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Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital
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Page 1: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Respiratory Failure in Children

Daniel Sloniewsky, MDAssociate Professor

Division of Critical CareDepartment of Pediatrics

Stony Brook University Hospital

Page 2: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Definitions: Acute Respiratory Failure

ARF is the inability of the respiratory system to deliver O2 and remove CO2 at a sufficient rate to meet the body’s metabolic demands

Can be hypoxic or hypercarbic

ABG abnormalities– PaCO2 > 55 mm Hg (with low pH)– PaO2 < 60 mm Hg– SaO2 < 90% (in absence of cyanotic CHD)

Page 3: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Problems with Oxygenation

Hypoxemia: Decrease in tissue O2 delivery

– Hypoxic Hypoxemia -- Lung Disease– Ischemic Hypoxemia -- Decreased Blood Flow

-- DO2 = O2 content x Cardiac Output

– Anemic Hypoxemia -- Decreased O2-Carrying Capacity

-- O2 Content = (1.39 x HgB x SaO2) + (0.003)(PaO2)

Page 4: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Hypoxic Hypoxemia: Where is the problem?

FIO2 (Ex. Altitude)

Decreased Air Entry-- Sedation (Ex. Opioid Overdose)

-- Respiratory Muscle Weakness (Ex. SMA)

-- Airway Obstruction (Ex. Croup, Asthma, etc)

V/Q Mismatches (Ex. Atelectasis, ARDS)

Shunting (Ex. CHD, pulmonary hypertension)

Diffusion Abnormalities (Ex. Pulmonary Fibrosis, ARDS)

Page 5: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Acute Respiratory Failure: Problems with Ventilation

Hypercapnea (increased CO2) can be seen with:1. Increased Dead Space (areas not involved in gas exchange) (Ex. Asthma, Pulmonary HTN)2. Decreased Alveolar Ventilation

- Decreased Tidal Volume or Respiratory Rate (Ex. Coma, Overdose, MG, ARDS, etc)

3. Obstructed Airways (Ex. Asthma)

4. Increased CO2 production (Ex. Burns,Overfeeding)

CO2 diffuses easily across alveolar-capillary membrane so diffusion problems usually do not cause hypercapnea

Page 6: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Acute Respiratory Failure: How to Diagnose

Clinical Exam -- MOST IMPORTANT1. Changes in RR and Breathing Effort:

Question - Why do infants “tire out?”2. Changes in lung exam (stridor, wheeze, etc.)3. Cyanosis – definition?

Flushing, tachycardia, HA, confusion – seen with acute hypercarbia

Mental Status

Page 7: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Chronic Hypoxemia/Hypercarbia

Clinical signs/lab evidence of chronic hypoxia:

-- Clubbing – seen with chronic hypoxemia

-- What might you see on abdominal exam?

-- Labs: Polycythemia

Lab evidence of hypercarbia

Page 8: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Hypoxic Hypoxemia: How to Diagnose

Pulse oximetry – How does it work? What are its limitations?

Arterial Blood Gas – What information does this provide that pulse-ox does not?

Page 9: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Pulse-oximetry: How does it work?

Current pulse-ox machines measure 2 types of light: red (wavelength=660 nm) and infrared (wavelength= 940 nm)

Red light is better absorbed by deoxy-Hgb, infrared light is better absorbed by oxy-Hgb, so the ratio gives you the SaO2

Page 10: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Pulse-oximetry Problems

1. Doesn’t work well with poor perfusion

2. Other light sources (Ex. phototherapy light) can interfere with the results

3. Abnormal Hgb can lead to overestimation of a true SaO2 (specifically carboxy-, and metHgb)

What laboratory test do you order in someone with met- or carboxy-hgb

Page 11: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Arterial Blood Gas and Oxygenation

ABG – can give you carboxy and metHgb levels (if you ask); will give you co-oximetry values (multiple wavelengths measured)

-- will also give you a PaO2 which can help you diagnose a patient with hypoxemic hypoxia using an equation called ………..

Page 12: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Alveolar Gas Equation

PAO2 = FIO2(PB-PH2O) – PCO2/R– PAO2 = Alveolar oxygen partial pressure– FIO2 = fraction of inspired oxygen– PB = barometric pressure (760 mm Hg at sea

level)– PH2O = partial pressure of water vapor (47 mm

Hg)– PCO2 = partial pressure of CO2

– R = respiratory quotient (usually ~ 0.8)

Page 13: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Alveolar Gas Equation

So at room air at sea level, your PAO2 should be 100

On 100% FIO2 at sea level, your PAO2 should be 663

The difference between Alveolar (PAO2) and arterial (PaO2) oxygen is called the A-a gradient and should be less than 20; this will help you figure out if this is hypoxic hypoxemia and the degree of hypoxia

Page 14: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Given a PaO2, what is the SaO2

(and vice-versa)

Curve moves to right withCurve moves to right with Lower pHLower pH Higher TemperatureHigher Temperature Increased 2,3 DPGIncreased 2,3 DPG

Page 15: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Hypercarbic Respiratory Failure: Who cares about CO2 and pH?

What makes you breathe?Primarily pH (can be PaO2 in some patients)

What happens to you if you are too alkalotic or acidotic? Acidosis: AMS, impaired cardiac contractility, pulmonary

vasoconstriction, metabolic abnormalities, etc.Alkalosis: tetany (sec. to decreased iCa), arrhythmias, etc.

Does it matter what the source of the altered pH is?Yes. For example: metabolic acidosis is worse for you than

respiratory acidosis.

Page 16: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Arterial Blood Gas, pH, and Ventilation

pH < 7.35 with high CO2: respiratory acidosis

pH > 7.35 with high CO2: compensated respiratory acidosis

pH < 7.35 with low bicarb: metabolic acidosis

pH > 7.35 with low bicarb: compensated metabolic acidosis

What is a base deficit?

Page 17: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Base Deficit

Given a normal pCO2, how much base would be needed to correct the pH.

Ex. 7.35/28/80/-15

Page 18: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Arterial Blood Gas, pH, and Ventilation

pH > 7.45 with low CO2: respiratory alkalosis

pH < 7.45 with low CO2: compensated respiratory alkalosis

pH > 7.45 with high bicarb: metabolic alkalosis

pH < 7.45 with high bicarb: compensated metabolic alkalosis

Page 19: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

How to Approach an ABGFirst – Is this an arterial or venous blood gas?

Second - does the patient have an acidosis or an alkalosis – Look at the pH

Third, what is the primary problem – metabolic or respiratory

– Look at the pCO2

– If the pCO2 change is in the opposite direction of the pH change, the primary problem is respiratory

– You never overcompensate

Page 20: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

How to Approach an ABG

Next, don’t forget to look at the effectiveness of oxygenation, (and look at the patient)– your patient may have a significantly

increased work of breathing in order to maintain a “normal” blood gas

– metabolic acidosis with a concomitant respiratory acidosis is concerning

Page 21: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Case 1

Sameer got into some of Dad’s barbiturates. He suffers a significant depression of

mental status and respiration. You see him in the ER 3 hours after ingestion with a respiratory rate of 12. A blood gas is

obtained. It shows pH = 7.16, pCO2 = 70, HCO3 = 22

Page 22: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Case 1

What is the acid/base abnormality?

1. Uncompensated metabolic acidosis

2. Compensated respiratory acidosis

3. Uncompensated respiratory acidosis

4. Compensated metabolic alkalosis

Page 23: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Case 2

You are evaluating a 15 year old female in the ER who was brought in by EMS from school because of abdominal pain and vomiting. Review of system is negative except for a 10 lb. weight loss over the past 2 months and polyuria for the past 2 weeks. She has no other medical problems and denies any sexual activity or drug use. On exam, she is alert and oriented, afebrile, HR 115, RR 26 and regular, BP 114/75, pulse ox 95% on RA.

Page 24: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Case 2

Exam is unremarkable except for mild abdominal tenderness on palpation in the midepigastric region and capillary refill time of 3 seconds. The nurse has already seen the patient and has sent off “routine” blood work. She hands you the result of the blood gas. pH = 7.21 pCO2= 24 pO2 = 45 HCO3 = 10 BE = -10 saturation = 72%

Page 25: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Case 2

What is the blood gas interpretation?

1. Uncompensated respiratory acidosis with severe hypoxia

2. Uncompensated metabolic alkalosis

3. Combined metabolic acidosis and respiratory acidosis with severe hypoxia

4. Metabolic acidosis with respiratory compensation

Page 26: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Case 3

10 year old with history of ALL and neutropenia presents with tachypnea. He has no O2 requirement but is breathing 30 – 40 times/minute. Lung exam (other than the tachypnea) is normal. CXR shows no infiltrate. An ABG is done: 7.45/30/90/22 on room air. Does this patient need a bronchoscopy to diagnose his respiratory compromise? Why or why not?

Page 27: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Case 3

Answer: No; This is a trick question because he doesn’t have respiratory compromise

The patient is tachypneic for some other reason than acidosis, hypercarbia, or hypoxia (i.e. increased intracranial pressure, burgeoning sepsis, etc)

Page 28: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Other Laboratory Findings in ARF

CXR Abnormalities

Complete Blood Count (look at WBC and Hgb, which may suggest chronic hypoxia)

Electrolyte Abnormalities (look at bicarbonate)

Page 29: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Foreign Body AspirationForeign Body Aspiration

Page 30: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Right LungAtelectasis

Page 31: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Left LungPneumoniawith Effusion

Page 32: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Pneumothorax

Page 33: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

ARDS(BilateralInfiltrates)

Page 34: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.
Page 35: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Flail ChestFlail Chest

Page 36: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

A Case of Hypoxia

4 yo presents to the ER with fever and cough. On examination, the patient has the following vital signs: T 39.9, P 130, RR 32, O2 sats 87-90% on RA, Nl BP’s

PE: Lungs – tachypneic with good breathing effort, clear lung sounds, Cardiac -- 2/6 SEM at LSB, good pulses in all extremities Extremities -- mild clubbing of fingers and toes

Labs: WBC ct = 9.6, H/H = 14/41, platelets = 192kElytes normal except bicarbonate = 20; LFT’s Nl except AP = 358CXR showed normal sized heart, possible infiltrate in hilar area

Patient is admitted to the hospital with a diagnosis of pneumonia and is started on appropriate abx and supplemental oxygen. He defervesces after 24 hours but still has O2 saturations in the low 90’s that increase to mid-90’s on 4L NC. Physical exam remains the same and the repeat CXR is negative.

What is the cause of his hypoxia?

Page 37: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Clinical Scenario

Decreased O2 Availability? No

Decreased Air Entry? No

V/Q Mismatches? Possible

Shunt? Possible

Diffusion Problems? Possible

What lab test do you want to prove this?

Page 38: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Clinical Scenario

Arterial Blood Gas:ABG on RA: 7.27 / 57 / 52ABG on 100% O2: 7.29 / 60 / 69

What should his PaO2 be on RA and 100% FIO2?

RA = 78.5100% FIO2 (through NRB) > 353

Do these ABG’s confirm our suspicions about V/Q mismatch, shunt, or diffusion abnormalities? What role does the high pCO2 play?

Now what tests do you want?

Page 39: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Clinical Scenario

Echocardiogram = no lesions

Chest CT = loss of volume in the LLL with small consolidation, patchy atelectasis of right lung; enlarged caliber of the pulmonary vasculature in the dependent lung zones; rapid injection of contrast showed early filling of the pulmonary veins

Ventilation/perfusion scan = normal ventilation; no segmental defects in perfusion

So, what test was done to get a diagnosis?

Answer: Liver biopsy that confirmed the diagnosis of hepatopulmonary syndrome

Page 40: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

ARF -- Treatment

Monitoring– invasive (ABG, PAC) or noninvasive (pulse-

oximeter)

Prevention– Encourage coughing, frequent position

changes, reflux precautions, decompress abdomen, etc.

Page 41: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

ARF -- Treatment

Surgical: Thoracostomy tubes

Medications:– -agonists– Anticholinergics– Anti-inflammatory agents (steroids, NSAIDS)– Surfactant– Nitric Oxide

Page 42: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

ARF -- Treatment

O2 Delivery Systems: Low vs. High FlowLow Flow:

– Nasal Cannula: FIO2 < 40% (1L/min ~ 3%)– Blow-by O2

High Flow:– Head Hood: Flow >10 l/min– Venturi Face Masks: FIO2 ~ 50%– Nonrebreather Mask: FIO2 ~ 80-100%– Bag-Mask-Valve Units: FIO2 ~ 100%

Page 43: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

ARF -- Treatment

Continuous or Bilevel Positive Pressure (CPAP or BIPAP) -- applied through a tight-fitting mask

Best applied in an awake, cooperative patient who is expected to improve in 48-72 hours.

Page 44: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

ARF – Treatment with Mechanical Ventilation

Always Remember: Bag-mask ventilation is an effective method to oxygenate patients: use BMV if conditions are not ideal for intubation

Mechanical Ventilation: Indications– Airway Protection – Respiratory Failure– Shock– Treatment of Intracranial Hypertension– Other (for procedures, pulmonary toilet, etc.)

Page 45: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation: Modes

AC – assist control– no spontaneous breaths– delivers full breath with any ventilator and patient

initiated effort

SIMV -- synchronized intermittent mandatory ventilation– ventilator breaths synchronized with patient’s own

breaths– weaning mode

Page 46: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation: Modes

Pressure Ventilation (Control)– the size of the breath is determined by the pressure

that is set– the tidal volume then depends on the lung compliance

(it is the dependent variable)

Volume Ventilation (Control)– the size of the breath is determined by the volume

that is set– the pressure is the dependent variable

Page 47: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation: Goals

Your goals for gas exchange when a patient is on a ventilator must not be so rigid as to cause further injury to the lung when trying to obtain them.

Oxygenation is more important than ventilation

You should try to keep the FIO2 < 60%, the PIP < 35-40 cm H20, and the TV ~6-8 cc/kg

Page 48: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation: Terminology

Mean Airway Pressure (MAP): the average pressure over a respiratory cycle, measured at the proximal airway

Peak Inspiratory Pressure (PIP): the maximum amount of pressure needed to deliver a breath

Positive End Expiratory Pressure (PEEP): pressure applied at the end of exhalation

I time: total time spent during inspiration

Page 49: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation: Terminology

Tidal Volume: the size (volume) of the breath– goal ~ 6-10 cc/kg

Minute Ventilation: total volume of air inspired in one minute

Compliance: relationship of volume to pressure– C = V / P

Page 50: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation

Oxygenation – determined by FIO2 and Mean Airway

Pressure– MAP is determined by PEEP, PIP, and

inspiratory time (I time)

Ventilation– determined by rate and TV– rate x TV = MV

Page 51: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation -- Supportive Care

Fluids and electrolytes: permissive hypercapnia

Nutrition

HOB up at 30o

Suctioning/Chest PT

Page 52: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation -- Monitoring

ABG/VBG

Pulse-oximetry

EtCO2 -- depends on reason for respiratory failure (not good with obstructive diseases like asthma or if there is a big air leak around the ETT)

Page 53: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation -- Weaning

Is the problem solved?

Is the patient awake?

Is the patient NPO

Is there an airleak around the ETT

What are the mode of ventilation and settings?

Page 54: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Mechanical Ventilation --Complications

Oxygen Toxicity: keep O2 < 60%

Barotrauma/Volutrauma: Keep PIP < 35-40 and TV < or = to 6-8 cc/kg

Atelectasis

Ventilator Associated Pneumonia: keep HOB up at 30o

Fluid Retention

Airway Trauma: uncuffed tubes when <6 yo

Page 55: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

ARF -- Alternate Therapies

HFOV -- High Frequency Oscillatory Ventilation: used for problems with oxygenation, not very good for ventilation

ECMO -- Extra-corporeal membrane oxygenation

Liquid Ventilation – oxygen dissolves well in perfluorocarbons which can be used for gas exchange: only used in the lab

Page 56: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.
Page 57: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.
Page 58: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.
Page 59: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Summary

When a patient is in respiratory failure, you must decide the primary gas exchange problem.

While the clinical exam is the most important method of diagnosing someone with ARF, an ABG can help you with the diagnosis and can tell you the degree of hypoxia or hypercarbia

Page 60: Respiratory Failure in Children Daniel Sloniewsky, MD Associate Professor Division of Critical Care Department of Pediatrics Stony Brook University Hospital.

Summary

If hypoxia is the problem, going through the algorithm may help you decide which tests and therapies you need

If hypercarbia is the problem, going through that algorithm may help you manage the patient

A thoughtful, goal-directed approach to therapies must also be used in treating respiratory failure.


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