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Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

Amanda B Hassinger1, Ryan K Breuer1, Kirsten Nutty2

  • 1Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.

Respiratory Care
|September 2, 2017
PubMed

Insights

Negative-pressure ventilation (NPV) effectively supports critically ill children with respiratory failure, showing a 70% success rate and reducing intubation rates. A bedside scoring system may predict NPV failure early.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Support Technologies
  • Noninvasive Ventilation

Background:

  • Negative-pressure ventilation (NPV) is utilized for pediatric acute respiratory failure.
  • Its application in a diverse group of critically ill children is described.

Purpose of the Study:

  • To evaluate the effectiveness and outcomes of NPV in critically ill pediatric patients.
  • To identify factors associated with NPV response and failure.

Main Methods:

  • Retrospective chart review of pediatric ICU patients receiving NPV from 2012-2015.
  • Analysis of patient demographics, etiologies, duration of support, and outcomes.
  • Development and validation of a bedside scoring system for NPV failure prediction.

Main Results:

  • NPV supported 233 pediatric patients, most commonly for bronchiolitis (70%).
  • A 70% response rate was observed; non-responders often had upper airway obstruction.
  • A bedside scoring system demonstrated 98% specificity in predicting NPV failure within 4 hours.
  • Complications were rare (3%), but delayed enteral nutrition (33%) and sedation (51%) were frequent.
  • NPV introduction correlated with a 28% decline in pediatric ICU intubation rates.

Conclusions:

  • NPV is a safe and effective noninvasive respiratory support for pediatric acute respiratory failure.
  • A significant majority of patients respond to NPV, with a predictable failure pattern in some.
  • A bedside scoring system shows promise for early identification of NPV failure.
  • While complications are minimal, careful management of nutrition and sedation is necessary.
Abstract

Keywords:
childrendevice safetynegative-pressure ventilationnoninvasive ventilationrespiratory failuretreatment efficacy

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