Pediatric diseases requiring respiratory care
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Pediatric Diseases Requiring Respiratory Care. Mary P. Martinasek BS,RRT Director of Clinical Education Hillsborough Community College. ARDS. Acute Respiratory Distress Syndrome Mortality 60% Pathophysiology VQ mismatch Pulmonary hypertension Reduced compliance Pulmonary infiltrates.

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Pediatric diseases requiring respiratory care

Pediatric Diseases Requiring Respiratory Care

Mary P. Martinasek BS,RRT

Director of Clinical Education

Hillsborough Community College


ARDS

  • Acute Respiratory Distress Syndrome

  • Mortality 60%

  • Pathophysiology

    • VQ mismatch

    • Pulmonary hypertension

    • Reduced compliance

    • Pulmonary infiltrates


ARDS

  • Direct or Indirect Injury

  • Four distinct phases

    • I - dyspnea and tachypnea

    • II - 12 - 24 hours,alveolar damage, infiltrate on CXR

    • III - leaky alveolar capillary membranes

    • IV - progressive respiratory failure


ARDS

  • Signs and Symptoms

    • Initially = crackles, dyspnea, retractions, grunting, RR

    • Then compliance worsens, adventitious sounds more apparent, Vd 

  • Treatment

    • Supporting the lungs

    • Surfactant

    • Nitric Oxide

    •  lung edema

    • PGE ?


Asthma
Asthma

  • Most common pediatric disease

    Hyperreactive Airway

  • Etiology unknown

  • Pathophysiology

    • 2 phases

      • Early acute allergic phase

        • Spasm of bronchial smooth muscles

      • Late Inflammatory phase

        • Hypersecretion of mucus

        • Goblet cell hyperplasia

        • Smooth muscle hypertrophy

        • Influx of inflam. Cells into the airway


  • Late Phase reactions lead tosmall airway obstruction air trapping auto peep VQ mismatch

    More negative intrapulmonary pressure to maintain Tidal Volume


Precipitating factors
Precipitating Factors

  • Allergens

  • Outdoor irritants

  • Indoor irritants

  • Exercise

  • Viral infections

  • Foods

  • Emotions

  • Aspirin and related drugs


Asthma1
Asthma

  • Signs and Symptoms

    • Wheezing, RR, HR

    • SOB

    • Four stages according to ABG

  • Treatment

    • Avoid precipitating factors

    • Keep PaO2 greater than 55 torr

    • Heli-ox (80:20) (70:30)

    • Bronchodilators and Steroids


Asthma cont
Asthma cont.

  • Moderate attack: Audible wheezing

  • No wheeze may indicate severe obstruction

  • Patient with cyanosis and diaphoresis must be treated immediately

  • Pulsus Paradoxus


Asthmatic on vent
Asthmatic on vent

  •  PIP due to  airway resistance

  • PIP generated in ET tube and airways, not the alveoli

  • Goal = Keep plateau 35-40 cmH20

  • Do not  flow to  PIP

    • Result would be I:E change and auto peep


Asthmatic meds
Asthmatic Meds

  • Sympathomimetic works on small peripheral bronchioles

  • Parasympatholytic works on large airways

  • Sympathomimetics = Albuterol, Xopenex

  • Parasympatholytic = Atrovent


Asthma meds cont
Asthma Meds cont.

  • Corticosteroids = suppress the release of inflammatory mediators

  • Example = Flovent, Beclovent

  • Prevention of Mast cell degranulation

    • Intal and Tilade

  • Block leukotriene receptors (prophylaxis)

    • Singulair, Accolate (po)


Cystic fibrosis
Cystic Fibrosis

  • Autosomal Recessive disease

  • Observable by three clinical disorders

    • Pulmonary disease

    • Pancreatic insufficiency

    • Elevated sweat chloride concentrations

      • Ionotrophic testing - pilocarpine

      • Manifests itself as dehydration of secretions


CF

  • Colonization  infection  inflammation airway obstruction pulmonary dysfunction

  • CF affects every organ in the body that has epithelial surface

    • Lung, pancreas, intestines


Cystic fibrosis1
Cystic Fibrosis

  • Pathophysiology

    • Pancreatic fibrosis

    • Pulmonary disease

      • Pseudonas

      • S. Aureus

  • Diagnosis

    • Sweat Chloride Test

      • Greater than 60 meq/l

  • Treatment

    • O2, aerosolized abx,bronchodilators, CPT, flutter valve, nutrition, pancreatic enzyme


Neuromuscular disorders
Neuromuscular Disorders

  • Muscular Dystrophies

    • Largest group of muscle diseases that affect children

    • Progressive symmetrical weakness and wasting of skeletal muscles

    • Affect the muscles of respiration in four ways

      • Defects in the muscle itself

      • Defect in the transmission of nervous impulses to the muscles

      • Defect in the peripheral motor and sensory nerves

      • Defect in the CNS

    • Duchenne muscular dystrophy

      • Most severe and most common

    • (Pseudohypertrophic)


Neuromuscular disorders1
Neuromuscular Disorders

  • Guillian-Barre Syndrome (Infectious Polyneuritis)

    • Linked to mono, hepatitis, influenza, CMV

  • Tetanus

    • Preventable = vaccinations

    • Acquired through wound in skin

  • Botulism

    • Ingestion of food contaminated with Clostridium botulinum

      • Improperly prepared home-canned foods

      • Weakness, dizziness, headache, vomiting

      • Respiratory muscle paralysis

      • Treatment = botulism antitoxin


Neurologic disorders
Neurologic Disorders

  • Myasthenia Gravis - Tensilon Test

  • Spinal Cord Injuries -

    • 3 goals in management

      • Preservation of neurologic function

      • Maximization of neurologic recovery

      • Prevention of intercurrent nonneurologic complications

  • Head Injury

    • Primary and secondary injuries

  • Near Drowning= survival of victim of submersion for greater than 24 hours


Reyes syndrome
Reyes Syndrome

  • Life threatening illness causing liver function deterioration and encephalopathy of the brain

  • Associated with chicken pox, flu and aspirin ingestion during a viral illness

    • Signs= listlessness, loss of energy, drowsiness, irritability, aggresiveness, confusion, irrational behavior

    • SGOT and SPGT enzyme levels


Lung diseases
Lung Diseases

  • Pneumonia

    • RSV, Parainfluenza, Strep, Staph, H. flu

    • Bacterial = sudden onset, fever

    • Viral = preceded by common cold, low grade temp.

    • Diagnosis = CXR, blood cultures, CBC

  • Bronchiolitis - most common cause of lower respiratory infections in young children

    • Viral = RSV or Parainfluenza virus

    • Fall and Winter months

    • Diag. - NP cultures + PMH

    • TX - O2, CPT?, Ribavirin?, Synagist, Theophylline


Upper airway diseases
Upper Airway Diseases

  • Epiglottitis = supraglottic swelling

    • 80% H Flu

    • 2 - 6 yrs.

    • Drooling, Tripod position

    • Tx = antibiotics

    • Thumb sign on CXR

  • Croup (Laryngotracheobronchitis) = Subglottic swelling

    • Parainfluenza, RSV

    • Steeple sign on CXR

    • TX = cool mist, racemic epi, steroids


Upper airway diseases1
Upper Airway Diseases

  • Aspiration Syndrome

  • FBA = Foreign body aspiration

  • Severity depends on size and location of obstruction

  • Sign = Cough and gag then stridor and wheeze

  • CXR = Flexible bronchoscopy under anesthesia

  • Complications = air leak, pneumonia


Inhalation
Inhalation

  • Smoke Inhalation - COHb levels @ 20-30%

    • Tx with 100% O2

    • Half life of CO is 6 hours


SIDS

  • Sudden Infant Death Syndrome

    • Accounts for highest number of deaths in infants less than one year

    • Diagnosis made with autopsy

    • Back to Sleep program

    • Factors that increase the risk of SIDS

      • Use of natural fiber mattresses

      • Swaddling

      • Recent illness

      • Use of heating in room


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