Can respiratory failure be present without respiratory distress?
Absolutely. Children may hypoventilate because of reduced level of consciousness (ingestion, metabolic derangements, and head trauma) or neuromuscular dysfunction. After prolonged respiratory distress, children may become fatigued, and their work of breathing may appear normal in the presence of significant hypoventilation. Elevation of the P co 2 from hypoventilation may signal worsening fatigue and impending respiratory arrest
