Foundations in Neonatal and Pediatric Respiratory Care

Foundations in Neonatal and Pediatric Respiratory Care
Title Page
Copyright
Dedication
Brief Contents
Contents
Foreword
Preface
How to Use This Book
About the Authors
Contributing Authors
Reviewers
Chapter 1 Growth and Development
Introduction
Periods of Growth and Development
Infants: Developmental Milestones
Toddlers: Developmental Milestones
Preschoolers: Developmental Milestones
School-Age Children: Developmental Milestones
Adolescents: Developmental Milestones
Hospitalization and the Effect Hospitalizations Have on Growth and Developmental Needs
Effects of Hospitalization on Growth and Developmental Milestones
Supporting the Child’s and Family’s Needs through Family-Centered Care
References
Chapter 2 Family-Centered Care
Introduction
Family-Centered Care
Needs of the Hospitalized Infant, Child, and Adolescent
Infants
Toddlers
Preschoolers
School-Age Children
Adolescents
Needs of the Family
Information and Accommodations
Reassurance and Support
Consistency
Communication
Needs of Siblings
Role of the Child Life Specialist
Animal-Assisted Therapy
Conclusion
References
Chapter 3 Development of the Fetal Lung
Introduction
Stages of Lung Development
Embyronic Stage (3–7 Weeks’ Gestation)
Pseudoglandular Stage (7–17 Weeks’ Gestation)
Canalicular Stage (17–26 Weeks’ Gestation)
Saccular Stage (27–36 Weeks’ Gestation)
Alveolar Stage (36 Weeks’ Gestation through Postterm)
Development of Surfactant
Function
Production
Composition
Factors That Influence Fetal Lung Development
Hormones and Growth Factors
Fetal Breathing Movements
Fetal Lung Fluid
Inadequate Fetal Lung Development
Pulmonary Hypoplasia
Pulmonary Agenesis and Pulmonary Aplasia
References
Chapter 4 Fetal Gas Exchange and Circulation
Introduction
Embryonic Development
Early Development
Chamber Development
Maturation
Fetal and Transitional Circulation
The Placenta
Fetal Circulation
Transitional and Neonatal Circulations
References
Chapter 5 Maternal and Fetal Assessment
Introduction
Identifying the High-Risk Pregnancy
Maternal Medical History
Health Disorders
Prenatal Care
Maternal Age
Infections
Substance Abuse
Complications during Pregnancy
Placental and Cord Disorders
Hypertensive Disorders
Diabetes during Pregnancy
Abnormal Amniotic Fluid Volume
Twin to Twin Transfusion Syndrome
Antenatal Fetal Assessment
Ultrasound
Fetal Heart Rate Monitoring
Fetal Biophysical Profile
Amniocentesis
High-Risk Labor and Delivery
Preterm Labor and Delivery
Multiple Gestation
Postterm Pregnancy
References
Chapter 6 Evaluation of the Neonate
Introduction
Determining Gestational Age
Physical Assessment
Vital Signs
Respiratory Rate
Heart Rate
Blood Pressure
Size and Weight
Skin
Abdomen
Respiratory Assessment
Examination of the Chest
Evaluation of Respiratory Distress
Auscultation of the Chest
Chest Radiograph
Cardiovascular Assessment
Cardiac Murmurs
Peripheral Pulses
Capillary Refill Time
Preductal and Postductal Oxygen Saturation
Neurologic Assessment
Diagnostic Tests
References
Chapter 7 Neonatal Stabilization and Resuscitation
Introduction
Preparing for a High-Risk Delivery
Environmental Preparation
Equipment and Supplies
Suction
Ventilation Equipment
Intubation Equipment
Vascular Access Supplies
Resuscitative Drugs
Transport Equipment
Neonatal Stabilization
Preventing Heat Loss and Cold Stress
Securing and Maintaining a Patent Airway
Positioning to Prevent Airway Obstruction
Clearing Airway Secretions
Assessing the Neonate
Respiratory Effort
Heart Rate
Skin Color
Apgar Score
Neonatal Resuscitation
Administering Oxygen
CPAP and Positive Pressure Ventilation
CPAP Administration
Bag-Mask Ventilation
Ventilation with an Endotracheal Tube or Airway Adjunct
Provide Chest Compressions
Obtain Vascular Access
Administer Medications
Postresuscitation Care
References
Chapter 8 Respiratory Diseases of the Newborn
Introduction
Apnea of Prematurity
Etiology and Incidence
Pathophysiology
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
Respiratory Distress Syndrome
Etiology and Incidence
Pathophysiology
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
Transient Tachypnea of the Newborn
Etiology and Incidence
Pathophysiology
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
Neonatal Pneumonia
Etiology and Incidence
Pathophysiology
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
Meconium Aspiration Syndrome
Etiology and Incidence
Pathophysiology
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
Persistent Pulmonary Hypertension of the Newborn
Etiology and Incidence
Pathophysiology
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
References
Chapter 9 Congenital Disorders of the Respiratory System in the Neonate
Introduction
Choanal Atresia
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
Mandibular Hypoplasia
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
Macroglossia
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
Tracheoesophageal Fistula
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
Congenital Diaphragmatic Hernia
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
Surfactant Protein Deficiencies
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
Congenital Pulmonary Anomalies
Pulmonary Hypoplasia
Pulmonary Aplasia
Pulmonary Agenesis
Bronchogenic Cysts
Congenital Pulmonary Airway Malformation
Pulmonary Sequestration
Conclusion
References
Chapter 10 Neonatal Disorders Resulting from Respiratory Care
Introduction
Retinopathy of Prematurity
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
Bronchopulmonary Dysplasia and Chronic Lung Disease
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
Air Leak Syndrome
Pneumothorax
Pneumomediastinum
Pneumopericardium
Pulmonary Interstitial Emphysema
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications and Outcomes
References
Chapter 11 Congenital Heart Defects
Introduction
Classification of Congenital Heart Disease: Acyanotic versus Cyanotic Heart Disease
Acyanotic Heart Defects with Left-to-Right Shunts
Patent Ductus Arteriosus
Atrial Septal Defect
Ventricular Septal Defect
Atrioventricular Canal Defect
Mechanical Ventilation in Patients with Septal Defects (ASD, VSD, AVC)
Acyanotic Heart Defects with Left Ventricular Outflow Tract Obstruction
Coarctation of the Aorta
Aortic Stenosis
Tetralogy of Fallot
Pulmonary Stenosis
Pulmonary Atresia
Tricuspid Atresia
Ebstein’s Anomaly
Cyanotic Heart Defects with Increased Pulmonary Blood Flow
Transposition of the Great Arteries or Vessels
Total Anomalous Pulmonary Venous Return
Truncus Arteriosus
Single Ventricle Lesions
Hypoplastic Left Heart Syndrome
Mechanical Ventilation of the Single-Ventricle Patient
Conclusion
References
Chapter 12 Evaluation of the Child
Introduction
Initial Assessment
History
History-Taking Techniques
Medical History
Family and Social History
Physical Assessment
Head and Neck
Chest
Extremities
Summary
References
Chapter 13 Resuscitation and Stabilization of the Child
Introduction
Assessment of the Pediatric Patient
Pediatric Assessment Triangle
Assessing Appearance
Assessing Respirations and Characteristics of Breathing
Assessing Circulation
Primary Assessment
Airway
Breathing
Circulation
Disability
Exposure
Pediatric Shock
Vascular Access
Peripheral Vein Access
Intraosseous Access
Central Venous Line Placement
Airway Management
Bag-Mask Ventilation
Intubation
Assessing ETT Placement by Carbon Dioxide Monitoring
Assessing ETT Placement by Auscultation
Circulation
Medication Administration
Postresuscitation Care
References
Chapter 14 Acute Respiratory Disorders
Introduction
Bronchiolitis
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Viral Infections
Respiratory Syncytial Virus (RSV)
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Influenza
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Laryngotracheobronchitis
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Epiglottitis
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Pulmonary Air Leaks
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Pneumomediastinum
Diagnosis
Clinical Presentation
Treatment
Disorders of the Pleura
Pleural Effusion
Chylothorax
Hemothorax
References
Chapter 15 Chronic Respiratory Disorders of the Child
Introduction
Asthma
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications
Outcomes
Cystic Fibrosis
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Management
Complications
Outcomes
References
Chapter 16 Pediatric Neurodisability Disorders
Introduction
Neurodisability Disorders
Muscular Dystrophies
Spinal Muscular Atrophy
Cerebral Palsy
Spina Bifida
Guillain-Barré Syndrome
Myasthenia Gravis
Transverse Myelitis
Mitochondrial Disorders
The Pulmonary Composite
Airway Secretion Overload
Chronic Lung Disease
Patient Assessment
Patient History
Physical Examination
Pulmonary Function
Radiography
Assessment of Bacterial Colonization
Respiratory Management Plan
Medication Selection
Airway Clearance Therapy
Frequency of Therapy
Mechanical Ventilation
Caring for the Caregiver
Caregiver Education
Caregiver Skills Validation
Psychological Characteristics of Caregivers
Conclusion
References
Chapter 17 Sleep-Disordered Breathing in Infants and Children
Introduction
Evaluation of Pediatric Sleep Disorders
History
Polysomnography
Obstructive Sleep Apnea
Etiology and Pathophysiology
Risk Factors
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
Upper Airway Resistance Syndrome
Pathophysiology and Clinical Presentation
Diagnosis
Management
Central Sleep Apnea
Etiology and Pathophysiology
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
Congenital Central Hypoventilation Syndrome
Epidemiology
Clinical Presentation
Diagnosis
Management
Complications and Outcomes
References
Chapter 18 Childhood Disorders Requiring Respiratory Care
Introduction
Acute Respiratory Distress Syndrome
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Systemic Inflammatory Response Syndrome and Sepsis
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Shock
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Meningitis
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Hypoxic Ischemic Encephalopathy
Etiology
Pathophysiology
Diagnosis
Clinical Presentation
Treatment
Unintentional Injuries
Foreign Body Aspiration
Blunt Trauma
Penetrating Trauma
Poisoning
Near Drowning
References
Chapter 19 Cardiopulmonary Monitoring
Introduction
Noninvasive Monitoring
Pulse Oximetry
Capnometry and Capnography
Transcutaneous Monitoring
Impedance Pneumography
Near Infrared Spectroscopy
Invasive Monitoring
Arterial Blood Gas Analysis
Capillary Blood Gas Analysis
Umbilical Artery Catheter
Peripheral Artery Catheter
Central Venous Catheter
Pulmonary Artery Catheter
References
Chapter 20 Imaging
Introduction
Anteroposterior and Posteroanterior Views
Chest Radiography
Lateral Decubitus
Oblique
Neck
Examination of Anatomical Structures
Lines/Drains and Tubes
Computerized Tomography
Magnetic Resonance Imaging
References
Chapter 21 Pulmonary Function Testing in the Pediatric Population
Introduction
Preparing a Child for Testing
Communication
Incentives and Directions
Variables That Can Affect Testing
Involving Parents
Ending a Testing Session
Equipment Used for Testing
Standard Spirometry Measurements
Maximal Expiratory Measurements
Maximal Inspiratory Measurements
Acceptable and Repeatable Tests
Reference Sets and Predicted Values
Interpreting Spirometry Data
Obstructive and Restrictive Disorders
Trending Results
Interpretation Challenges
Beyond Spirometry: Lung Volumes and Airway Resistance
Bronchoprovocation and Exercise Testing
Methacholine Challenge
Exercise Testing
Mannitol Challenge
Eucapnic Voluntary Hyperpnea Testing
Specialized Tests
Maximal Inspiratory and Expiratory Pressures
Cough Peak Flow
Diffusing Capacity
Infant and Toddler Pulmonary Function Testing
Equipment Used
Obtaining Measurements
Challenges
Flow-Volume Loops
Airway Resistance
Nitric Oxide Measurement
Multiple Breath Washout
Bedside Pulmonary Function Testing
Equipment Used
Bedside Measurements
Mobile Testing
Considerations and Limitations
Summary
References
Chapter 22 Airway Management
Introduction
Upper Airway Devices
Oropharyngeal Airways
Nasopharyngeal Airways
Supraglottic Airway Devices
Lower Airway Devices
Endotracheal Tubes
Videolaryngoscopy
Fiberoptic Intubation
Tracheostomy Tubes
Suctioning
Suctioning and Artificial Airway
References
Chapter 23 Oxygen Therapy
Introduction
Indications of Oxygen Therapy
Clinical Signs and Symptoms of Hypoxemia and Hypoxia
Monitoring Oxygen Therapy
Hazards/Complications
Oxygen Delivery Devices
Variable Performance Oxygen Delivery Devices
Reservoir Devices
Fixed Performance Oxygen Delivery Devices
Enclosure Devices
References
Chapter 24 Aerosol Therapy
Introduction
Aerosol Medicine: A Review of Basic Concepts
Factors Influencing Aerosol Deposition in Infants and Children
Age-Related Factors Affecting Aerosol Lung Dose
Device-Related Considerations
Other Considerations
Aerosol Devices
Nebulizers
Metered Dose Inhalers
Dry Powder Inhalers
How to Choose the Right Device for My Patient
Role of the Respiratory Therapist in the Outpatient Clinic
Aerosol Administration in Patients Receiving Respiratory Support
Aerosol Administration with a High-Flow Nasal Cannula
Aerosol Administration during Noninvasive Mechanical Ventilation
Aerosol Administration through Tracheostomy Tubes
Aerosol Administration during Invasive Mechanical Ventilation
Aerosol Delivery Considerations with Neonatal Patients
References
Chapter 25 Airway Clearance and Lung Expansion Therapy
Introduction
Incentive Spirometry
Indications and Contraindications
Administration
Chest Physiotherapy
Indications and Contraindications
Administration
Complications
Oscillatory Positive Expiratory Pressure Therapy
Indications and Contraindications
Administration
Autogenic Drainage
Indications and Contraindications
Administration
High-Frequency Chest Wall Compression and Oscillation
Indications and Contraindications
Administration
Complications
Intrapulmonary Percussive Ventilation
Indications and Contraindications
Administration
Complications
MetaNeb System
Cough Assistance Therapy
Indications and Contraindications
Administration
Complications
Summary
References
Chapter 26 Mechanical Ventilation of the Neonate
Introduction
Noninvasive Ventilation
CPAP
Assisting Ventilation with the Use of NIV
Indications and Goals
Contraindications
Interfaces
Delivery Devices
Challenges
Management of the Patient
Safety Considerations
Weaning and Liberation from CPAP and NIV
Heated High-Flow Nasal Cannula
Monitoring during NIV
Invasive Mechanical Ventilation
Indications and Goals
Strategies for Preventing Lung Injury
Physiologic Challenges Influencing Mechanical Ventilation of the Preterm Infant
Management of the Patient
Modes of Ventilation
Breath Sequence
Pressure versus Volume Control Ventilation
Time Constants
Trigger Sensitivity and Cycle Criteria
Nonconventional Modes of Ventilation
High-Frequency Oscillatory Ventilation
High-Frequency Jet Ventilation
Ventilatory Management
Adjusting Ventilator Parameters
Mechanical Ventilation of the Neonate with Cardiac Disease
References
Chapter 27 Mechanical Ventilation of the Pediatric Patient
Introduction
Noninvasive Ventilation
Indications for CPAP and NIV
Patient Interfaces
Challenges and Contraindications for the Use of NIV in Pediatric Patients
Management of the Patient Using CPAP and NIV
The Use of Sedation During NIV
Patient Monitoring During CPAP and NIV
Adjuncts or Alternative Approaches to Noninvasive Ventilation
Complications and Safety During NIV
Invasive Mechanical Ventilation
Indications and Goals
Ventilator Modes
Setting Mandatory Breath Rate
Setting Tidal Volume (VT) or Inspiratory Pressure (IP)
Adjusting Inspiratory Time, Flow, and I:E Ratios
The Use of PEEP
Setting and Adjusting Inspired Oxygen Concentration (FiO2)
Setting and Adjusting Trigger and Cycle Sensitivity
Strategies for Preventing Lung Injury
Advanced Modes of Ventilation and Concepts: High-Frequency Jet Ventilation and High-Frequency Oscillatory Ventilation (HFJV, HFOV)
Biphasic Ventilation and APRV
Neurally Adjusted Ventilatory Assist (NAVA)
Prone Positioning
Management of the Patient Requiring Invasive Ventilation
Weaning and Extubation
Complications of Mechanical Ventilation
Summary
References
Chapter 28 Surfactant Replacement Therapy
Introduction
Description
Physiology in Normal Term Infants
Components of Pulmonary Surfactant
Fetal Lung Maturity Testing
Antenatal Steroids and Surfactant Production
Indications
Preparations
Administration
Clinical Considerations for Therapeutic Administration
Hazards/Complications
Limitations
Summary
References
Chapter 29 Specialty Gas Administration
Introduction
Helium–Oxygen Mixtures
Gas Physics
Mechanism of Action
Indications
Delivery Devices
Limitations
Hazards/Complications
Nitric Oxide
Gas Physics
Mechanism of Action
Indications
Delivery Devices
Limitations
Hazards/Complications
Subambient Oxygen and Inhaled Carbon Dioxide
Gas Physics
Mechanism of Action
Indications
Delivery Devices
Limitations
Hazards/Complications
Anesthetic Gas Mixtures
Gas Physics
Mechanism of Action
Indications
Delivery Devices
Limitations
Hazards/Complications
References
Chapter 30 Extracorporeal Membrane Oxygenation
Introduction
Background
Clinical Application
Selection Criteria
Newborn Respiratory Failure
Pediatric Respiratory Failure
Cardiac Support
Types of ECMO Support
Venous-Arterial
Venous-Venous
ECMO Circuits and Systems
Roller Pumps
Centrifugal Pumps
Extracorporeal Physiology
Membrane Oxygenators
Blood Pathway and Gas Exchange
Clinical Management
Anticoagulation
Patient Monitoring
Weaning and Separation from ECMO
Complications
Outcomes
References
Chapter 31 Bronchoscopy
Introduction
Indications for Bronchoscopy
Rigid Bronchoscopy
Flexible Airway Endoscopy
Preparing for Flexible Airway Endoscopy
Performing Flexible Airway Endoscopy
Personnel
Examining the Airway
Flexible Airway Endoscopy Techniques
Postprocedure Care
Complications Associated with Flexible Airway Endoscopy
Infection Control
Summary
References
Chapter 32 Pharmacology
Introduction
Bronchodilators
Indications
Beta-Adrenergic Receptor Agonists
Alpha-Adrenergic Receptors
Anticholinergic Bronchodilators
Methylxanthines
Corticosteroids
Indications
Mechanism of Action
Systemic Corticosteroids
Inhaled Corticosteroids
Mucolytics
Side Effects
Leukotriene Modifiers
Antimicrobials
Inhaled Antibiotics
Oral Antibiotics
Skeletal Muscle Relaxants
References
Chapter 33 Transport of the Neonate and Child
Introduction
Transport Team
Crew Configuration
Team Requirements
Training Requirements
Transport Modes
Ground
Rotor Wing
Fixed Wing
The Role of Medical Control
Triage and Mode of Transportation
Medical Control Communication
Equipment
Clinical Care in Pediatric and Neonatal Critical Care Transport
Airway Care
Mechanical Ventilation
Altitude
Family on Transport
References
Chapter 34 The Respiratory Technology–Dependent Infant and Child
Introduction
Preparing for Discharge
Transition from Hospital to Home
Benefits of Providing Care at Home
Risks of Providing Care at Home
Multidisciplinary Discharge Planning Team
Criteria for Discharge Home
Medical Stability
Skilled Caregivers
Available Home Medical Equipment and Nursing Staff
Caregiver Education and Preparation
Education Skill Proficiencies
Rooming-In
Transportation Home
Preparing the Home
Home Medical Equipment
Day of Discharge
Barriers to Discharge
Outpatient Care
Transition from Pediatric to Adult Care
Summary
Acknowledgments
References
Chapter 35 Pediatric Palliative and Hospice Care
Introduction
Pediatric Palliative Care
Definition
Goals
Indications
Communication
Psychosocial and Spiritual Concerns
Symptom Management
Pediatric Hospice Care
Concurrent Care for Children
When Goals of Care Change
A Case Study: Assisting with End-of-Life Care
Medical History and Present Illness
Escalation of Care
Wishes Honored
Celebration of Life
Palliative and Hospice Care Projections
References
Glossary
Index