Negative pressure ventilation in pediatric critical care setting

Abstract

Invasive ventilation is associated with both pulmonary and non-pulmonary complications. There has been a renewed interest in the use of negative pressure ventilation (NPV) for various medical conditions to minimise the complications associated with positive pressure ventilation. The routine use of NPV in an ICU setting still requires further studies and research. In this article, the authors review the clinical applications of NPV together with associated risks and limitations. Case reports of patients with cardiac, neuromuscular and respiratory diseases managed with NPV on our unit are described. NPV improved the clinical condition in each of these patients and decreased the requirement for invasive therapy.

Negative Pressure Ventilation as a Therapy for Post-operative Complications in a Patient with Single Ventricle Physiology

“…None of the haemodynamic studies have shown this to be the case. Rather, NPV has been shown to improve left ventricular function and cardiac output in patients such as in acute myocarditis to successfully avoid intubation and inotropic support as well as in adult patients after coronary artery surgery [7,8].…”

Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

“…8,9 Existing literature dedicated to NPV use is limited to small case series or case reports in homogeneous disease states, such as acute lung injury, neuromuscular disorders, 7,10 neuromuscular disorders, 11,12 central hypoventilation, 4 bronchiolitis, 8 heart failure, and postoperative management of congenital heart disease. 6,[13][14][15] No published data on complication rates of NPV in a general pediatric population are available. Reported complications and limitations of current NPV devices have included hypothermia, skin irritation at contact points, and upper-airway obstruction because tracheal pressures can become more negative during NPV than during spontane-ous respiration.…”

“…Reported complications and limitations of current NPV devices have included hypothermia, skin irritation at contact points, and upper-airway obstruction because tracheal pressures can become more negative during NPV than during spontane-ous respiration. 13 There have also been reports of gastroesophageal reflux and aspiration due to the effects of negative-pressure on the tone of the lower esophageal sphincter. 16 We describe a single-center experience with NPV in pediatric subjects with acute respiratory failure from any cause admitted to a pediatric ICU.…”

Long term negative pressure ventilation: Rescue for the failing fontan?

“…Overtime, positive pressure ventilators have completely replaced them as conventional modes of ventilation. As a result, there are very limited circumstances in contemporary medicine under which negative pressure ventilation negative pressure ventilation (NPV) is being considered [17,18] . An example would be patients with neuromuscular disorders for long term respiratory support [17] .…”

“…Main issues are related to obtaining a good comfortable fit so as to minimize skin contact injury. Patients with upper airway obstruction or significant tracheomalacia are not suitable candidates for NPV and should be excluded [17,18] .…”