RT Journal Article
SR Electronic
T1 Negative-Pressure Ventilation in the Pediatric ICU
JF Respiratory Care
FD American Association for Respiratory Care
SP 354
OP 365
DO 10.4187/respcare.11193
VO 69
IS 3
A1 DeRusso, Michelle
A1 Miller, Andrew G
A1 Caccamise, Melissa
A1 Alibrahim, Omar
YR 2024
UL http://rc.rcjournal.com/content/69/3/354.abstract
AB Negative-pressure ventilation (NPV) is a form of noninvasive ventilation that has been recently utilized in pediatric acute respiratory failure. Negative-pressure ventilators apply negative pressure onto the chest wall via a cuirass to recruit areas of atelectasis. Continuous negative extrathoracic pressure, the most common mode, is similar to CPAP, where negative pressure is maintained at a constant level throughout the respiratory cycle while patients initiate their own breaths and continue to breathe spontaneously throughout. Control mode, which is similar to bi-level positive airway pressure, alternates negative pressure with positive pressure and controls both phases of breathing at a mandatory frequency set higher than the patient’s spontaneous frequency. Supplemental oxygen is provided through a nasal cannula or face mask due of the lack of NPV devices’ interface with the mouth or nose. NPV can improve preload to the heart and cardiac output (CO) in patients with restrictive right-ventricular physiology requiring CO augmentation and those with Fontan physiology. The purpose of this article is to review the physiological principles of spontaneous and NPV, examine the evidence supporting the use of NPV, give practical and meaningful guidance on its clinical application in the pediatric ICU, and summarize areas for future studies on its uses.