Determination of optimal work of breathing with negative pressure ventilation: "Best NPV"

Negative pressure ventilation (NPV) is used classically in a control mode for patients with neuromuscular disease. The conventional negative pressure ventilator can only be adjusted according to rate and negative pressure. However, a microprocessor-based negative pressure ventilator, such as the NEV 100 (Respironics, Murrysville, PA), allows for an assist mode of ventilation and the incorporation of extrathoracic positive pressure during ventilation cycles. Traditionally, titration of optimal settings with a conventional NPV is adjusted to patient comfort and arterial blood gases (ABG). We present a case report in which NPV parameters for a 14-month-old child with pulmonary hypoplasia were optimized by evaluating pulmonary mechanics. To date, no studies using pulmonary mechanics to titrate NPV have been published in the literature.