---
title: "Negative-Pressure vs Noninvasive Positive-Pressure Ventilation in Young Children With Acute Respir"
id: "pubmed-42841699"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42841699"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42841699/"
doi: "10.1177/19433654261486084"
published_at: "2026-10-07T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Negative-Pressure vs Noninvasive Positive-Pressure Ventilation in Young Children With Acute Respir
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42841699
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42841699/)
- **DOI:** [10.1177/19433654261486084](https://doi.org/10.1177%2F19433654261486084)
- **Published At:** 2026-10-07T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This multi-center retrospective cohort study used the Virtual Pediatric Systems (VPS) database to compare **negative-pressure ventilation (NPV)** and **noninvasive positive-pressure ventilation (NIV)** in children younger than 3 years with acute or acute-on-chronic respiratory failure. - Outpatient use of either modality was excluded; subjects were categorized by the initial noninvasive respiratory support received during a pediatric ICU admission. - The primary outcome was subsequent **endotracheal intubation** after initiation of noninvasive support. - Crude intubation rates were higher in the NPV group than the NIV group (27.3% vs 10.4%; P < .001). - After adjustment using multivariable mixed-effects logistic regression with center as a random intercept, ventilation modality was not independently associated with intubation (adjusted OR for NIV vs NPV 0.675, 95% CI 0.393–1.158; P = .154). - A propensity-score-matched sensitivity analysis (matching on PRISM III score, age, sex, weight, diagnostic variables, and center) showed a numerically higher intubation rate with NPV but not statistically significant (NPV vs NIV OR 1.64, 95% CI 0.92–2.93; P = .12). - NPV was used in a small minority of children under 3 years in this cohort. - Authors conclude that after adjustment for measured confounders and center-level clustering, ventilation modality was not independently associated with intubation, and they call for prospective studies to clarify patient selection and the role of NPV in pediatric acute respiratory failure. - Specific details such as absolute cohort sizes, baseline characteristics, duration of support, complication rates, and center-level practice patterns were not reported in the abstract and therefore are not available from the source provided.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Comparing the Efficacy of Negative-Pressure Ventilation to Noninvasive, Positive-Pressure Ventilation in Children With Acute Respiratory Failure [Syeda Zabreen Afzal](https://pubmed.ncbi.nlm.nih.gov/?term=Afzal+SZ&cauthor_id=42841699)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#full-view-affiliation-1 "Drs. Afzal and Breuer are affiliated with the Department of Pediatrics, Division of Pediatric Critical Care, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Noah Stanco](https://pubmed.ncbi.nlm.nih.gov/?term=Stanco+N&cauthor_id=42841699)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#full-view-affiliation-2 "Drs. Stanco, Wrotniak, and Welliver are affiliated with the Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Ryan K Breuer](https://pubmed.ncbi.nlm.nih.gov/?term=Breuer+RK&cauthor_id=42841699)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#full-view-affiliation-1 "Drs. Afzal and Breuer are affiliated with the Department of Pediatrics, Division of Pediatric Critical Care, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Amanda Hassinger](https://pubmed.ncbi.nlm.nih.gov/?term=Hassinger+A&cauthor_id=42841699)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#full-view-affiliation-3 "Dr. Hassinger is affiliated with the Department of Pediatrics, Division of Pediatric Critical Care/Sleep Medicine, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Brian Wrotniak](https://pubmed.ncbi.nlm.nih.gov/?term=Wrotniak+B&cauthor_id=42841699)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#full-view-affiliation-2 "Drs. Stanco, Wrotniak, and Welliver are affiliated with the Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Robert Welliver](https://pubmed.ncbi.nlm.nih.gov/?term=Welliver+R&cauthor_id=42841699)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#full-view-affiliation-2 "Drs. Stanco, Wrotniak, and Welliver are affiliated with the Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York.") Affiliations Expand ### Affiliations * 1 Drs. Afzal and Breuer are affiliated with the Department of Pediatrics, Division of Pediatric Critical Care, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York. * 2 Drs. Stanco, Wrotniak, and Welliver are affiliated with the Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York. * 3 Dr. Hassinger is affiliated with the Department of Pediatrics, Division of Pediatric Critical Care/Sleep Medicine, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York. * PMID: **42841699** * DOI: [ 10.1177/19433654261486084 ](https://doi.org/10.1177/19433654261486084) Item in Clipboard # Comparing the Efficacy of Negative-Pressure Ventilation to Noninvasive, Positive-Pressure Ventilation in Children With Acute Respiratory Failure Syeda Zabreen Afzal et al. Respir Care. 2026. Show details Display options Display options Format Abstract PubMed PMID Respir Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Respir+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Respir+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42841699/) . 2026 Oct 7:19433654261486084. doi: 10.1177/19433654261486084. Online ahead of print. ### Authors [Syeda Zabreen Afzal](https://pubmed.ncbi.nlm.nih.gov/?term=Afzal+SZ&cauthor_id=42841699)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#short-view-affiliation-1 "Drs. Afzal and Breuer are affiliated with the Department of Pediatrics, Division of Pediatric Critical Care, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Noah Stanco](https://pubmed.ncbi.nlm.nih.gov/?term=Stanco+N&cauthor_id=42841699)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#short-view-affiliation-2 "Drs. Stanco, Wrotniak, and Welliver are affiliated with the Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Ryan K Breuer](https://pubmed.ncbi.nlm.nih.gov/?term=Breuer+RK&cauthor_id=42841699)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#short-view-affiliation-1 "Drs. Afzal and Breuer are affiliated with the Department of Pediatrics, Division of Pediatric Critical Care, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Amanda Hassinger](https://pubmed.ncbi.nlm.nih.gov/?term=Hassinger+A&cauthor_id=42841699)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#short-view-affiliation-3 "Dr. Hassinger is affiliated with the Department of Pediatrics, Division of Pediatric Critical Care/Sleep Medicine, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Brian Wrotniak](https://pubmed.ncbi.nlm.nih.gov/?term=Wrotniak+B&cauthor_id=42841699)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#short-view-affiliation-2 "Drs. Stanco, Wrotniak, and Welliver are affiliated with the Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York."), [Robert Welliver](https://pubmed.ncbi.nlm.nih.gov/?term=Welliver+R&cauthor_id=42841699)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841699/#short-view-affiliation-2 "Drs. Stanco, Wrotniak, and Welliver are affiliated with the Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York.") ### Affiliations * 1 Drs. Afzal and Breuer are affiliated with the Department of Pediatrics, Division of Pediatric Critical Care, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York. * 2 Drs. Stanco, Wrotniak, and Welliver are affiliated with the Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York. * 3 Dr. Hassinger is affiliated with the Department of Pediatrics, Division of Pediatric Critical Care/Sleep Medicine, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, New York. * PMID: **42841699** * DOI: [ 10.1177/19433654261486084 ](https://doi.org/10.1177/19433654261486084) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Negative-pressure ventilation (NPV) avoids a positive-pressure facial interface, but contemporary multi-center pediatric data comparing NPV with noninvasive positive-pressure ventilation (NIV) are limited. We describe modern NPV epidemiology and compare outcomes with NIV in children younger than 3 years with acute respiratory failure. **Methods:** We conducted a multi-center retrospective cohort study using the Virtual Pediatric Systems (VPS) database. Children younger than 3 years who received NPV or NIV during a pediatric ICU (PICU) admission for acute or acute-on-chronic respiratory failure were included; outpatient use of either modality was excluded. Subjects were categorized according to initial respiratory support modality. The primary outcome was endotracheal intubation after initiation of noninvasive respiratory support. The primary analysis used multivariable mixed-effects logistic regression with center included as a random intercept. Propensity-score matching using Pediatric Risk of Mortality III score, age, sex, weight, diagnostic variables, and center was performed as a sensitivity analysis. **Results:** Crude intubation rates were higher in the NPV group than in the NIV group (27.3% vs 10.4%, _P_ < .001). After adjustment for measured subject-level factors and center-level clustering, ventilation modality was not independently associated with intubation (NIV vs NPV adjusted OR 0.675, 95% CI 0.393-1.158, _P_ = .154). In the propensity-score-matched cohort, intubation remained numerically higher in the NPV group but was not statistically significant (NPV vs NIV OR 1.64, 95% CI 0.92-2.93, _P_ = .12). **Conclusions:** In this multi-center retrospective cohort, NPV was used in a small minority of children younger than 3 years with acute respiratory failure. After adjustment for measured confounders and center-level clustering, ventilation modality was not independently associated with intubation. Prospective studies are needed to define optimal patient selection and the role of NPV in pediatric acute respiratory failure. **Keywords:** critical care; negative-pressure ventilation; noninvasive ventilation; pediatric. 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