Negative-pressure ventilation: is there still a role?

Abstract

Negative-pressure ventilation (NPV) was the primary mode of assisted ventilation for patients with acute respiratory failure until the Copenhagen polio epidemic in the 1950s, when, because there was insufficient equipment, it was necessary to ventilate patients continually by handviaan endotracheal tube. Thereafter, positive-pressure ventilation was used routinely. Since it was also observed that patients with obstructive sleep apnoea could be treated noninvasively with positive pressureviaa nasal mask, noninvasive positive-pressure ventilation (NPPV) has become the most widely used noninvasive mode of ventilation.However, NPV still has a role in the treatment of certain patients. In particular, it has been used to good effect in patients with severe respiratory acidosis or an impaired level of consciousness, patients that to date have been excluded from all prospective controlled trials of NPPV. NPV may be used in those who cannot tolerate a facial mask because of facial deformity, claustrophobia or excessive airway secretion.NPV has also been used successfully in small children, and beneficial effects on the cardiopulmonary circulation maybe a particular advantage in children undergoing complex cardiac reconstructive surgery.This review is divided into two parts: the first is concerned with the use of negative-pressure ventilation in the short term, and the second with its use in the long term.

Negative Pressure Ventilation as a Therapy for Post-operative Complications in a Patient with Single Ventricle Physiology

“…The notable applications in current use are long-term supportive care for neuromuscular disorders, central hypoventilation syndrome and chronic lung diseases [1,2]. There has been limited utilisation of NPV in cardiac patients in the current era with no application of note in congenital heart patients in recent years.…”

Randomized Crossover Study of Lung Expansion Therapy Using Negative Pressure and Positive Pressure in Bronchiectasis

“…10,20 The excessive airway secretion in patients with bronchiectasis is one indication for therapy with NPV. 21,22 Documented guidelines for treating noncystic fibrosis bronchiectasis include the following point: "Where postural drainage is essential for clearing secretion in a breathless patient, consider offsetting the increased load using noninvasive ventilatory support, such as noninvasive ventilation or intermittent positive pressure breathing." 4 These guidelines are relevant to clinical practice.…”

Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: a new gold standard?

“…In a recent epidemiological study of 42 ICUs over a 3-week period NIV was never used in coma [33]. Although mask positive pressure ventilation is far away the most widely used non-invasive modality, negative pressure ventilation using an iron lung still has its advocates [34], and this technique has been used successfully in comatose patients [35]. Its use, however, is confined to a few specialised units.…”