Negative extrathoracic pressure in treatment of respiratory failure in infants and young children.

Samuels, Martin; Southall, D P

doi:10.1136/bmj.299.6710.1253

Cited by 64 publications

(47 citation statements)

References 20 publications

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“…A negative pressure of -0.6 kPa (-6 cm H,O) was applied using a system developed over the past 5 y to overcome the technical difficulties described previously (8). It consists of a chamber with a Perspex lid on an incubator heater base with five portholes to allow easy access to the patient and the insertion of monitoring leads and treatment lines.…”

Section: Cnepmentioning

confidence: 99%

“…A new system for applying negative extrathoracic pressure respiratory support has been designed to overcome many of the previous technical problems such as access to the infant, adequate neck seal, and temperature control (8). Preliminary results from ongoing controlled clinical trials suggest that negative extrathoracic pressure support may have benefits beyond those of conventional therapy in the management of lung disease in neonates and infants.…”

mentioning

confidence: 99%

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Effect of Continuous Negative Extrathoracic Pressure on Respiratory Mechanics and Timing in Infants Recovering from Neonatal Respiratory Distress Syndrome

Gappa¹,

Costeloe

Southall

et al. 1994

Pediatr Res

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Stoke-on-Trent, United Kitlgdom (D. P.S. IChanges in respiratory mechanics and timing produced by continuous negative extrathoracic pressure (CNEP) of -0.6 kPa were assessed in 18 infants recovering from neonatal respiratory distress syndrome. The mcdian gcstational age was 28 wk (range 2 4 3 6 wk). All infants were recruited before discharge from neonatal intensive care and were measured at a median postnatal age of 58 d (range 10-127 d) and a mcdian wcight of 2.67 kg (range 1.99-3.77 kg). All had been treated for respiratory distress syndrome; 11 were diagnosed as having chronic lung disease. At the time of the study, all infants were stable breathing room air. There was a significant decrease of the respiratory rate in all but one infant from 63.6 2 10.0 to 49.3 ? 9.1 breaths per min (mean * SD) during CNEP. This was predominantly due to a marked prolongation of the expiratory timc. Passive respiratory mechanics were assessed using airway occlusion techniques. Whereas respiratory system compliance (C,,) did not change in the infants with a normal baseline measurement, there was a significant improvement of C,, in the 11 infants with low C,, values in atmosphere: In the latter, all of whom were very-low-birthweight infants, C,, assessed by the multiple occlusion technique (mean ? SD) corrected for body wcight increased from 7.9 ? 1.5 to 9.4 ? 1.9 mL-kPa-'.kg-' in CNEP (p = 0.012). There was no consistent change in respiratory system resistance in this population of 18 infants. These preliminary results suggest that the beneficial effects of CNEP observed in clinical studies may be partially explained by its effects on respiratory mechanics and timing. (Pediatr Res 36: 364-372, 1994) Abbreviations CNEP, continuous negative extrathoracic pressure RDS, respiratory distress syndrome C,, respiratory system compliance (mL.kPa I ) IPPV, intermittent positive pressure ventilation C,,.,,,, dynamic lung compliance (mL-kPa-I) VLBW, very-low-birth-weight infants ( < 1500 g) CLD, chronic lung disease MOT, multiple occlusion technique SBT, single breath technique R,,, respiratory system resistance (kPa.L-'.s) Pa,, pressure at the airway opening (kPa) t,,,,, expiratory time during end-inspiratory occlusion (s) t,, expiratory time (s) V.,., tidal volume (mL) t,, inspiratory time (s) FRC, functional residual capacity (mL) EEL, end-expiratory level PNT, pneumotachograph CI, confidence interval The use of negative extrathoracic pressure as a means described in 1889. Intermittent negative extrathoracic of respiratory support has a long history dating back to pressure ventilation was subsequently used widely for the first half of the last century (1). The first apparatus treatment of respiratory failure in children with poliomydesigned for use in the resuscitation of neonates was elitis and, during the 1960s and 1970s, both intermittent negative extrathoracic pressure and CNEP ventilation

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Section: Cnepmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Continuous Negative Extrathoracic Pressure on Respiratory Mechanics and Timing in Infants Recovering from Neonatal Respiratory Distress Syndrome

Gappa¹,

Costeloe

Southall

et al. 1994

Pediatr Res

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“…Furthermore, it was suggested that the collar could induce a garrotting effect responsible for the potentially harmful increase in endocranial pressure [61]. More recently, however, after substantial technical improvement [62], NPV has been reintroduced for the treatment of respiratory failure [63,64]. PALMER et al [65], using a new model of tank ventilator ( fig.…”

Section: Paediatric Diseasesmentioning

confidence: 99%

“…SAMUELS and SOUTHALL [62] studied, in an uncontrolled clinical trial, the effects of NPV in 88 infants and young children (aged 1 day to 2 yrs) with respiratory failure principally due to bronchopulmonary dysplasia and neonatal distress syndrome. When NPV was initiated, 59…”

Section: Paediatric Diseasesmentioning

confidence: 99%

“…can enter chamber; 10) tubing to pressure monitor. (Modified and used with permission, from SAMUELS and SOUTHALL [62] 28 were successfully extubated with the aid of negative extrathoracic pressure and 24 survived. Fifty four patients (61%) survived and were discharged; among these, six needed to be ventilated at home with a negative extra thoracic ventilatory support.…”

Section: Paediatric Diseasesmentioning

confidence: 99%

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Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered

Corrado¹,

Gorini²,

Villella³

et al. 1996

European Respiratory Journal

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Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered. A. Corrado, M. Gorini, G. Villella, E. De Paola. ©ERS Journals Ltd 1996. ABSTRACT: Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure ventilators. Negative pressure ventilators, such as the "iron lung", support ventilation by exposing the surface of the chest wall to subatmospheric pressure during inspiration; whereas, expiration occurs when the pressure around the chest wall increases and becomes atmospheric or greater than atmospheric.In this review, after a description of the more advanced models of tank ventilators and the physiological effects of negative pressure ventilation (NPV), we summarize the recent application of this old technique in the treatment of acute respiratory failure (ARF). Several uncontrolled studies suggest that NPV may have a potential therapeutic role in the treatment of acute on chronic respiratory failure in patients with chronic obstructive pulmonary disease and restrictive thoracic disorders, reducing the need for endotracheal intubation. In the paediatric field, after substantial technical improvement, NPV has been successfully reintroduced for the treatment of ARF due to neonatal distress syndrome and bronchopulmonary dysplasia, and for the weaning from positive pressure ventilation in intubated patients.The positive results of these reports need to be formally confirmed by further prospective and controlled studies before recommending the generalized use of negative pressure ventilation in acute respiratory failure as a standard of care.

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Proceedings from the First International Symposium on the Congenital Central Hypoventilation Syndrome held in New Orleans, LA, on May 11, 1996

Gozal

Gaultier

1997

Pediatr. Pulmonol.

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Negative extrathoracic pressure in treatment of respiratory failure in infants and young children.

Cited by 64 publications

References 20 publications

Effect of Continuous Negative Extrathoracic Pressure on Respiratory Mechanics and Timing in Infants Recovering from Neonatal Respiratory Distress Syndrome

Effect of Continuous Negative Extrathoracic Pressure on Respiratory Mechanics and Timing in Infants Recovering from Neonatal Respiratory Distress Syndrome

Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered

Proceedings from the First International Symposium on the Congenital Central Hypoventilation Syndrome held in New Orleans, LA, on May 11, 1996

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