Negative-pressure ventilation (NPV) avoids the use of a positive-pressure facial interface and represents an alternative noninvasive support strategy for children with respiratory failure. Contemporary multi-center pediatric data directly comparing negative-pressure ventilation with noninvasive positive-pressure ventilation (NIV) are limited. This study describes modern NPV epidemiology and compares clinical outcomes between NPV and NIV in children younger than 3 years admitted to pediatric ICUs with acute or acute-on-chronic respiratory failure.
This investigation was a multi-center retrospective cohort study that used the Virtual Pediatric Systems (VPS) database. The analysis was performed using routinely collected clinical data from participating pediatric intensive care units. The article was published online ahead of print in Respir Care with PubMed PMID 42841699 and DOI 10.1177/19433654261486084.
Included were children younger than 3 years who received either NPV or NIV during a pediatric ICU admission for acute or acute-on-chronic respiratory failure. Outpatient use of either modality was explicitly excluded. Subjects were categorized according to the initial respiratory support modality received in the PICU. Further patient-level inclusion or exclusion criteria and the sample size were not reported in the abstract available.
The primary outcome was endotracheal intubation after initiation of noninvasive respiratory support. The outcome measures reported in the abstract focus on intubation rates and the association between initial modality and subsequent intubation. Other outcomes such as duration of noninvasive support, mortality, PICU length of stay, or device-related complications were not reported in the abstract.
The primary analysis used multivariable mixed-effects logistic regression with center included as a random intercept to account for clustering by center and measured subject-level confounders. As a sensitivity analysis, the authors performed propensity-score matching. The propensity model included the Pediatric Risk of Mortality (PRISM) III score, age, sex, weight, diagnostic variables, and center.
In unadjusted comparisons, the crude intubation rate was higher in the NPV group than in the NIV group (27.3% vs 10.4%, P < .001). This descriptive finding indicates that, before adjustment, children who initially received NPV experienced intubation more frequently than those started on NIV.
After adjustment for measured subject-level factors and accounting for center-level clustering with mixed-effects logistic regression, the initial ventilation modality was not independently associated with subsequent intubation. The adjusted odds ratio comparing NIV to NPV was 0.675 (95% CI 0.393–1.158), with a P value of .154, indicating no statistically significant difference after covariate adjustment.
In the propensity-score-matched cohort—matching on PRISM III score, age, sex, weight, diagnostic variables, and center—the intubation rate remained numerically higher in the NPV group but did not reach statistical significance. The matched analysis reported an odds ratio for NPV versus NIV of 1.64 (95% CI 0.92–2.93; P = .12).
The authors report that NPV was used in a small minority of children younger than 3 years with acute respiratory failure in this multi-center cohort. Specific prevalence, center-level variability, or temporal trends were not detailed in the abstract.
In this retrospective multi-center analysis, crude intubation rates were higher for children who initially received NPV than for those who received NIV; however, after adjustment for measured confounders and center-level clustering, the initial ventilation modality was not independently associated with subsequent endotracheal intubation. The authors conclude that prospective studies are needed to better define optimal patient selection and the role of NPV in pediatric acute respiratory failure.
The abstract does not report several details that would clarify interpretation and generalizability, including absolute cohort sizes for each modality, baseline demographic and clinical characteristics, reasons for modality selection, duration of support, device-specific complications, physiologic response measures, or long-term outcomes. Because the study is retrospective and relies on registry data, residual confounding and unmeasured variables may influence associations between modality and intubation despite multivariable adjustment and propensity matching. The authors specifically call for prospective studies to address these knowledge gaps.
Note: All statements above are based on the study abstract as the sole source of information. Where additional methodological or numerical details were not provided in the abstract, those specifics are not available from the source provided.