There are two types of respiratory problems: respiratory distress and respiratory failure. Both types are defined by their effect on the severity of illness.

Respiratory Distress

A critically ill child in respiratory distress presents with increases in respiratory rate and respiratory effort. Respiratory distress in children describes a continuum of signs and symptoms, ranging from mild to severe. The severity of respiratory distress can be graded through respiratory rate and effort, quality of breath sounds, and alterations in mental status. 

Severe respiratory distress can also indicate imminent respiratory failure. The PALS provider must always be on the lookout for cases like these and implement an immediate intervention to stop the progression into cardiac arrest.

Respiratory Failure

Inadequate gas exchange leads to respiratory failure. Respiratory failure can be caused by a failure in either ventilation, oxygenation, or both. Upper airway obstruction, lower airway obstruction, lung tissue disease, and disordered control of breathing interrupt gas exchange and lead to respiratory failure. 

Respiratory failure is apparent when the patient exhibits altered mental status changes characterized by agitation and, in severe cases, a depressed level of consciousness. Bradypnea and apnea are other grave indicators of respiratory failure. Respiratory failure may come on gradually or occur abruptly with no noticeable prior decline in respiratory effort.

Child in Acute Respiratory Distress

A diagnosis of respiratory failure is confirmed with blood gas analysis, but the treatment should not be delayed while waiting on lab results. If left untreated, respiratory failure can progress into cardiac arrest. Survival to hospital discharge and better outcomes are observed in critically ill patients that are treated for respiratory distress or failure compared to patients that have been treated for cardiac arrest.

Signs of Severe Respiratory Distress and Probable Respiratory Failure

Signs of severe respiratory distress and probable respiratory failure.

Pediatric patients with certain chronic diseases may have baseline physiology that regularly indicates respiratory failure. A child with a neuromuscular disorder, for example, may have a chronically elevated PaCO₂. An SpO₂ of 75% may be normal for a patient with cyanotic congenital heart disease. The primary and secondary assessments are particularly important when assessing and treating chronically ill children.