Pediatric Respiratory Failure

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There is NOT a universally accepted definition for respiratory failure in the pediatric population. Respiratory failure is the inability to provide O2 and remove CO2 at a rate that meets metabolic demands.

Acute Respiratory Failure (ARF)
▪ Not all patients with acute respiratory failure require intubation and mechanical ventilation.
▪ Any of the following interventions meet the criteria for acute respiratory failure.

▪ Supplemental oxygen with a FiO2 > 30-35% to maintain oxygenation (SpO2 ≥ 90%)

• Room air = FiO2 0.21, 2L NC 0.28, 3L NC 0.32

▪ High-flow nasal cannula, vapotherm or non-rebreather mask oxygen, CPAP or BiPAP

Chronic Respiratory Failure (CRF)
▪ Continuous home oxygen or ventilator support (mechanical vent or nasal BiPAP) or
▪ Having baseline SaO2 < 88% on room air or pCO2 > 50 with a normal pH due to a respiratory

Acute on Chronic Respiratory Failure
▪ Chronic respiratory failure is worsening of SaO2 and/or pCO2 with symptoms

Documentation Caveat: ICD-10-CM does not dictate which criteria a provider must use, BUT auditors question clinical validation. If a patient has respiratory failure, it must be justified in the documentation.

Respiratory Failure Compared to Respiratory Distress:
• Respiratory insufficiency or respiratory distress is sometimes documented when the child clinically meets criteria for respiratory failure. These are lower-weighted, therefore use respiratory failure when the child meets criteria.
• In ICD-10-CM, respiratory failure is divided into: acute respiratory failure, chronic respiratory failure or acute and chronic respiratory failure.

• Each of these divisions is subdivided into: With hypoxia, with hypercapnia or unspecified.

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