PAEDS Flashcards
2 types of NIV
CPAP
BiPAP
Benefits of BiPAP
Treats hypoventilation of whatever cause- Pressure to support respiratory failure- May be used to improve airway clearance- Rate to overcome lack of central drive
HFNC
Humidified High flow nasal cannula
what does HFNC administer
Humidified High flow nasal cannula
heated and humidified blend of air and oxygen higher than pts inspiratory flow
generally 6ml/min
signs of respiratory distress of WOB in children
Tachypnoea
Nasal flare
Tracheal tug
Recession
intercostal, subcostal, substernal
Mild / moderate/ severe
Grunting (adduction of laryngeal muscles to try and increase auto PEEP & FRC)
paradoxical breathing
lower ribs sucked in during inspiration as the diaphragm pull on non
compliant lungs)
normal peak cough flow in adults
> 400L/min
interpret peak cough flow of <270ml
Unable to clear secretions during LRTI
interpret peak cough of <160L/min
Unable to clear secretions on a daily basis
expulsive flow - normal cough mechanism
irritation trigger
deep inspiration - 80-90% normal capacity
0.2 s of glottis closure with simultaneous contraction to generate pressure ~ 190cm H2O
Opening of glottis
effective contraction of expiratory muscles
list the physiological difference of child vs adult lung
↑ Compliance in chest wall, ↓ compliance of lungs
↓ % of type 1 (Fatigue resistant) muscle fibres in diaphragm (Child 30% vs. adult 50-60%)
Poorly developed intercostal muscles
↑metabolic rate of 02 consumption
Preferential ventilation of upper lung when positioned in side lying
reduced diameter of airway
preferential nasal breathers
proportionally larger tonsils and tongue
floppy cartilage
what is implied if the child has ↑ Compliance in chest wall, ↓ compliance of lungs
↓ FRC and ↑ work of breathing
what is implied if the child has ↓ % of type 1 (Fatigue resistant) muscle fibres in diaphragm (Child 30% vs. adult 50-60%)
Diaphragm more prone to fatigue → less able to withstand respiratory distress
what is implied if the child has poorly developed intercostal muscles
Near solely reliant on diaphragm for respiration
what is implied if the child has ↑metabolic rate of 02 consumption
Hypoxia develops more rapidly
what is implied if is child has Preferential ventilation of upper lung when positioned in side lying
Ensure Sa02 maintenance when repositioning
what is implied with reduced airway diameter
↑ airway resistance → ↑respiratory difficulties with any inflammation of airways
what is implied with preference of nasal breathing
NG tubes etc. narrows diameter and ↑ WOB. Ensure nasal passages are cleared of secretions
what is implied with proportionally larger tonsils and tongue
increased airway obstruction
what is implied with floppy cartilage
predispose to airway collapse
Airway resistance is inversely proportional to the fourth power of the radius of the airway - Poiseuilles law
Halving the internal diameter of the trachea will increase the resistance (reduce air flow) by __
16
anatomical difference in children lungs
Immature cilia
↓alveolar surface area (24 million vs. 300 million at 8 years)
↑ heart size in infants
More horizontal ribs and more cylindrical
Poor collateral ventilation in infancy
implication for cilia
↑ accumulation of secretions, mucus plugging
implication for reduced alveolar surface area
reduced space for gas exchange
implication for increased heart size
less room for lung expansion
implication for horizontal ribs and more cylindrical
Lack of bucket handle and pump handle movement, unable to increase lung volumes
implication of poor collateral ventilation in infancy
increased risk of atelectasis of RTI
Pores of Kohn
inter alveolar
Canals of Lamber
brionchar-alveolar
channels of martin
interbronchiolar
benefits of sidelying positioning
Ventilation better in non dependent lung but still receives blood flow
Dependent lung is compromised due to compliant chest wall
Head up reduces pressure from abdominal contents so diaphragm can move more freely
benefits of prone positioning
Less compression of lung tissue from heart
Helps with drainage of secretions and redistribution of oedema
benefits of supine positioning
Ventilation best anteriorly, with perfusion best posteriorly
V/Q mismatch
Avoid head down tip as risk of reflux and aspiration
contrindications of manual techniques
Undrained pneumothorax
Raised intracranial pressure
Rib fractures
Osteopenia/Osteoporosis
Platelets of <40
Pulmonary haemorrhage
benefits of manual hyperinflation
Prevent atelectasis and recruit areas of collapsed lung
Improve lung compliance and gas exchange
Increases movement of pulmonary secretions toward central airways
Prevent airway mucus plugging
how is manual hyperinflation performed
2 breaths at PIP/PEEP on ventilator, 3rd breath 10% above PIP
Followed by end inspiratory hold with quick release to increase expiratory air flow
indications of manual assisted cough
Secretions causing respiratory compromise that patient is unable to effectively clear
* Reduced PCF
Considerations:
* Position dependant, requires skill
* Risk of abdominal trauma and reflux
* Need to time with cough
contraindications of manual assisted cough
Rib fractures
Raised ICP
Undrained pneumothorax
Osteopenia / Osteoporosis
how oropharyngeal suctioning meaured
Measure corner of mouth to ear lobe and add approx 2 cms
how is nasopharyngeal suctioning measured
Measure tip of nose to ear lobe to thyroid cartilage
benefits of beta 2 agonists
Bronchodilates airways
Reduces inflammation
Improve mucocillary clearance
effects of mucolytics
Rehydrate secretions
- Improve mucocilliary clearance
- Stimulate cough
benefits of pulmozyme
Targets and cleaves the extracellular DNA to ↓mucus viscosity and ↑ sputum clearance
reasons for paediatric trache
Airway
Congenital or acquired e.g tracheomalacia
Breathing
Respiratory muscle weakness
CLD
Chest wall deformities
Circulation
Ongoing cardiac support required
Disability/Neuro
Congenital or acquired injury e.g high SCI, severe TBI
Central hypoventilation syndrome
aims of long term ventilation
Maintain airway patency
Maintain adequate lung recruitment
Reverse hypoventilation
Reduced WOB
Reduce frequency of respiratory infections
Promote clinical stability
Transition to home environment
Allow neurodevelopmental progress
GDD
Global developmental delay
