To report the use of negative pressure ventilation as a therapeutic rescue in a patient with post-operative complications of Kawashima procedure.

Case report.

Paediatric cardiac critical care unit in a tertiary care teaching hospital.

Nine month-old patient with single ventricle physiology developed complications after Kawashima procedure that were worsened by use of positive pressure ventilation.

Utilisation of negative pressure ventilation due to its unique cardiopulmonary interactions and haemodynamic effects.

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.

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.