Pediatric Respiratory Conditions/Diseases

• Pneumonitis


  A general term that refers to inflammation of the lung tissues.

  • Non-infectious type
  • Infectious type (Pneumonia)- where alveoli are filled with fluids, blood cells and microorganisms (bacteria, virus or fungi)
• Complications of Pneumonitis

  1. pulmonary edema, phagocytic infiltration; accompanied with exudation and consolidation (typically localized i.e. lobar pneumonia.
  2. bacteremia
  3. pleural effusion
  4. lung abscess
  5. acute respiratory distress syndrome (ARDS)
  6. Pulmonary fibrosis
• Pneumonitis: Non-infectious Causes

  Factors that lead to non-infectious pneumonitis include:

  1. Inhalation of asbestos or silica dusts, toxic chemical gas (chlorine), or smoke/fumes
  2. Use of certain drugs like chemotherapy drugs
  3. Aspiration of gastric contents
  4. Inhalation of feather dusts or bird excrement
  5. Radiation therapy for treatment of cancer
  6. Aspiration of foreign matter into the lungs (i.e hydrocarbon aspiration)
  7. Physical injury of the lungs
• Examples of Conditions Leading to Non-infectious Pneumonitis

  SMOKE/TOXIC INHALATION

  1. Exposure to smoke has been recognized as capable of causing damage or death exclusive of burn injury; fire related deaths.
  2. Lungs are exposed to thermal and chemical products of combustion.
  3. Thermal airway injury above the larynx common due to excellent heat dissipation by the upper AW.
  4. Steam inhalation more damaging; thermal injuries may be seen far more distally in the airways.
  5. Extent of damage correlated with composition of smoke, length of exposure, and patient’s VE
• Examples of Conditions Leading to Non-infectious Pneumonitis


  SMOKE/TOXIC INHALATION

  1. Combustion of materials may contain organic acids, aldehydes, SO2, NO2, HCl, phosgene, chlorine, ammonia, HCN and CO.
  2. CO and HCN can be absorbed by the blood.
  3. Other substances cause direct injury to the airway mucosa and alveolar epithelium. If severe, this may lead to PARDS.
  4. Results to mucosal edema, activation of inflammatory receptors, tissue necrosis, sloughing of AW mucosa, AW obstruction, leading to hypoxemia , atelectasis and even reduced bacterial clearance.
• Examples of Conditions Leading to Non-infectious Pneumonitis

  TOXIC GAS INHALATION – Carbon monoxide (CO)

  1. Binds to hemoglobin forming carboxyhemoglobin; affinity >200X than that of O2
  2. Shifts oxyhemoglobin dissociation curve to the left making O2 release at the tissues more difficult.
  3. COHgb >20% - mild; with nausea, vomiting, dizziness, headache and fatigue
  4. COHgb >40% - visual, fine motor, and intellectual impairment, decreased sensorium; may lead to coma
  5. COHgb >60% - fatal level
• Examples of Conditions Leading to Non-infectious Pneumonitis


  MANAGEMENT OF SMOKE/TOXIC INHALATION (with or without CO inhalation)

  1. High FiO2 levels; hyperbaric O2 therapy (HBO) if CO poisoning is involved
  2. Bronchial drainage
  3. Intubation or tracheostomy – depends on severity or extent of AW involvement or face/neck involvement with burn injuries
  4. Mechanical ventilation with PEEP
  5. Therapeutic bronchoscopy – if there is no artificial AW
  6. Bronchodilators if there is bronchospasm – racemic epinephrine
  7. Antibiotics – if patient developed pneumonia
• Examples of Conditions Leading to Non-infectious Pneumonitis

  TOXIC GAS INHALATION – Chlorine gas

  • May cause damage to the airways and lung parenchyma after prolonged exposure resulting to pulmonary edema, respiratory failure and possibly death.
  • Patient may show nausea and vomiting after exposure, and characteristic chlorine odor on breath.
  • Provide O2 therapy, and CPAP of 5 – 10cmH2O
  • Severe injury may lead to PARDS
• Examples of Conditions Leading to Non-infectious Pneumonitis

  CHEMICAL ASPIRATION

  • Small children (usually <5 years old) may accidentally drink certain chemicals that are accessible to them and aspirated to lungs resulting to airway damage.
  • Common chemicals: hydrocarbons such as kerosene, gasoline, turpentine, etc.
  • May lead to pneumonitis, CNS depression and weakness, GI irritation, renal and hepatic toxicity, cardiomyopathy.
• Examples of Conditions Leading to Non-infectious Pneumonitis

  CHEMICAL ASPIRATION

  • Clinical findings: non-productive cough, tachypnea, retractions, cyanosis, lethargy, fever, and the odor of hydrocarbon on the breath.
  • CXR: bilateral patchy infiltrates or densities with air trappings; usually apparent by 12 hours after ingestion/aspiration.
  • Lung injuries with fatal outcomes: hemorrhage, pulmonary edema, hyperemia, atelectasis, mucosal necrosis, interstitial inflammation, WBC exudation, and hyaline membranes.
• Examples of Conditions Leading to Non-infectious Pneumonitis

  CHEMICAL ASPIRATION

  Treatment and management:

  1. O2 therapy
  2. humidity therapy
  3. secretion clearance
  4. intubation, mechanical ventilation with PEEP
  5. antibiotics if patient develops pneumonia
• Pneumonitis: Infectious Causes

  Pneumonia (infectious pneumonitis) is caused by a number of factors that include:

  1. Exposure to bacteria, virus or fungal agents (molds)
  2. Aspiration of upper airway secretions
  3. A parasitic infection of the lungs (such as ascariasis, schistosomiasis, toxoplasmosis, paragonimiasis)
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• Signs and Symptoms of Pneumonia in Pediatric Patient

  ◼ High fever

  ◼ Persistent cough

  ◼ Shortness of breath

  ◼ Sweating

  ◼ Chills

  ◼ Chest pain

  ◼ Headache

  ◼ Muscle pain

  ◼ Fatigue
• Clinical Manifestations of Pneumonia

  1. fever (usually low grade if viral)
  2. cough
  3. tachypnea
  4. Retractions
  5. Wheezing, rales, and dull percussion over affected area
  6. Loss of energy and playfulness
• General Treatment for Pneumonitis

  1. Anti-inflammatory (corticosteroids)
  2. Antibiotics (bacterial causes or with bacterial infiltration) – initially broad spectrum
  3. Antiviral – for viral pneumonia; supportive therapy
  4. Antifungal – for pulmonary mycoses
  5. Oxygen therapy
• General Treatment for Pneumonitis

  1. Bronchial lavage – for non-infectious type
  2. Secretion management: • Suctioning • Chest physiotherapy • Aerosol therapy
  3. Plenty of rest or consider confinement
  4. Fluid and electrolyte replacement – IV
  5. Mechanical ventilation for severe cases