@article {Nunezrespcare.07020, author = {Crystal A Nunez and Amanda B Hassinger}, title = {Predictors of Negative Pressure Ventilation Response in Pediatric Acute Respiratory Failure}, elocation-id = {respcare.07020}, year = {2019}, doi = {10.4187/respcare.07020}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Use of negative-pressure ventilation is neither well described nor widespread in pediatric critical care; existing data are from small, specialized populations. We sought to describe a general population of critically ill subjects with acute respiratory failure supported with negative-pressure ventilation to find predictors of response or failure.METHODS: We conducted a retrospective cohort study of subjects 0{\textendash}18 y old admitted to a single (non-cardiac) pediatric ICU who received acute respiratory failure support via negative-pressure ventilation from May 2015 through May 2016.RESULTS: In 118 subjects, the most common causes of acute respiratory failure were viral bronchiolitis (86.4\%) and pneumonia (15.3\%). A majority of subjects (68.6\%) stabilized with negative-pressure ventilation and did not need a change of respiratory support; in those who failed with negative-pressure ventilation, median time to respiratory support change was 5.1 h (interquartile range 1.9{\textendash}11.0). Subjects stabilized with negative-pressure ventilation did not differ from those needing a change of respiratory support in terms of age, comorbidities, or FIO2 at initiation of ventilation. Compared to those who did not respond to negative-pressure ventilation, mean SpO2/FIO2 was higher at 1 h after start of negative-pressure ventilation (218.8 vs 131.7) in those who did respond. Subjects with SpO2/FIO2 \< 192 after 1 h on negative-pressure ventilation support had 5-fold higher odds of needing a respiratory support change (odds ratio 5.143, 95\% CI 1.17{\textendash}22.7, P = .031). Analysis of SpO2/FIO2 was limited by 81.3\% (96/118) of subjects who had an SpO2 \> 97\% at 1 h after the start of negative-pressure ventilation.CONCLUSIONS: Negative-pressure ventilation successfully supported 69\% of pediatric subjects with all-cause acute respiratory failure. Oxygen requirement was lower in subjects who were responsive to negative-pressure ventilation within 1 h of initiation. Standardized negative-pressure ventilation protocols should include weaning of supplemental oxygen to determine responsiveness.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/early/2019/10/01/respcare.07020}, eprint = {https://rc.rcjournal.com/content/early/2019/10/01/respcare.07020.full.pdf}, journal = {Respiratory Care} }