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. 2024 Feb 28;69(3):354-365.
doi: 10.4187/respcare.11193.

Negative-Pressure Ventilation in the Pediatric ICU

Michelle DeRusso  1 , Andrew G Miller  1 , Melissa Caccamise  1 , Omar Alibrahim  2
Affiliations

Negative-Pressure Ventilation in the Pediatric ICU

Michelle DeRusso et al. Respir Care. .

Abstract

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.

Keywords: Fontan physiology; NPV; critical care; history; mechanical ventilation; pediatrics; positive-pressure ventilation; respiratory failure.

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Conflict of interest statement

Mr Miller is a section editor for Respiratory Care. Mr Miller discloses a relationship with Saxe Communications. The remaining authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Components of the commercially available negative-pressure ventilator. BCV = Biphasic Cuirass Ventilator; RTX = Hayek RTX Ventilator.
Fig. 2.
Fig. 2.
Photograph of the cuirass in place on a simulated patient.
Fig. 3.
Fig. 3.
Graph of pressure delivery in continuous negative extrathoracic pressure mode. This mode is akin to CPAP. CNEP = continuous negative extrathoracic pressure.
Fig. 4.
Fig. 4.
Graph of pressure delivery in continuous negative extrathoracic pressure mode. This mode is akin to bi-level ventilation.
Fig. 5.
Fig. 5.
Algorithm for negative pressure ventilation initiation and titration. EKG = electrocardiogram; CNEP = continuous negative extrathoracic pressure; PPV = positive-pressure ventilation; V̇/Q̇ = ventilation/perfusion; WOB = work of breathing; ENT = ear, nose, and throat; CO = cardiac output; Paw = mean airway pressure; Pplat = plateau pressure. NPV = negative pressure ventilation
See this image and copyright information in PMC

References

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