LIBRO + ANEXOS NEUMOLOGÍA PEDIÁTRICA

Neumología Pediátrica. Anexos ❚ 147 16. Know that strength and endurance of the infant's diaphragm is less than that of pubertal children and adults, potentially contributing to diaphragm fatigue and respiratory failure 17. Know that increased respiratory loads contribute to diaphragm fatigue and respiratory failure 18. Know that decreased or absent central respiratory drive can cause respiratory failure and that this will be worse in the presence of increased respiratory loads 4. Diagnosis and clinical manifestations a. History 1. Recognize the symptoms of recurrent nocturnal hypoxemia and hypercapnia 2. Recognize that frequent and/or severe pneumonia in children with neuromuscular disease indicates ventilatory muscle weakness and an increased likelihood of respiratory failure 3. Recognize that children with progressive neuromuscular diseases and disorders of respiratory control manifest symptoms first during sleep and only later during wakefulness 4. Recognize that morning headaches may indicate hypercapnia and/or hypoxemia occurring during sleep 5. Recognize that respiratory failure may appear to occur suddenly in children with chronic disorders of respiratory control or ventilatory muscle function, even though they have a chronic disorder affecting respiration b. Physical examination 1. Understand that patients with severe neuromuscular disease and chronic respiratory failure may not manifest clinical symptoms, such as retractions and nasal flaring 2. Recognize the physical findings typical of acute hypoxemia 3. Recognize the physical findings typical of acute carbon dioxide retention 4. Recognize the signs of respiratory failure in patients with severe neuromuscular weakness (e.g., tachycardia, diaphoresis) 5. Understand that symptoms normally associated with respiratory distress (tachypnea, retractions, nasal flaring, etc.) require intact ventilatory control 6. Recognize that children with disorders of respiratory control may not manifest respiratory distress or typical symptoms (retractions, nasal flaring, tachypnea, etc.) c. Imaging 1. Recognize the radiologic findings in spinal muscular atrophy and other neuromuscular diseases 2. Know how to use fluoroscopy and/or abdominal ultrasound to diagnose unilateral and bilateral diaphragm paralysis d. Pulmonary function tests 1. Recognize that spirometry and blood gas tensions correlate poorly in patients with respiratory failure e. Other investigations 1. Know the age-dependent normal values for PaO2, PaCO2, and pH 2. Know the techniques for and complications of obtaining arterial blood samples 3. Recognize the effects of sample errors on blood gas values