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Modified setting of negative pressure in children with mild respiratory disease

Shingo Ishimori1,2, Shizuka Nagase1, Atsuko Kanagawa1

  • 1Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|November 30, 2020
PubMed

Insights

Continuous negative extra-thoracic pressure (CNEP) effectively reduced respiratory symptoms in hospitalized children. This modified CNEP approach was well-tolerated and safe, avoiding the need for intubation in most cases.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine

Background:

  • Continuous negative extra-thoracic pressure (CNEP) is known to prevent severe respiratory infections requiring endotracheal intubation in children with apnea.
  • Limited data exists on CNEP's efficacy and safety in children with mild acute respiratory disease, particularly concerning clinical respiratory symptoms.

Purpose of the Study:

  • To evaluate the safety and effectiveness of a modified CNEP setting in hospitalized children presenting with chest-wall retraction or nasal alar breathing.
  • To assess CNEP's impact on clinical respiratory symptoms in this pediatric population without immediate need for intubation.

Main Methods:

  • A prospective, observational study was conducted from July 2014 to July 2017 at a single center.
  • A modified CNEP protocol involved 4 hours of treatment: 3 consecutive hours of CNEP followed by 1 hour of rest.
  • Nineteen hospitalized children meeting specific respiratory symptom criteria were included, with no sedative drugs administered.

Main Results:

  • The study included 19 children (median age 0.9 years) treated with CNEP for a median of 6 days.
  • A significant decrease in chest-wall retraction or nasal breathing was observed within 24 hours of CNEP initiation (68% vs 100%, P=0.02).
  • No patients required transfer for intubation; no adverse events such as upper airway obstruction, skin injury, or hypothermia were reported.

Conclusions:

  • Modified CNEP management is a safe and tolerable treatment option for hospitalized children with specific respiratory symptoms.
  • This approach can be successfully implemented without significant adverse events, potentially avoiding endotracheal intubation.
Abstract

Keywords:
acute respiratory distresschest-wall retractionchildrencontinuous negative extra-thoracic pressurenegative pressure ventilation

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