The respiratory system is responsible for the exchange of oxygen and carbon dioxide in the body. It consists of organs and structures that work together to facilitate breathing and ensure the body receives the oxygen it needs while eliminating waste carbon dioxide.

Respiratory conditions in children can be categorized into upper airway obstructions, lower airway obstructions, lower airway restrictive pathology, and disordered control of breathing.

Upper airway obstructions occur when there is an increased work of breathing due to an obstruction above the thorax. This is demonstrated in croup and epiglottitis. Lower airway obstructions, by contrast, result from obstructive problems below the thorax such as increased swelling, or bronchospasm. Obstructions can originate from multiple causes, a few common ones being foreign bodies, infections, or anaphylaxis.

Restrictions in the lower airways can be a result of “stiffening” of lung tissue, caused by increased fluid accumulation, toxic exposure, allergic reactions, infiltration, or inflammation.  These situations can be best managed with a staged approach of oxygenation and/or ventilation strategies.

Dysfunction within the respiratory center of the brain is responsible for the development of disordered breathing.  These situations typically stem from neurological disfunction and secondarily affect respiratory patterns. This can include problems such as increased intracranial pressure, neuromuscular disease, and some poisonings and overdoses.

Respiratory failure occurs when a patient’s breathing becomes inadequate and results in ineffective oxygenation and/or ventilation. 

• The PAT is designed to be a quick and efficient assessment tool. In emergency situations, where time is crucial, healthcare providers can rapidly observe a child's appearance, breathing, and circulation to gather essential primary assessment information about the patient's condition in a short amount of time.
• The PAT relies on visual observation and doesn't require any specialized equipment or extensive medical knowledge
• The component of appearance can be assessed utilizing the mnemonic TICLS, which stands for Tone, Interactiveness, Consolability, Look and Speech.

• Upper airway obstruction can be an uncomfortable call to attend as many patients may look ill or unwell, but require purely comfort levels for treatment.
  • See → B04: Croup and Epiglottitis for additional information on the management of upper airway obstructions
• Lower airway obstruction results in an inability for the patient to get air out of the chest.  This is usually due to excessive swelling or bronchospasm.
• Lower airway restrictive pathologies consist of numerous conditions that result in decreasing lung compliance or stiffening of the lung.  The general management of these conditions concern correcting oxygenation and ventilation utilizing an escalation pathway of increasing FiO₂ via nasal cannula, face mask, heated HiFlow nasal cannula (2 L/min to a max of 60 L/min), NIV therapy, then intubation.  Bronchospasm can be treated with a B₂ agonist.
• Disordered Control of Breathing are a series of conditions affecting the respiratory control center in the brain or neuromuscular diseases.

Refer to the additional clinical practice guidelines for symptom-specific treatment planning:

• → B01: Airway Management
• → B02: Airway Obstruction
• → B03: Asthma and Bronchospasm
• → B04: Croup and Epiglottitis 

• Continuous salbutamol can decrease serum potassium.
• Ventilating the lower airway restrictive disease patient may require high peak inspired pressure of up to 32 cmH₂O and high PEEP of up to 10-15 cmH₂O.  Diligent monitoring for the development of a pneumothorax is required.
• Succinylcholine should be avoided in the patient with neuromuscular disease due to the possibility of triggering hyperkalemia or malignant hyperthermia.

Pediatric Wheeze/Bronchospasm

Pediatric Stridor