Continuous negative chest wall pressure as therapy for severe respiratory distress in older children

Continuous negative chest wall pressure (CNP) was used to treat five children, 4 to 11 years of age, who had progressively severe respiratory distress caused by Pneumocystis carinii pneumonitis. After initial improvement, two patients developed progressive increases in respiratory rate, alveolar arterial oxygen gradient, intrapulmonary right to left shunt, and hypoxia. The disease ended fatally in both. The remaining three patients continued to improve and recovered from their pulmonary disease. These results show that CNP therapy provides an effective means of improving arterial oxygenation in spontaneously breathing older children, just as in neonates, without the need for endotracheal intubation, prolonged sedation, and muscle relaxants.