Fatigue of the respiratory muscle and respiratory insufficiency

Recent results on respiratory muscle function are reviewed, with special regard to the muscle fatigue theory of respiratory failure. In this respect diagnostic measures and clinical symptoms are reported. Therapy is directed to reduce the work of respiratory muscles and temporarily rest them. Within this special role is given to the treatment with respirator and positive pressure breathing.     

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.     

Pulmonary hemorrhage with respiratory insufficiency in Henoch- Schoenlein purpura

A 20-year-old woman presented with abdominal pain, purpura on the extremities, and arthralgia. The diagnosis of Henoch-Sch?nlein purpura was made based on granular IgA deposits in the vessels in a skin biopsy. Three weeks after onset of these symptoms, she developed glomerulonephritis and diffuse alveolar haemorrhage; she developed respiratory failure and needed mechanical ventilation. She recovered upon treatment with corticosteroids. Diffuse alveolar bleeding has occasionally been reported in adults with Henoch-Sch?nlein purpura; this is the first report from the Netherlands.