e as formas de utilizacao em outras doencas que nao a SDR deverao ser aperfeicoadas.

Diffuse Alveolar Hemorrhage Following Allogeneic Bone Marrow Transplantation in Children

Diffuse alveolar hemorrhage (DAH) is a frequent life-threatening complication of bone marrow transplantation (BMT) in adults. This noninfectious pulmonary disorder is rarely reported following BMT in neonates and children. To review the clinical features and course of children who underwent allogeneic BMT and developed DAH in the posttransplant period. A retrospective 6-year chart review. Pediatric ICU in a university hospital. At total of 138 children who had undergone allogeneic BMT for nonmalignant (n = 66) or malignant (n = 72) diseases. Six of 138 children (4.3%) aged 2 months to 10 years (male/female ratio, 1:1) developed DAH. Each had a fulminant course with rapidly developing severe respiratory failure, mandating mechanical ventilation within 24 h following symptom onset. They were all treated with methylprednisolone, 6 mg/kg/d for 3 days. Only one child survived, and there have been no sequelae at 2 years post-BMT. Four children died of respiratory causes, and one died of multiorgan failure. DAH is a potentially fatal respiratory complication that should be included early in the differential diagnosis of acute respiratory failure in children following allogenic BMT for both malignant and nonmalignant diseases. Therapy with high doses of steroids apparently do not affect the course of the disease.

Invasive mechanical ventilation for acute respiratory failure in children with cystic fibrosis: outcome analysis and case-control study.

The outcome for cystic fibrosis (CF) patients requiring intubation and invasive mechanical ventilation (IMV) due to acute respiratory failure (ARF) has been poor. Mortality rates have been reported as high as 60-90%. However, a review of mortality in children has not been published in 20 years. Our objectives were to study outcomes in CF patients requiring IMV due to ARF between 1988-1998, compare recent outcomes with those previously reported, and identify risk factors associated with poor outcome. We additionally attempted to identify factors suggesting an increased risk of developing ARF requiring IMV. A retrospective cohort study design was used, comparing IMV survivors and nonsurvivors with a nested case-control study to identify risk factors for ARF leading to IMV. All patients cared for at our Center who required IMV for ARF between 1988-1998 were identified. Outcome, age, steroid use, forced vital capacity (FVC), forced expired volume in 1 sec (FEV(1)), microbiology, nutritional status, CF-related diabetes (CFRD), liver dysfunction, and history of major hemoptysis (HEM) or pneumothorax (PTX) were recorded. Cases were matched for gender and age with CF controls identified through a clinical database.Thirty-eight episodes of IMV due to ARF were reported in 33 patients. Three subjects underwent IMV on two or more occasions, but only the first episode was included in analysis. Older age was the only factor that was significantly associated with mortality: 9 subjects were <5 years of age (mortality, 22%), while 24 were 5-34 years old (mortality, 75%) (P = 0.013). There was an increased risk of having an episode of ARF requiring IMV in malnourished subjects (OR = 4.2; 95% CI = 1.66-10.51) and in those with a history of HEM (OR = 6.3; 95% CI = 1.75-22.65). Infants and young children with CF requiring IMV due to ARF have a favorable prognosis, whereas those >or=5 years of age suffer significantly higher mortality. Malnutrition and a history of HEM are important risk factors for having an episode of ARF requiring IMV.