Pediatric respiratory failure

cmclose@saintfrancis.com

Need some help with pediatric resp failure; new CDI program for
pediatrics. In our hospital it is RARE that an ABG is done, usually
VBG's are done on kids. Physicians/residents label pt's with "acute resp
distress" even with documentation (by nurse/resident) of suprasternal,
intercostal retractions, abd breathing, grunting, increase WOB, giving
now breathing treatments, pt on continuous pulse ox, O2 per NC (Haven't
found cyanosis documented on chart reviews so far). Resp failure
charted if pt transfers to PICU. Any suggestions on other criteria you
use to query for resp failure? Anyone have VBG criteria they use for
Resp Failure? I checked with our CDI consulting company and they use ABG
only. Please email me: chutchinson@saintfrancis.com
Thanks.
Claudine Hutchinson RN
Clinical Documentation Improvement Coordinator
Children's Hospital at Saint Francis
Office: (918) 502-6603
Pager: 98-1001

robert.hodges2

I don't have pediatrics but here is the criteria I use in my queries. 
Some of it is not based on ABG's so it may be helpful.

Signs and Symptoms:

Acute: Develops over minutes to hours, Change in 2 or more ABG values
and/or other physical symptoms.

Chronic: Develops over several days or longer lasting more than 3
months; requires ongoing home treatment to maintain stable state and
will decompensate without treatment.

Types:

· Hypoxemic (pO2 50)

· pH of ≤ 7.30; if history of COPD, pH ≤ 7.50

· pCO2 of ≥50 on room air

· pO2 of < 60 on room air

· RR of ≥ 24

· Alteration in mental status: anxiety

· Accessory muscle use

· Unable to speak in complete sentences

· Ventilator support required

· "End Stage" COPD, polycythemia, cor pulmonale, or chronic hypoxemia
documented

· Continuous home O2 required

· Chronic home mechanical vent used

· Invasive or non - (BiPAP, CPAP)

· Continuous or scheduled home nebulizers used

· Chronic oral steroids used continuously

Sources: 

Bernard, GR. Acute Respiratory Distress Syndrome: A Historical
Perspective. Am J Respir Crit Care Med 2005; 172:798

Bernard, G, Artigas, A, Carlet J, et al. The American-European
consensus conference on ARDS: Definitions, mechanisms, relevant
outcomes, and clinical trial coordination. Am J. Respir Crit Care Med
1994; 149:818.


And don't forget, that the providers judgment carries all the weight
you need for the diagnosis.



Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov 


"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens

dbutler

Great stuff Robert, will be chasing down your references.

I agree, many/all of the clinical factors described in the initial
question is all it really takes to establish the clinical diagnosis of
acute resp failure, with the hope being one can manage the patient
aggressively so they don't require transfer to the PICU for that level
of monitoring or invasive intervention.

Would also suggest consider -- ability to talk (phrases or words only),
tiredness, toxic appearance, overall color (not just cyanotic), general
gestalt impression....

Don

robert.hodges2

I worked with our Pulmonologist on this one. I don't see it often here, but on occasion I do get to ask the question based on presentation and it's nice to have his backup when I ask the question.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
 
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
 
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens