Acute Respiratory Failure and Management

  • Prakadeshwari RajapreyarEmail author
  • Whitney Kopp
  • Adrienne Randolph


Acute respiratory failure is a common reason for admission to the pediatric intensive care unit in oncology patients. Acute respiratory complications are also common after pediatric hematopoietic stem cell transplant (HSCT), accounting for a high proportion of HSCT-related morbidity and mortality. Evaluation of these patients requires a thorough workup that includes identification and treatment of infectious etiologies, and treatment for noninfectious causes once infectious causes are ruled out. These patients should be closely monitored for development of pediatric acute respiratory distress syndrome (PARDS) with early escalation of respiratory support. Patients undergoing a trial of noninvasive ventilation (NIV) should be continuously monitored to ensure they are responding. Prolonged delay of endotracheal intubation in patients who do not improve or worsen on NIV could worsen their outcome. Optimal treatment of immunocompromised patients with acute lung failure requires early and aggressive lung protective ventilation, prevention of fluid overload, and rapid diagnosis of underlying causes to facilitate prompt disease-directed therapy.


Hematopoietic stem cell transplant Immunocompromised pediatric patients Invasive mechanical ventilation Noninvasive positive pressure ventilation Pediatric acute respiratory distress syndrome 


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Copyright information

© Springer International Publishing 2019

Authors and Affiliations

  • Prakadeshwari Rajapreyar
    • 1
    Email author
  • Whitney Kopp
    • 1
  • Adrienne Randolph
    • 2
    • 3
  1. 1.Division of Pediatric Critical Care MedicineMedical College of Wisconsin/Children’s Hospital of WisconsinMilwaukeeUSA
  2. 2.Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain MedicineBoston Children’s HospitalBostonUSA
  3. 3.Departments of Anesthesia and PediatricsHarvard Medical SchoolBostonUSA

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