(1215) Negative-Pressure Ventilation Utilization in a Rural PICU

Introduction: Acute hypoxemic respiratory failure (AHRF) causes most pediatric intensive care unit (PICU) admissions. High flow nasal cannula, non-invasive positive pressure ventilation, and invasive positive pressure ventilation (IPPV) are used to manage AHRF. Negative pressure ventilation (NPV) has been shown to be effective in some patient populations. This retrospective analysis is part of a feasibility assessment to inform a prospective pilot on NPV. We hypothesize adjunctive NPV use is associated with decreased respiratory rate (RR) and fraction of inspired oxygen (FiO2) within 12 hours of initiation.

Methods: Single center retrospective chart review of patients 0-17 years old admitted to a rural PICU from January 2023 to June 2024 with AHRF who received NPV. Demographics, vital signs, and respiratory support data were collected. Heart rate (HR), RR, FiO2, and oxygen saturation (SpO2) 1 hour prior to NPV initiation were compared to 1, 4, 8, and 12 hours after initiation. Statistical analyses were performed using R with ‘tidyverse’ package. Demographic variables were analyzed with descriptive statistics. Continuous parametric and non-parametric were analyzed with paired t-tests and Mann-Whitney U respectively. Categorical variables were analyzed with Fisher’s exact test.

Results: Eleven patients with mean age 7.7 years (SD=7.1 years) were included. Mean PICU length of stay (LOS) was 21.0 days (17.1 days); mean hospital LOS was 28.3 days (24.3 days). Median duration of NPV use was 31.5 hours (IQR: 14.5 to 66 hours). There was no statistical significance between HR, RR and SpO2 prior to and after NPV initiation at any time interval. Mean FiO2 at NPV initiation was 61% (SD=23.3%); there was significance at 1 hour (55% (19%), p=0.006), 4 hours (51% (19%), p=0.003), and 12 hours (44% (12%), p=0.020). At NPV initiation, 5 (45%) were on HFNC, 5 (45%) on NIPPV, and 1 (9%) on IPPV. At NPV termination, 6 (55%) were on HFNC, 3 (27%) on NIPPV, and 2 (18%) on IPPV. There were no adverse events.

Conclusions: Adjunctive NPV was associated with decreased FiO2 and no difference in RR, HR or SpO2. This is similar to previously published literature and supports feasibility of prospective pilot study on NPV in pediatric AHRF.