Acute respiratory insufficiency in children

Acute respiratory distress in children is often a consequence of asthma. Other causes are subglottic laryngitis, epiglottitis, aspiration of a foreign body, acute bacterial pneumonia or pneumothorax. History and physical examination should differentiate between the various diseases. Asthma is characterized by recurrent symptoms and signs, while this is not the case with the other causes of acute breathlessness described. An asthma exacerbation is often preceded by one or more prodromes. In case of aspiration of a foreign body, like a peanut, immediate action is needed to prevent irreversible damage to the airways. Subglottic laryngitis and epiglottitis are both characterized by an inspiratory stridor; in case of epiglottitis immediate action is needed, while in case of subglottic laryngitis observation time is available in most cases. Pneumothorax as a cause of acute breathlessness is rare in childhood; it should be considered in male smoking leptosomic asthmatic adolescents.     

Bacterial tracheitis as the cause of acute respiratory insufficiency in 2 teenagers

A 13-year-old girl and a 12-year-old boy developed acute respiratory insufficiency caused by an upper airway obstruction, which necessitated intubation and mechanical ventilation. Cultures from throat swabs from the girl and boy yielded Haemophilus parainfluenzae and Streptococcus pneumoniae, respectively. Diagnoses of bacterial tracheitis were confirmed by tracheoscopy and both children were treated with antibiotics. After 11 and 4 days of mechanical ventilation, respectively, they were successfully extubated. No further complications were encountered. Bacterial tracheitis is a rare but significant cause of upper airway obstruction in children.