Pediatric Respiratory Failure: A Peril in Young Children
Highlights
- Infants needs more oxygen than an adult, with a metabolic rate is roughly double the adult rate. Their CO2 production is also higher. (View Highlight)
- FRC in an adult is about 70 mL/kg and is about 18 mL/kg in the infant. With a 75% smaller oxygen tank, the infant can’t hold his breath as long as an adult. (View Highlight)
- Dead space, the area of the lung not participating in gas exchange, is also higher in the infant (3 mL compared with 2 mL/kg in the adult) (View Highlight)
- the infant or toddler must have a higher respiratory rate and heart rate to compensate for smaller tidal volumes, larger dead space, higher oxygen consumption, and higher carbon dioxide production. (View Highlight)
(View Highlight)- Babies “belly breathe.” To take a deep breath, the infant’s chest can only expand a little because of the more horizontal angles of the rib cage. The abdomen therefore expands a lot as the diaphragm descends, pushing abdominal contents down and out of the way. Anything that interferes with descent of the diaphragm, such as a stomach or intestines distended with air or liquid, can seriously impair an infant’s breathing. (View Highlight)
(View Highlight)- Hypoxia in an adult or older child usually triggers a sympathetic response, producing a tachycardia that improves oxygen delivery. Bradycardia is a late and very dangerous sign of imminent cardiovascular collapse. (View Highlight)
- bradycardia in babies and young children may be the first sign of hypoxia—not the last. The small child’s immature nervous system has a better developed parasympathetic nervous system. (View Highlight)
- Infants and small children have a cardiac output that is rate dependent. Bradycardia significantly lowers cardiac output and oxygen delivery; hypoxia and hypercarbia worsen. Acidosis develops, further depressing the myocardium. Cardiac arrest can occur very quickly in the hypoxic child and must be treated urgently with oxygen, ventilation, and if needed, atropine**.** (View Highlight)