7 - Pediatric Respiratory Diseases

respiratory distress syndrome (RDS)

• summary

immature alveoli + low surfactant → alveolar collapse, ↓FRC, shunt

respiratory distress syndrome (RDS)

• O₂ therapy

• target S_pO₂ 90-95%

• CPAP 5-6 cmH₂O

• rescue surfactant if CPAP fails

respiratory distress syndrome (RDS)

• bronchial hygiene

gentle suction PRN

respiratory distress syndrome (RDS)

• aerosol

surfactant (usually via ETT) PRN

transient tachypnea of the newborn (TTN)

• summary

delayed fetal lung clearance

• mild V/Q mismatch

• lasts 24-72 hours

transient tachypnea of the newborn (TTN)

• O₂ therapy

• low-flow NC 1-2 L/min

• wean as tachypnea lessens

transient tachypnea of the newborn (TTN)

• bronchial hygiene

gentle nasal/oral suction PRN

meconium aspiration syndrome (MAS)

• summary

obstruction + chemical pneumonitis + surfactant inactivation → severe V/Q mismatch

meconium aspiration syndrome (MAS)

• O₂ therapy

• HFNC/CPAP

• surfactant if severe

meconium aspiration syndrome (MAS)

• bronchial hygiene

suction PRN

meconium aspiration syndrome (MAS)

• aerosol

bronchodilator trial if bronchospasm suspected

pneumonia (neonatal)

• summary

infection → consolidation + shunt

pneumonia (neonatal)

• O₂ therapy

• S_pO₂ 90-95%

• HFNC/CPAP if distress present

• antibiotics based on culture results

pneumonia (neonatal)

• bronchial hygiene

gentle suction PRN

bronchopulmonary dysplasia (BPD)

• summary

chronic lung disease of prematurity

• alveolar simplification and ↑PVR

bronchopulmonary dysplasia (BPD)

• O₂ therapy

• long-term low flow O₂

• S_pO₂ 90-95%

• diuretics?

bronchopulmonary dysplasia (BPD)

• bronchial hygiene

• suction PRN

• no CPT unless secretion burden

bronchopulmonary dysplasia (BPD)

• aerosol

• bronchodilator trial if reactive 

• inhaled steroids?

bronchiolitis

• summary

viral airway edema/mucus plug → air trapping, atelectasis, V/Q mismatch

bronchiolitis

• O₂ therapy

• S_pO₂ ≥ 92%

• HFNC 1-2 L/min/kg

• CPAP if severe or apnea

bronchiolitis

• bronchial hygiene

nasal suction (especially pre-feeding)

bronchiolitis

• aerosol

• bronchodilator if asthma

• 3% hypertonic saline

asthma

• summary

bronchospasm + inflammation + mucus

asthma

• O₂ therapy

• O₂ for acute cases

• NRB 10-15 L/min for moderate/severe cases

• S_pO₂ ≥ 92-94%

asthma

• bronchial hygiene

gentle suction PRN

asthma

• aerosol

• SABA nebulizer or MDI

• ipratropium for moderate/severe cases

• steroids

• magnesium sulfate IV if refractory

pneumonia (pediatric)

• summary

alveolar consolidation + shunt

pneumonia (pediatric)

• O₂ therapy

• S_pO₂ ≥ 92%

• HFNC if distress or hypoxemia

• antibiotics

pneumonia (pediatric)

• bronchial hygiene

• effective cough

• gentle suction PRN

pneumonia (pediatric)

• aerosol

bronchodilator trial if wheezing/reactive

congenital heart defect (cyanotic)

• summary

parallel/mixed circulation

congenital heart defect (cyanotic)

• O₂ therapy

• S_pO₂ 75-85%

• PGE1 if needing to keep ductus arteriosis open

congenital heart defect (cyanotic)

• bronchial hygiene

gentle suction PRN

acute respiratory distress syndrome (ARDS)

• summary

alveolar damage, shunted refractory hypoxemia

acute respiratory distress syndrome (ARDS)

• O₂ therapy

• lung protective ventilation

• proning

• iNO as rescue

• ECMO if severe

acute respiratory distress syndrome (ARDS)

• bronchial hygiene

• suction PRN

• no routine CPT

acute respiratory distress syndrome (ARDS)

• aerosol

bronchodilator for bronchospasm

cystic fibrosis (CF)

• summary

CFTR mutation → thick mucus, chronic infection, bronchiectasis, obstruction

cystic fibrosis (CF)

• O₂ therapy

• O₂ PRN for hypoxemia

• titrate if risk of CO₂ retention

cystic fibrosis (CF)

• bronchial hygiene

• daily airway clearance (vest, PEP, CPT)

• exercise

cystic fibrosis (CF)

• aerosol

• hypertonic saline (3-7%)

• dornase alfa

• bronchodilator pre-treatment if reactive

• antibiotics for Pseudomonas

bronchiectasis

• summary

airway dilation, impaired cilia, mucus pooling, recurrent infection

• chronic cough, crackles, wheezing

• CT: “signet sign”

bronchiectasis

• O₂ therapy

• O₂ for advanced stages

• titrate based on symptoms/S_pO₂

bronchiectasis

• bronchial hygiene

• CPT/vest

• OPEP (al capella, flutter)

• regular clearance

bronchiectasis

• aerosol

• bronchodilator

• mucolytic

• antibiotics for infection