Predictors of Negative Pressure Ventilation Response in Pediatric Acute Respiratory Failure.

Abstract

Use of negative pressure ventilation is neither well described nor widespread in pediatric critical care; existing data are from small, specialized populations. We sought to describe a general population of critically ill subjects with acute respiratory failure supported with negative pressure ventilation to find predictors of response or failure. We conducted a retrospective cohort study of subjects 0-18 y old admitted to a single (non-cardiac) pediatric ICU who received acute respiratory failure support via negative pressure ventilation from May 2015 through May 2016. In 118 subjects, the most common causes of acute respiratory failure were viral bronchiolitis (86.4%) and pneumonia (15.3%). A majority of subjects (68.6%) stabilized with negative pressure ventilation and did not need a change of respiratory support; in those who failed with negative pressure ventilation, median time to respiratory support change was 5.1 h (interquartile range 1.9-11.0). Subjects stabilized with negative pressure ventilation did not differ from those needing a change of respiratory support in terms of age, comorbidities, or FIO2 at initiation of ventilation. Compared to those who did not respond to negative pressure ventilation, mean SpO2 /FIO2 was higher at 1 h after start of negative pressure ventilation (218.8 vs 131.7) in those who did respond. Subjects with SpO2 /FIO2 < 192 after 1 h on negative pressure ventilation support had 5-fold higher odds of needing a respiratory support change (odds ratio 5.143, 95% CI 1.17-22.7, P = .031). Analysis of SpO2 /FIO2 was limited by 81.3% (96/118) of subjects who had an SpO2 > 97% at 1 h after the start of negative pressure ventilation. Negative pressure ventilation successfully supported 69% of pediatric subjects with all-cause acute respiratory failure. Oxygen requirement was lower in subjects who were responsive to negative pressure ventilation within 1 h of initiation. Standardized negative pressure ventilation protocols should include weaning of supplemental oxygen to determine responsiveness.