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failure are listed in Table 99.3 . Appreciation of complicating underlying
conditions and the current clinical status, including response to chronic therapy
and details of prior exacerbations will help to assess those at risk of deteriorating
respiratory failure and inform treatment decisions.
Triage
Children with signs of impending or acute respiratory failure should be rapidly
identified based on appearance or vital signs and immediately evaluated with
attention to necessary lifesaving maneuvers. Supplemental oxygen and support of
ventilation should be provided emergently as indicated, while additional efforts to
determine underlying etiology are being addressed.
Initial Assessment/H&P
Diagnosis of acute respiratory failure is commonly made clinically, though
laboratory or pulmonary function testing can be supportive. Initial assessment
involves prompt appraisal of the child’s appearance, level of alertness, airway
patency, breathing effort, and circulation.
Resuscitative efforts may be necessary to clear or support an obstructed airway,
provide oxygen, and support effective ventilation. Initial history should be brief,
focused, and succinct. One approach to consider is the “AMPLE” history, which
involves queries into allergies, medications, pertinent medical history, last meal,
and events involved in present illness including treatments already administered.
Patients with acute respiratory failure should be continually assessed using
cardiopulmonary monitoring of heart rate, cardiac rhythm, respiratory rate, pulse
oximetry, and blood pressure. Noninvasive monitoring of end-tidal carbon
dioxide (ETCO2 ) (i.e., capnography) is also an important adjunct, providing
information about ventilatory status, including adequacy of assisted ventilation if
performed.
Management
Management of acute respiratory failure is critical in the ED. It involves
performing necessary therapeutic interventions to assist oxygenation and
ventilation along with close monitoring for further deterioration and consideration
of appropriate diagnostic testing ( Table 99.4 ).

Supplemental oxygen should be provided during initial assessment and any
resuscitative efforts. This is most appropriately accomplished using a
nonrebreather mask for spontaneously breathing patients. The goal oxygen
saturation percentage may vary according to underlying and suspected acute