(PALS) Management of Pediatric Respiratory Distress and Failure
A large proportion of pediatric emergencies are a result of respiratory problems which, if not treated quickly and appropriately, can result in cardiopulmonary arrest. Early recognition and treatment of respiratory problems is therefore of primary importance to improve the outcome of pediatric emergencies.
There are 4 main respiratory problems that must be addressed for the management of pediatric respiratory distress and failure. These include upper airway obstruction, lower airway obstruction, lung tissue disease, and disordered control of breathing.
After reviewing this page thoroughly, use the links below to review important aspects and specific interventions of each problem.
- Upper airway obstruction
- Lower airway obstruction
- Lung tissue disease
- Disordered control of breathing
General Management Interventions
There are general management interventions that you will initially be using that apply to all of the above listed respiratory problems. The application of the general interventions is for the purpose of stabilizing the condition of the patient.
Once oxygenation and ventilation have been stabilized, targeted interventions are used to reverse and treat the above listed problems.
The general management interventions are carried out as you use the “evaluate, identify, and intervene” sequence to address Airway, Breathing, and Circulation. General management interventions for Airway, Breathing, and Circulation are listed below.
General AIRWAY interventions:
- Maintain an open airway, and if necessary open the airway. This is accomplished with the head tilt-chin lift. If cervical spine injury is suspected, use the jaw thrust maneuver to open the airway. However, if the jaw thrust does not adequately open the airway, use the head-tilt chin lift or jaw thrust with slight head extension.
- Clear the airway if necessary. Let your evaluation guide your interventions. If evaluation reveals secretions or a visualized foreign body obstruction, use the appropriate intervention to clear the airway.
- Consider basic airway adjuncts such as an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA) to reduce the risk of developing airway obstruction and improve airway patency.
General BREATHING interventions:
- Monitor the oxygen saturation level using non-invasive pulse oximetry.
- Administer oxygen and titrate to keep the oxygen saturation > 94%. Use appropriate oxygen delivery methods for the situation, and for severe respiratory distress/failure use a delivery method that will provide high concentrations of oxygen. A non-rebreathing mask is an example of a high-concentration delivery device.
- Provide assisted ventilations using a bag-valve mask device.
- Administer inhaled medications to help improve breathing.
- Prepare for the possibility of endotracheal intubation.
General CIRCULATION interventions:
- In the pediatric patient, heart rate, rhythm and blood pressure can be early indicators of how you interventions are affecting the patient. Therefore, it is important to monitor heart rate, heart rhythm, and blood pressure as your proceed with the Evaluate-Identify-Intervene Sequence.
- Establish IV or IO access. Many pediatric emergencies require the administration of fluids and medications for the treatment of problem specific conditions.
Once oxygenation and ventilation are stabilized using the initial general interventions discussed above, identification of the specific respiratory problem will help guide further problem specific interventions. Use the links below to review the four types of respiratory problems that facilitate targeted management.