Acute respiratory failure is a common pediatric emergency. It refers to a clinical syndrome caused by primary or secondary disorders of the respiratory center or respiratory system, leading to impaired ventilation or gas exchange, resulting in hypoxia or carbon dioxide retention and a series of physiological and metabolic disturbances. This condition is termed respiratory failure. When the onset is sudden, it is called acute respiratory failure. Affected children may exhibit symptoms such as cyanosis, dyspnea, irregular breathing, and abnormal respiratory rhythms. The prognosis for this condition is poor, with a high mortality rate. However, with advancements in medical care and the use of ventilators, the cure rate has improved.

bubble_chart Clinical Manifestations

1. Cyanosis and hypoxemia, presenting as cyanosis or pallor.
2. Dysphoria or lethargy, profuse sweating, severe cases may lead to unconsciousness and spasms.
3. Difficulty breathing, manifested as changes in frequency and rhythm.
4. Chest tightness, palpitation, and arrhythmia, pulmonary edema, and left heart failure.
5. Gastrointestinal disturbances: may include vomiting, bleeding, even intestinal paralysis, as well as abnormal liver function.

bubble_chart Auxiliary Examination

1. Respiratory failure: Items 2 and 5 in box limit "A" must be checked, as they are of great significance for understanding electrolyte disturbances, diagnosis, and guiding treatment.
2. In severe cases, heart failure and abnormal liver function are common, so items 3 and 4 in box limit "A" and item 4 in "B" need to be checked.
3. If conditions permit, items 1 and 2 in box limit "B" can be checked, as they are meaningful for the prognosis of respiratory failure.
4. If there is poor circulation, heart failure, or DIC, items 3 and 5 in box limit "B" can be examined.

bubble_chart Diagnosis

1. Various factors (such as respiratory, circulatory, nervous system diseases, and medications) cause severe impairment of respiratory function, leading to hypoxia or carbon dioxide retention, resulting in a series of clinical syndromes of physiological dysfunction and metabolic disturbances.
2. Respiratory dysfunction: severe dyspnea, cyanosis, changes in respiratory rate and rhythm.
3. Cardiovascular dysfunction: early-stage hypertension, advanced-stage hypotension, peripheral capillary and venous dilation, arrhythmia, pulmonary edema, and even right heart failure.
4. Nervous system dysfunction: depressive symptoms—drowsiness, unconsciousness; excitatory symptoms—dysphoria, headache, mental confusion, spasm, miosis, optic disc edema, etc.
5. Digestive system dysfunction: abdominal distension and fullness, vomiting, upper gastrointestinal bleeding, and symptoms of liver function impairment.
6. Manifestations of acid-base imbalance and water-electrolyte disturbances.
7. Blood gas analysis: under resting conditions, while breathing room air, PaO₂ <6.67KPa (50mmHg) or PaCO₂ >6.67KPa (50mmHg).

bubble_chart Treatment Measures

Principles of Treatment:

1. Treat the disease cause.
2. Maintain airway patency.
3. Oxygen therapy: Nasal oxygen inhalation or mechanical positive pressure oxygen delivery.
4. Application of bronchodilators.
5. Use of respiratory stimulants.
6. Cardiotonic and vasoactive drugs.
7. Maintain water, electrolyte, and acid-base balance.
8. Application of mechanical ventilators.
9. Use of antibiotics.

Principles of Medication:

1. For early respiratory failure, administer sedatives, oxygen, maintain airway patency, and treat the disease cause.
2. For respiratory failure with dyspnea and wheezing, also use antiasthmatic drugs (such as aminophylline, isoproterenol, salbutamol, etc.) or add hormones.
3. For irregular respiratory rhythms, lobeline is commonly used, while in cases with concurrent cardiac insufficiency, nikethamide may be selected. Central stimulants must be used under conditions of airway patency and enhanced oxygen delivery.
4. Supportive therapy and energy mixtures, dehydrating agents, vasoactive drugs, and cardiotonics (such as cedilanid, regitine, 654-2, etc.) should be used as appropriate.
5. Severe respiratory failure usually requires the use of artificial ventilators for oxygen delivery and maintenance of effective respiratory function.

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bubble_chart Cure Criteria

1. Cure
   1. All symptoms of respiratory failure have disappeared.
   2. Blood gas analysis: PaO₂, SO₂, and PaCO₂ have returned to normal.
   3. Blood pH is within the normal range, and blood potassium, sodium, chloride, calcium, magnesium, etc., have returned to normal levels.
2. Improvement
   1. All symptoms of respiratory failure have improved or alleviated.
   2. Blood gas analysis: <9.42KPa (70mmHg), PaO₂ >6.76KPa (>50mmHg), SO₂ >80%, PaCO₂ <6.76KPa (<50mmHg).
   3. Blood pH is mostly normal, and blood potassium, sodium, chloride, calcium, magnesium, etc., are mostly close to or have returned to normal.
3. No cure: No improvement or worsening of the condition after treatment.

Expert tip

The mortality rate of respiratory failure is very high, with severe respiratory failure mortality reaching 40-50%. Therefore, it must be taken very seriously. If symptoms such as rapid or irregular breathing are observed in a child, immediate hospitalization for early treatment is necessary to reduce mortality. The basic principles are to treat the underlying disease and eliminate triggers, prevent and control infections, improve respiratory function, maintain airway patency, improve O₂ deficiency and promote CO₂ elimination, correct acid-base imbalance and electrolyte disturbances, and maintain heart, brain, lung, and kidney function, with timely assisted ventilation.