Paeds Vivas · respiratory-sleep-and-airway
Respiratory distress and failure in children — viva
Branching structured oral on recognising the continuum from respiratory distress to failure and escalating support.
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Study tools
Target exams
RACP DCEMRCPCH Clinical
Prompt
You are the paediatric registrar assessing a series of children in the emergency department with increased work of breathing, from a wheezy infant to a tiring child with a quiet chest.
Opening (must-hit)
"I treat respiratory distress and failure as one continuum. I clear the pre-arrest threat gate first, give oxygen, and then read the trend in the child's effort — rising effort means they are compensating, falling effort with a quieter chest and a drowsier child means they are failing. I localise the cause to the upper airway, lower airway, lung tissue, or the pump and drive, and I escalate support in steps while treating the cause." [1] [6] [8]
References6ShowHide
- [1]Fleming S Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet, 2011.PMID 21411136
- [2]Franklin D A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med, 2018.PMID 29562151
- [5]Ramnarayan P Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Therapy on Liberation From Respiratory Support in Acutely Ill Children Admitted to Pediatric Critical Care Units: A Randomized Clinical Trial. JAMA, 2022.PMID 35707984
- [6]Emeriaud G Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med, 2023.PMID 36661420
- [8]Schlapbach LJ International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA, 2024.PMID 38245889
- [12]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. Lancet Child Adolesc Health, 2025.PMID 40451224