Management of Respiratory Failure-Reply

Abstract

In Reply.— The use of negative-pressure breathing devices has declined since the advent of reliable positive-pressure breathing machines. However, there certainly are clinical situations in which devices such as the iron lung, cuirass respirator, or rocking bed might be indicated. Caution must be exercised when using these devices just as with any other treatment regimen. Secretions or upper airway obstruction can be a serious problem in patients with swallowing difficulties. If the disease process involves the cranial nerves and muscles concerned with deglutition and phonation, then these types of respirators would be contraindicated in the absence of a protected airway until sufficient function had returned for the patient to protect his own airway. Gastrointestinal function should be intact, as aspiration of stomach contents can be disastrous in paralyzed patients. Also, nursing care, so important to the well-being of these patients, can be compromised when more cumbersome breathing devices are used.