Acute respiratory failure

lnsavage10@yahoo.comlnsavage10@yahoo.com
in Pediatrics

One of my many favorite diagnoses- acute respiratory failure. My facility is working to come up with a definition for acute respiratory failure. Would anyone be willing to share the criteria that you use for diagnosing acute respiratory failure? Does anyone have the criteria that was discussed at conference from Texas Children's?


Thank you!

Leah Savage, RN, MSN, CCDS

Kosair Children's Hospital

Louisville, KY

leah.savage@nortonhealthcare.org

Comments

  • jackietouch@aol.comjackietouch@aol.com

    Hi, Leah~

    We use the criteria in the CDI Pocket Guide as well as criteria listed under the resources in Dr. Kennedy's website cdimd.com. Generally speaking, in order for us to clarify for acute respiratory failure,  patient has to have evidence of hypoxia or hypercapnia (pulse ox, vbg or abg, SF or PF ratio); acidosis (if gas is available); signs of distress (altered mental status, retractions, tachypnea or bradypnea/apnea, flaring, grunting); and the need for intervention to maintain oxygen saturations >92% such as noninvasive or invasive mechanical ventilation and oxygen (includes high flow nasal cannula).

    Unfortunately, I did not attend the conference so don't have the criteria from Texas Children's  :(


    Jackie Touch, MSN, RN, CCM

    CHOC Children's, Orange, CA



  • lnsavage10@yahoo.comlnsavage10@yahoo.com

    Thank you! I will definitely use this.


    Leah                  

  • Eva2016Eva2016

    If your provider documented the following under Acute Problems in the chart

    1. Acute Respiratory Failure

    2. Dehydration

    3. Bronchiolitis

    4. Hypoxia

    Would you code acute respiratory failure with hypoxia. Or, would you query for hypoxia.

    Thank you,

    Eva


  • cmclose@saintfrancis.comcmclose@saintfrancis.com

    Hi Eva~

    I would code "AcRF w/ hypoxia". That is what I have seen our coders do.

    Claudine

  • morris-jeff@CooperHealth.edumorris-jeff@CooperHealth.edu

    I'd pick up the Acute Resp Failure with hypoxia from that list.

  • hillsandovals@email.chop.eduhillsandovals@email.chop.edu
    Me too Eva, I would take ARF with Hypoxia.
  • hillsandovals@email.chop.eduhillsandovals@email.chop.edu
    Leah, this is such a sore spot for us all. We have attempted to meet with our Pulm and ICU attendings and no one wants to commit on a definition. We have been working on this for the past 2 yrs.

    Steph
  • jackietouch@aol.comjackietouch@aol.com
    We would capture it as acute respiratory failure with hypoxia. There is an Excludes 1 note for R0902 (hypoxia) instructing that it should never be used with J9600 (unless they are not related to each other which is unlikely).

    Funny how we are all challenged by the same issues!

    Jackie Touch
  • vbica@nemours.orgvbica@nemours.org
    Eva, I would look for a venous or art gas with a pH, if less than 7.2 would also ask for hypercapnia. if none documented, hypoxia would be the other choice- there are 2 types of arf- w/hypoxia and w/hypercarbia, but kids often have both!
  • lostwaterlostwater

    Dr. Kennedy's recent blog past contains some excellent information.  He also linked back to the Maryland Hospital Association's Physician Workgroup on Respiratory issues.  I still do not see a "gold standard" for pediatric respiratory failure, but we do have some resources to use in crafting our own guidelines.

    Mark N. Dominesey


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