Dr. Omar Alibrahim, a pediatric intensivist at Duke University, shares insights on negative pressure ventilation for treating acute respiratory failure in children. He discusses the management of a case involving a seven-month-old battling RSV bronchiolitis and explains the importance of ventilation strategies like Continuous Negative Intrathoracic Pressure. The conversation also covers challenges with sensitivity triggers in ventilation systems and the critical factors to consider when providing respiratory care to young patients.
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question_answer ANECDOTE
Wide Patient Range for NPV
Dr. Omar Alibrahim shared he has used negative pressure ventilation on patients ranging from 3.5 to 170 kilos.
This highlights the versatility and wide applicability of the technology in pediatric and adult critical care.
volunteer_activism ADVICE
Starting Negative Pressure Ventilation
Begin negative pressure ventilation (NPV) with CNIP mode, starting pressures at minus 14 to minus 18 cm H2O.
Proper cuirass fitting and sedation with dexmedetomidine at initiation improve patient comfort and effectiveness.
volunteer_activism ADVICE
Escalation and Sedation in NPV
If patient struggles at minus 18 on CNIP, increase pressure in increments of two up to minus 30.
Escalate to control mode when pressures reach minus 24-25, recognizing this mode often requires sedation.
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Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship.
Learning Objectives:
By the end of this podcast series, listeners should be able to:
Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.
Understand the experience of introducing a novel form of respiratory support in a PICU.
Describe the stepwise escalation of NPV settings often used in acute respiratory failure.
References:
Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193
Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.
Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.
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