Breathing

Due to their higher metabolic rate, children have a higher respiratory rate than adults, and respiratory distress is a common finding in children who are ill for any reason.  Signs of respiratory distress include grunting, nasal flaring, subcostal recession, paradoxical bradypnoea and head bobbing, in addition to the 'adult' signs to tachypnoea, cyanosis, indrawing and tracheal tug.

 
Young children are diaphragmatic breathers, and tolerate gastric distension poorly.  An NGT may be needed, and is mandatory on intubated children.

NIV

Widely used, particularly in children with bronchiolitis or asthma.  If tolerance is an issue, it may be appropriate to give a dose of sedative such as chloral hydrate, 15-30mg/kg NG, as long as the child is appropriately monitored.

Positive pressure ventilation   

Preferred mode is SIMV pressure control (rather than volume), as it is better to compensate for an ETT leak.  A good starting point is PEEP 5, PIP 15-20, aiming for TV 6-8ml/kg, RR 18-25 (titrate to CO2).  Chest should be seen to rise and fall.  Manipulation of ventilator parameters is similar to that in adults.

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Page last reviewed: 14 May 2014
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