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Respiratory emergencies in children
Paediatric Respiratory Reviews 14 (2013) 63
Contents lists available at SciVerse ScienceDirect
Paediatric Respiratory Reviews
Editorial
Respiratory emergencies in children
Respiratory distress is one of the most common reasons for paediatric emergency department visits and hospitalisations. Many conditions may cause acute respiratory distress in children. Usually, the underlying pathology is within the respiratory system, but can also be within other organ systems such as the cardiovascular or nervous systems. Prompt recognition and anticipatory, early and accurate treatment are essential to prevent respiratory failure and/or cardiopulmonary arrest, especially in neonates, infants and young children who for various reasons are particularly vulnerable and can rapidly progress to respiratory failure. In many cases of severe respiratory distress intervention is necessary before a comprehensive evaluation can be performed. For patients who develop cardiopulmonary arrest as a consequence of respiratory failure outcomes are poor. This symposium includes four articles on important aspects of respiratory emergencies in children, written by experienced paediatric pulmonologists, intensivists and surgeons. The first article starts with a short review of the definition of respiratory failure and then describes in detail the considerable differences in respiratory physiology between infants (children) and adults which explain the higher susceptibility to respiratory failure in young children, emphasising the appreciation of the peculiarities of paediatric respiratory physiology as the basis for correct assessment of ill children. A problem-based rather than a diagnosis-based approach is recommended, and basic and general management issues are discussed. The second review focusses on general principles of clinical assessment and airway management in paediatric patients with acute severe upper airway obstruction, with special emphasis on history taking, physical examination, and assessment of severity. In addition, a number of important examples of congenital and acquired upper airway obstruction in infants, children and adolescents are described and specific
1526-0542/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.prrv.2013.03.001
therapeutic issues discussed. The third article deals with the management of status asthmaticus in children. After a review of the pathophysiology of status asthmaticus and the determination of severity both standard treatment in the emergency department and more advanced treatment in the paediatric intensive care unit are discussed. Finally, the fourth review provides a comprehensive overview of the management of chest trauma in children. After reviewing epidemiological aspects and emphasising the relevance of chest trauma because of the considerable mortality the particular clinical features of trauma to the thoracic wall, lung, tracheobronchial tree, heart, diaphragm and oesophagus are described. Further, both general management issues and specific treatment modalities of chest injuries are discussed. It is hoped that this mini-symposium not only provides the readers with current scientific evidence but also useful practical information. The four articles all highlight the importance of early recognition and appropriate management of respiratory emergencies in children as delay may result in progress to lifethreatening respiratory failure. A problem-based approach is recommended in many situations, and airway management in children with impending respiratory failure must be initiated prior to full evaluation. Ernst Eber*, Respiratory and Allergic Disease Division, Paediatric Department, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria *Tel.: +43 316 385 12620; fax: +43 316 385 13276 E-mail address: [email protected]
Contents lists available at SciVerse ScienceDirect
Paediatric Respiratory Reviews
Editorial
Respiratory emergencies in children
Respiratory distress is one of the most common reasons for paediatric emergency department visits and hospitalisations. Many conditions may cause acute respiratory distress in children. Usually, the underlying pathology is within the respiratory system, but can also be within other organ systems such as the cardiovascular or nervous systems. Prompt recognition and anticipatory, early and accurate treatment are essential to prevent respiratory failure and/or cardiopulmonary arrest, especially in neonates, infants and young children who for various reasons are particularly vulnerable and can rapidly progress to respiratory failure. In many cases of severe respiratory distress intervention is necessary before a comprehensive evaluation can be performed. For patients who develop cardiopulmonary arrest as a consequence of respiratory failure outcomes are poor. This symposium includes four articles on important aspects of respiratory emergencies in children, written by experienced paediatric pulmonologists, intensivists and surgeons. The first article starts with a short review of the definition of respiratory failure and then describes in detail the considerable differences in respiratory physiology between infants (children) and adults which explain the higher susceptibility to respiratory failure in young children, emphasising the appreciation of the peculiarities of paediatric respiratory physiology as the basis for correct assessment of ill children. A problem-based rather than a diagnosis-based approach is recommended, and basic and general management issues are discussed. The second review focusses on general principles of clinical assessment and airway management in paediatric patients with acute severe upper airway obstruction, with special emphasis on history taking, physical examination, and assessment of severity. In addition, a number of important examples of congenital and acquired upper airway obstruction in infants, children and adolescents are described and specific
1526-0542/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.prrv.2013.03.001
therapeutic issues discussed. The third article deals with the management of status asthmaticus in children. After a review of the pathophysiology of status asthmaticus and the determination of severity both standard treatment in the emergency department and more advanced treatment in the paediatric intensive care unit are discussed. Finally, the fourth review provides a comprehensive overview of the management of chest trauma in children. After reviewing epidemiological aspects and emphasising the relevance of chest trauma because of the considerable mortality the particular clinical features of trauma to the thoracic wall, lung, tracheobronchial tree, heart, diaphragm and oesophagus are described. Further, both general management issues and specific treatment modalities of chest injuries are discussed. It is hoped that this mini-symposium not only provides the readers with current scientific evidence but also useful practical information. The four articles all highlight the importance of early recognition and appropriate management of respiratory emergencies in children as delay may result in progress to lifethreatening respiratory failure. A problem-based approach is recommended in many situations, and airway management in children with impending respiratory failure must be initiated prior to full evaluation. Ernst Eber*, Respiratory and Allergic Disease Division, Paediatric Department, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria *Tel.: +43 316 385 12620; fax: +43 316 385 13276 E-mail address: [email protected]