Skip to Main Content


Respiratory disease in its various forms remains the most common cause of pediatric and neonatal morbidity and mortality. One of the most common reasons for admission to pediatric or neonatal intensive care units is the need for ventilatory support for acute or impending respiratory failure. The major challenge for these units is to deal with a very heterogeneous population of patients who are characterized by enormous differences in age and size and marked developmental changes in organ physiology during growth. In particular, the pediatric intensive care unit population is characterized by a wide variety of rare and unique medical problems that make large clinical trials, even on general topics such as ventilator support, very difficult to conduct.1,2 Despite worldwide daily use of mechanical ventilation in pediatric and neonatal intensive care units, many clinical and practical questions remain unresolved. Answers are often extrapolated from the results of adult studies. This may seem sensible for older children but is dangerous when applied to neonates, infants, and children up to the age of 12 years, because of developmental alterations in the physiology of their organ systems, particularly (but not only) their respiratory system.


The considerable differences in respiratory physiology and anatomy between infants and adults3 explain why infants and young children have a higher susceptibility to more severe manifestations of respiratory diseases, and why respiratory failure is a common problem in neonatal and pediatric intensive care units (Table 23-1). The appreciation of the peculiarities of pediatric respiratory physiology is essential for correct management of critically ill and/or ventilated infants and children.

Table Graphic Jump Location
Table 23-1: Physiologic Reasons for the Increased Susceptibility for Respiratory Compromise of Infants in Comparison to Adults 



The basal metabolic rate is approximately twofold higher in infants than in adults (7 mL/kg/min at birth vs. 3 to 4 mL/kg/min in the adult). Hence, the normal resting state in ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.