Practical Approach to the Child with Rapid Breathing

Respiratory distress in children must be promptly recognised as clinical deterioration is common and may be rapid. Respiratory distress may be a marker of both respiratory and other non-respiratory severe and evolving illnesses. Children are at risk of rapid deterioration due to smaller airways, reduced functional residual capacity, increased metabolic demands and inadequate compensatory mechanisms. The principles of rapid response to respiratory distress in order of importance are detection and prevention of impending respiratory arrest, acute management of signs and symptoms, determination of severity and need to escalate monitoring and/or therapy and determination of underlying cause. Determination of severity, projection of course and intervention to prevent respiratory deterioration and, in particular, cardiorespiratory arrest should be the priority of the rapid response team.