Continuous negative extrathoracic pressure or continuous positive airway pressure for acute hypoxemic respiratory failure in children.

Acute hypoxemic respiratory failure (AHRF) is an important cause of mortality and morbidity in the pediatric age group. Despite varied etiologies and different population characteristics the aims of therapy are to achieve adequate oxygenation and ventilation. Positive pressure ventilation is currently the standard of care. It is ordinarily provided by intubation and mechanical ventilation, which is associated with a number of well recognized complications. Continuous negative extrathoracic pressure ventilation (CNEP) or continuous positive airway pressure ventilation delivered via non-invasive approaches (Ni-CPAP) have shown certain beneficial effects in animal and uncontrolled human studies. In a systematic review of studies involving neonates, continuous distending pressure using either CNEP or CPAP (applied via face mask) was associated with reduction in mortality but with an increased incidence of pneumothoraces, in neonates.