Dr. Omar Alibrahim, a pediatric intensivist at Duke University and expert in critical care, joins to discuss negative pressure ventilation (NPV) for bronchiolitis. He examines how NPV enhances lung function and cardiac output, particularly in children with unique cardiac conditions. The conversation also highlights the implementation challenges and benefits of this innovative technique in pediatric care. Dr. Alibrahim shares his experiences developing a clinical program for NPV, aiming to improve respiratory support while fostering teamwork in healthcare settings.
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insights INSIGHT
Negative Pressure Ventilation Physiology
Negative pressure ventilation (NPV) creates sub-atmospheric pressure on the chest wall, helping lung and alveoli recruitment.
NPV's active exhalation phase reduces work of breathing, especially beneficial for children with compliant chest walls.
insights INSIGHT
Cardiopulmonary Benefits of NPV
NPV improves venous return and cardiac output by creating negative thoracic pressure, especially valuable in patients with Fontan physiology.
It optimizes right ventricular preload and afterload, benefiting biventricular physiology but may increase afterload in LV dysfunction.
question_answer ANECDOTE
Starting NPV Program in Buffalo
Dr. Alibrahim's team in Buffalo started NPV after encountering it via FDA contact and found it physiologically sensible and minimally harmful.
They began targeting neuromuscular patients, eventually using it most for bronchiolitis with acute respiratory failure.
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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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