title: Negative pressure ventilation as a therapy for post-operative complications in a patient with single ventricle physiology.
abstract: OBJECTIVE
  To report the use of negative pressure ventilation as a therapeutic rescue in a patient with post-operative complications of Kawashima procedure.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Paediatric cardiac critical care unit in a tertiary care teaching hospital.
  
  
  METHODS
  Nine month-old patient with single ventricle physiology developed complications after Kawashima procedure that were worsened by use of positive pressure ventilation.
  
  
  METHODS
  Utilisation of negative pressure ventilation due to its unique cardiopulmonary interactions and haemodynamic effects.
  
  
  RESULTS
  There was gradual and persistent improvement in the passive diastolic pulmonary blood flow through the Kawashima circuit along with improvement in oxygenation and ventilation. The patient was successfully weaned off ventilator support and discharged to home.
  
  
  CONCLUSIONS
  Patients with single ventricle physiology depend on passive diastolic blood flow to the lungs through surgical pathways such as Fontan or Kawashima circuits. Prolonged use of positive pressure ventilation can significantly affect this forward flow and result in haemodynamic compromise. Use of negative pressure ventilation with its unique cardiopulmonary interactions can be an effective rescue as demonstrated in our case.
authors.affiliation: Pediatric Cardiology Division, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States. deshpandes@kidsheart.com
authors.forename: Shriprasad R
authors.initials: SR
authors.lastname: Deshpande
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
authors.forename: Kevin O
authors.initials: KO
authors.lastname: Maher
mesh_terms: D006348:Cardiac Surgical Procedures; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D011859:Radiography; D012121:Respiration, Artificial; D015919:Ventilators, Negative-Pressure