Author: Dorothy Chen, MD
Respiratory failure is the inability of the respiratory system to facilitate adequate gas exchange and meet the metabolic needs of the body. Failure of the respiratory system can be caused by abnormalities in the respiratory, neuromuscular, or central nervous system. Respiratory distress is defined as signs of increased work of breathing, nasal flaring, use of accessory muscles, and inspiratory retractions. This does not always accompany respiratory failure, because respiratory failure can be due to lack of respiratory effort. Within the pulmonary system, there can be hypoventilation, diffusion impairment, intrapulmonary shunting or a ventilation-perfusion mismatch. Abnormal arterial pO2 and pCO2 is found in respiratory failure, but it is not necessary to measure and document these values prior to initiating care. Physical exam is the key to determining respiratory failure and treatment should not be delayed for blood gas analysis.
The ABCs of Pediatric Advanced Life Saving are vital to recognizing respiratory failure; patients should be assessed for airway, breathing, and circulation. The airway should be examined to be clear and maintainable without intervention. For breathing, it is important to assess for signs of upper and lower airway obstruction, respiratory rate, respiratory effort, the adequacy of ventilation, use of accessory muscles, and signs of cyanosis. When assessing circulation, evaluate responsiveness, heart rate, blood pressure, and perfusion. If respiratory failure is identified, intubation should be initiated. Timely intervention and treatment of respiratory failure improves outcomes. The natural progression of respiratory failure will result in pulseless cardiac arrest, so intervention should not be delayed.
ABG analysis is useful in evaluating perfusion, ventilation, and respiratory versus metabolic acidosis. However, one ABG is only a single lab value and still needs to be considered in the context of the clinical scenario. It can be obtained as a component of the comprehensive evaluation and as confirmation of the clinical exam, but ABGs are not required before intervening and treating a patient for respiratory failure. The basics of Pediatric Advance Life Saving should always be initiated: access airway, breathing and circulation.
American Academy of Pediatrics, American Heart Association. PALS Provider Manual. Dallas: American Academy of Pediatrics, American Heart Association; 2002.
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Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Williams & Wilkins.
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Title: Avoiding Common Pediatric Errors Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7489-6 
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