Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

Hassinger, Amanda; Breuer, Ryan; Nutty, Kirsten; Ma, Changxing; Ibrahim, Omar S Al

doi:10.4187/respcare.05531

Cited by 24 publications

(19 citation statements)

References 21 publications

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“…The time frame was chosen to follow a previous cohort study as a validation dataset for a model to predict intubation. 5 The only exclusion criterion was negative pressure ventilation use for chest physiotherapy only. The Institutional Review Board of the University at Buffalo approved this study with a waiver of consent.…”

Section: Methodsmentioning

confidence: 99%

“…Data collected include demographics, past medical history, admission diagnosis, comorbidities (ie, history of asthma or reactive airways, chronic lung disease, or prematurity using physician documentation of these conditions), vital signs, any available blood gas results, and level of respiratory support 1 h prior to and 1, 4, 8, and 12 h after initiation of negative pressure ventilation. A previous study 5 of negative pressure ventilation in similar pediatric populations reported median time to negative pressure ventilation failure of ϳ 7 h; therefore, data collection regarding predictor variables stopped at 12 h after start of negative pressure ventilation. The primary outcome was negative pressure ventilation failure, which was defined as a change in respiratory support from negative pressure ventilation as determined by providers at the time.…”

Section: Data Collectionmentioning

confidence: 98%

“…Secondary outcomes included previously reported and theoretical complications of negative pressure ventilation, such as hypothermia, skin breakdown, pneumothorax, gastroesophageal reflux, delayed enteral nutrition (Ͼ 48 h), and agitation requiring sedation. 5…”

Section: Data Collectionmentioning

confidence: 99%

“…2,4 In the largest pediatric negative pressure ventilation study to date, 70% of 233 critically ill subjects treated with a biphasic cuirass ventilator in a single pediatric ICU had resolution of acute respiratory failure with negative pressure ventilation with a 3% complication rate. 5 As proven in other forms of NIV, ways to detect treatment response are crucial before widespread application of negative pressure ventilation in critically ill patients can be recommended. 6 For example, adults using bilevel positive airway pressure intubated within 12 h had lower hospital mortality than those whose intubation was delayed past that point.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Negative Pressure Ventilation Response in Pediatric Acute Respiratory Failure

Nunez

Hassinger

2019

Respir Care

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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 -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 -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 F IO 2 at initiation of ventilation. Compared to those who did not respond to negative pressure ventilation, mean S pO 2 /F IO 2 was higher at 1 h after start of negative pressure ventilation (218.8 vs 131.7) in those who did respond. Subjects with S pO 2 /F IO 2 < 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 1.17-22.7, P ‫؍‬ .031). Analysis of S pO 2 /F IO 2 was limited by 81.3% (96/118) of subjects who had an S pO 2 > 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.

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Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 98%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Negative Pressure Ventilation Response in Pediatric Acute Respiratory Failure

Nunez

Hassinger

2019

Respir Care

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“…Long-term non-invasive ventilation (LT-NIV) is provided via a nasal, oronasal, or facial mask with a bilevel positive airway pressure machine or a portable ventilator. Negative pressure ventilation, which is still mentioned in rare publications on children with acute respiratory failure ( 4 , 5 ), is virtually absent from recent reports on home long-term ventilation.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications

Praud

2020

Front. Pediatr.

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This review focuses on the delivery of non-invasive ventilation-i.e., intermittent positive-pressure ventilation-in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO 2 monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.

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Noninvasive Respiratory Support in Pediatric Acute Respiratory Distress Syndrome

Alibrahim

Slain

2019

Pediatric Acute Respiratory Distress Syndrome

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Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

Cited by 24 publications

References 21 publications

Predictors of Negative Pressure Ventilation Response in Pediatric Acute Respiratory Failure

Predictors of Negative Pressure Ventilation Response in Pediatric Acute Respiratory Failure

Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications

Noninvasive Respiratory Support in Pediatric Acute Respiratory Distress Syndrome

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