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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

slide2
ARDS
  • Acute Respiratory Distress Syndrome
  • Mortality 60%
  • Pathophysiology
    • VQ mismatch
    • Pulmonary hypertension
    • Reduced compliance
    • Pulmonary infiltrates
slide3
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
slide6
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
slide8
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
slide22
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
slide42
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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