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