विवरण
One of the most common reasons an infant is admitted to the neonatal intensive care unit is due to Respiratory distress. Respiratory distress describes symptoms related to breathing problems. There can be many causes of respiratory distress in children. However, respiratory distress is caused by infections, chronic illness or a blocked airway.
Please join us in the upcoming Pediatric webinar with Dr Bharat Parmar Professor and Head of Pediatrics at Zydus Medical College, Civil Hospitals,Dahod Gujarat for an insightful case based discussion on Respiratory Distress in children.
सारांश
- Respiratory distress in children can arise from inadequate compensatory mechanisms, requiring supportive care and aggressive treatment of underlying causes. While most children recover uneventfully, outcomes are poor for those experiencing cardiopulmonary arrest due to respiratory deterioration.
- Tachypnea, an increased respiratory rate beyond specific age limits, is a key indicator. Respiratory distress is further characterized by signs of increased work of breathing such as stridor, wheezing, hyperpnea, accessory muscle use, and chest retractions. Respiratory failure is defined as the respiratory system's inability to meet the patient's gas exchange needs.
- Clinical symptoms associated with respiratory distress include breathing difficulties, rapid breathing, retractions (subcostal, intercostal, supraclavicular), abdominal muscle use, seesaw respiration, positional distress, color changes, and noisy breathing (wheezing, stridor, grunting). Non-localized symptoms can include fever, poor feeding, weight loss, pain, and diaphoresis.
- Physical examination should assess respiratory rate, heart rate, temperature, perfusion, blood pressure, and sensorium. Oxygen saturation via pulse oximetry is useful but can be inaccurate with inappropriate probe size, cold extremities, poor perfusion, carbon monoxide poisoning, or significant hemoglobin issues.
- Important clinical signs include chest in-drawing (suprasternal), subcostal in-drawing, and intercostal in-drawing. Stridor indicates upper airway pathology, while wheezing indicates lower airway pathology. Grunting is associated with parenchymal lung disease.
- Investigation indications include suspected cardiac disease, rapid deterioration (requiring arterial blood gas, serum electrolytes, glucose, and ammonia), suspected carbon monoxide poisoning or methemoglobinemia, upper airway obstruction, persistent asymmetric breath sounds, and significant respiratory distress requiring chest X-ray.
- Lifesaving maneuvers for acute respiratory distress include needle cricothyrotomy for complete upper airway obstruction, back blows/chest thrusts for foreign body aspiration, head-tilt/chin-lift or jaw thrust for soft tissue upper airway obstruction, bag and mask ventilation, endotracheal intubation, and needle thoracentesis for tension pneumothorax.
- Common case studies include croup (barking cough, stridor), pneumonia (teacupia, chest in drawing, grunting, and severe pneumonia), bronchiolitis (wheezing, respiratory distress), bronchial asthma (recurrent wheezing, chest retractions), and foreign body aspiration (sudden onset of respiratory distress, choking spell, wheezing).
- Respiratory emergencies are common and life-threatening. Respiratory distress is characterized by normal sensorium and increased work of breathing. Respiratory failure involves altered sensorium, except in CNS problems. Respiratory failure is a clinical diagnosis, not solely based on arterial blood gases.
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Dr Bharat Parmar
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