• Michelle DeRusso, Andrew G Miller, Melissa Caccamise, and Omar Alibrahim.
• Drs DeRusso and Alibrahim are affiliated with Division of Pediatric Critical Care Medicine, Duke University, Durham, North Carolina. Mr Miller is affiliated with Division of Pediatric Critical Care Medicine, Duke University, Durham, North Carolina; and Respiratory Care Services, Duke University, Durham, North Carolina. Ms Caccamise is affiliated with Respiratory Care Services, Duke University, Durham, North Carolina.
• Respir Care. 2024 Feb 28; 69 (3): 354365354-365.

AbstractNegative-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.Copyright © 2024 by Daedalus Enterprises.

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