• Cynthia A Moffitt, Kathleen Deakins, Ira Cheifetz, Jason A Clayton, Katherine N Slain, and Steven L Shein.
• Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, OH.
• Pediatr Crit Care Me. 2021 Jun 1; 22 (6): e363-e368.

ObjectivesNegative pressure ventilation may be more physiologic than positive pressure ventilation, but data describing negative pressure ventilation use in the PICU are limited. We aimed to describe the epidemiology and outcomes of PICU patients receiving negative pressure ventilation.DesignDescriptive analysis of a large, quality-controlled multicenter database.SettingFifty-six PICUs in the Virtual Pediatric Systems database who reported use of negative pressure ventilation.PatientsChildren admitted to a participating PICU between 2009 and 2019 who received negative pressure ventilation.InterventionsNone.Measurements And Main ResultsAmong 788 subjects, 71% were less than 2 years old, and 45% had underlying health conditions. Two concurrent aspiration events were the only adverse events reported. After excluding one over-represented center, the 3 years with the most negative pressure ventilation usage were 2017-2019 (all > 25 cases/yr and ≥ 13 centers reporting usage). Among those 187 children, the most common primary diagnoses were bronchiolitis and cardiac disease (both 15.5%), 24.1% required endotracheal intubation after negative pressure ventilation, and 9.1% died.ConclusionsNegative pressure ventilation is being used in many PICUs, most commonly for pulmonary infections or cardiac disease, in children with high rates of subsequent intubation and mortality and with few documented adverse events. Use at individual centers is rare but increasing, suggesting need for prospective collaboration to better evaluate the role of negative pressure ventilation in the PICU.Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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