Use Of Negative Pressure Ventilation Research Articles

The Autumn Ghost. How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care

The Autumn Ghost. How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care

Negative Pressure Ventilation for COVID-19 Respiratory Failure: A Phoenix from the Ashes?

Aim:To critically review the clinical question: does negative pressure ventilation (NPV) have a role in the management of COVID-19-associated respiratory failure?Background: NPV was commonly used in the management of respiratory failure until the 1950s when positive pressure devices began to be utilized. Physiological responses to NPV differ from responses to positive pressure ventilation, PPV, in a number of ways that may have clinical advantages in the management of respiratory failure in general, and specifically in the care of COVID-19-associated respiratory failure.Design:Narrative review based on systematic literature research.Data sources:A search on OVID MEDLINE and EMBASE for NPV provided key publications, which were combined with recent relevant literature related to the present COVID-19 pandemic.Results:A total of 83 papers are included in the review and analysis. NPV has been used for >100 years across a range of clinical conditions including polio, adult respiratory distress syndrome, acute respiratory failure in chronic obstructive pulmonary disease patients, a range of neuromuscular disorders, chest wall disease, and post-cardiothoracic and spinal surgery. The potential benefits of NPV, in comparison the treatment of COVID-19 patients, may include improved ventilation, decreased lung damage, improved hemodynamics, ease of proning, and prevention of escalation to intubation.Conclusions:Historic and recent published evidence from animals and man support the use of NPV in acute respiratory failure in general, and strongly suggests that it may be particularly useful in COVID-19-associated respiratory failure. Clinical evaluation of a new lightweight, cost-effective NPV device is justified as it may result in a safe, effective, and economical solution to COVID-19-associated respiratory failure. It could be useful worldwide, but particularly in low and middle-income countries.

Use of Negative Pressure Ventilation in Pediatric Critical Care: Experience in 56 PICUs in the Virtual Pediatric Systems Database (2009-2019).

Negative pressure ventilation may be more physiologic than positive pressure ventilation, but data describing negative pressure ventilation use in the PICU are limited. We aimed to describe the epidemiology and outcomes of PICU patients receiving negative pressure ventilation. Descriptive analysis of a large, quality-controlled multicenter database. Fifty-six PICUs in the Virtual Pediatric Systems database who reported use of negative pressure ventilation. Children admitted to a participating PICU between 2009 and 2019 who received negative pressure ventilation. None. Among 788 subjects, 71% were less than 2 years old, and 45% had underlying health conditions. Two concurrent aspiration events were the only adverse events reported. After excluding one over-represented center, the 3 years with the most negative pressure ventilation usage were 2017-2019 (all > 25 cases/yr and ≥ 13 centers reporting usage). Among those 187 children, the most common primary diagnoses were bronchiolitis and cardiac disease (both 15.5%), 24.1% required endotracheal intubation after negative pressure ventilation, and 9.1% died. Negative pressure ventilation is being used in many PICUs, most commonly for pulmonary infections or cardiac disease, in children with high rates of subsequent intubation and mortality and with few documented adverse events. Use at individual centers is rare but increasing, suggesting need for prospective collaboration to better evaluate the role of negative pressure ventilation in the PICU.

Predictors of Negative Pressure Ventilation Response in Pediatric Acute Respiratory Failure.

Use of negative pressure ventilation is neither well described nor widespread in pediatric critical care; existing data are from small, specialized populations. We sought to describe a general population of critically ill subjects with acute respiratory failure supported with negative pressure ventilation to find predictors of response or failure. We conducted a retrospective cohort study of subjects 0-18 y old admitted to a single (non-cardiac) pediatric ICU who received acute respiratory failure support via negative pressure ventilation from May 2015 through May 2016. In 118 subjects, the most common causes of acute respiratory failure were viral bronchiolitis (86.4%) and pneumonia (15.3%). A majority of subjects (68.6%) stabilized with negative pressure ventilation and did not need a change of respiratory support; in those who failed with negative pressure ventilation, median time to respiratory support change was 5.1 h (interquartile range 1.9-11.0). Subjects stabilized with negative pressure ventilation did not differ from those needing a change of respiratory support in terms of age, comorbidities, or FIO2 at initiation of ventilation. Compared to those who did not respond to negative pressure ventilation, mean SpO2 /FIO2 was higher at 1 h after start of negative pressure ventilation (218.8 vs 131.7) in those who did respond. Subjects with SpO2 /FIO2 < 192 after 1 h on negative pressure ventilation support had 5-fold higher odds of needing a respiratory support change (odds ratio 5.143, 95% CI 1.17-22.7, P = .031). Analysis of SpO2 /FIO2 was limited by 81.3% (96/118) of subjects who had an SpO2 > 97% at 1 h after the start of negative pressure ventilation. Negative pressure ventilation successfully supported 69% of pediatric subjects with all-cause acute respiratory failure. Oxygen requirement was lower in subjects who were responsive to negative pressure ventilation within 1 h of initiation. Standardized negative pressure ventilation protocols should include weaning of supplemental oxygen to determine responsiveness.

Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure.

The objective of this work was to describe the use of negative-pressure ventilation (NPV) in a heterogeneous critically ill, pediatric population. A retrospective chart review was conducted of all patients admitted to a pediatric ICU with acute respiratory failure supported with NPV from January 1, 2012 to May 15, 2015. Two hundred thirty-three subjects at a median age of 15.5 months were supported with NPV for various etiologies, most commonly bronchiolitis (70%). Median (interquartile range) duration of support was 18.7 (8.7-34.3) h. The majority were NPV responders (70%), defined as not needing escalation to any form of positive-pressure ventilation. In non-responders, escalation occurred at a median (interquartile range) of 6.9 (3.3-16.6) h. More NPV non-responders had upper-airway obstruction (P = .02), and fewer had bronchiolitis (P = .008) compared with responders. A bedside scoring system developed on these data was 98% specific in predicting NPV failure by 4 h after NPV start (area under the curve 0.759, 95% CI 0.675-0.843, P < .001). Complications from NPV were rare (3%); however, delayed enteral nutrition (33%) and continuous intravenous sedation use (51%) in children while receiving NPV were more frequent. The annual percentage of pediatric ICU admissions requiring intubation declined by 28% in the 3 y after NPV introduction, compared with the 3 y prior. NPV is a noninvasive respiratory support for pediatric acute respiratory failure from all causes with few complications and a 70% response rate. Children receiving NPV often required intravenous sedation for comfort, and one third received delayed enteral nutrition. Those who required escalation from NPV worsened within 6 h; this may be predictable with a bedside scoring system.

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

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.

Negative pressure ventilation in pediatric critical care setting

Invasive ventilation is associated with both pulmonary and non-pulmonary complications. There has been a renewed interest in the use of negative pressure ventilation (NPV) for various medical conditions to minimise the complications associated with positive pressure ventilation. The routine use of NPV in an ICU setting still requires further studies and research. In this article, the authors review the clinical applications of NPV together with associated risks and limitations. Case reports of patients with cardiac, neuromuscular and respiratory diseases managed with NPV on our unit are described. NPV improved the clinical condition in each of these patients and decreased the requirement for invasive therapy.

Review of treatment of bronchiolitis related apnoea in two centres

Aims: To determine whether the use of negative pressure ventilation (NPV) was associated with a lower rate of endotracheal intubation in infants with recurrent apnoea secondary to acute bronchiolitis. Methods:...

Endobronchial Endometriosis Nd-YAG Therapy vs Drug Therapy

I read with great interest the selected report by Puma et al 1 Puma F Carloni A Casucci G et al. Successful endoscopic Nd-YAG laser treatment of endobronchial endometriosis. Chest. 2003; : 1168-1170 Abstract Full Text Full Text PDF Scopus (28) Google Scholar in a recent issue of CHEST (September 2003). They described a case of endobronchial endometriosis that was successfully treated by Nd-YAG laser therapy. However, I would like to suggest that pulmonary endometriosis is probably less rare than is commonly thought, as I have counted 104 cases of tracheobronchial or pulmonary endometriosis as a result of searches of the medical literature (including 23 cases published in languages other than English). Some of these cases presented evidence such as a pattern of lung opacities or necropsy findings and not catamenial hemoptysis. I also think that Nd-YAG laser therapy could be useful for the treatment of endobronchial endometriosis only when drug therapy is not effective, or when the adverse effects of this drug therapy are intolerable, as this procedure is associated with a certain morbidity. Although the risk of general anesthesia is considered to be low, hypoxemia, hypercapnia, and acidosis secondary to apneas, and the reduction of ventilation are presumed to be the major causes of intraoperative and postoperative complications. 2 Vitacca M Natalini G Cavaliere S et al. Breathing pattern and arterial blood gases during Nd-YAG laser photoresection of endobronchial lesions under general anesthesia: use of negative pressure ventilation: a preliminary study. Chest. 1997; 112: 1466-1473 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Cardiac arrest due to ventricular fibrillation may occur during rigid bronchoscopic laser therapy even in young patients with benign bronchial lesions. 3 D'Aloia A Faggiano P Fiorina C et al. Cardiac arrest due to ventricular fibrillation as a complication occurring during rigid bronchoscopic laser therapy. Monaldi Arch Chest Dis. 2003; 59: 88-90 Google Scholar The authors maintained that “Medical therapy has been recommended as the first choice in pulmonary endometriosis. It consists of the suppression of endometrial tissue with progesterone (ie, pseudopregnancy) or danazol (ie, pseudomenopause).” I only partly agree with this statement, as the authors failed to mention that gonadotropin-releasing hormone agonists have been prescribed for > 10 years and are effective in the treatment of this disease, as in our published case. 4 L'Huillier JP Salat-Baroux J Une observation d'endométriose pulmonaire. Rev Pneumol Clin. 2002; 58: 233-236 Google Scholar 5 Espaulella J Armengol J Bella F et al. Pulmonary endometriosis: conservative treatment with GnRH. Obstet Gynecol. 1991; 78: 535-537 PubMed Google Scholar Finally, I think that the follow-up period was not sufficiently long enough to ensure that the treatment was permanently effective. Unfortunately, the authors did not mention whether follow-up fiberoptic bronchoscopy was performed during menses.

Treatment of Acute Exacerbations of Chronic Respiratory Failure: Integrated Use of Negative Pressure Ventilation and Noninvasive Positive Pressure Ventilation

Acute respiratory failure (ARF) can be treated with either invasive mechanical ventilation (IMV) or noninvasive mechanical ventilation (NIMV), which can spare the complications of artificial airways. To evaluate the efficacy of an integrated approach using negative pressure ventilation (NPV) with iron lung and noninvasive positive pressure ventilation (NPPV), we performed a prospective study in a group of patients admitted to our respiratory ICU (RICU) for ARF due to exacerbation of chronic respiratory failure (CRF). RICU at "R. Silvestrini" Hospital in Perugia, Italy. One hundred fifty-two consecutive patients were included in the study and treated with iron lung as first choice or, when contraindicated or not tolerated, with NPPV using a nasal or facial mask. After 2 h of noninvasive mechanical ventilation (NIMV), the patients were reevaluated; in case of clinical deterioration, patients receiving NPV were switched to NPPV. When NPPV as a first or second line of treatment failed the patients were intubated. One hundred fifty-two patients received NIMV, 97 with iron lung as the first choice of treatment, and 55 with NPPV. Six patients treated with NPV were switched to NPPV during the first 2 h of treatment. Twenty-five patients required IMV. The success rate of the integrated use of NIMV (NPV plus NPPV) was 81.6%, compared to that of NPV (83.5%) and NPPV (70.5%). Twenty-one patients (13.8%) required tracheostomy; the duration of hospital stay was significantly lower in patients treated with NIMV only. Thirty patients required mechanical ventilation at home. Few severe complications were observed in patients receiving IMV. The integrated use of two NIMV techniques is effective in patients with acute exacerbation of CRF. In most cases intubation and tracheostomy were avoided, thus reducing the complication rate of mechanical ventilation.

Negative-pressure ventilation: is there still a role?

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 hand via an 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 pressure via a 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.

Noninvasive Ventilation: Past, Present, and Future: A Focus on Pediatric Applications

Noninvasive ventilation (NIV) is a technique of augmenting alveolar ventilation without requiring an indwelling artificial airway. Use of negative pressure ventilation began in the 1830s and antedates the development of artificial airways by almost a century. It has had a long history of success in the treatment of chronic respiratory failure in patients with neuromuscular disease, thoracic dysplasia, or central hypoventilation. In the 1980s, the concept of body ventilation evolved to include negative pressure ventilation and positive pressure ventilation via nasal mask. Nasal mask positive pressure ventilation has several advantages compared with negative pressure ventilation. It is more portable, easier to use and to fit, causes less discomfort, and avoids upper airway obstruction. Many additional uses of nasal mask positive pressure ventilation have been explored in pediatric practice, including treatment of patients with acute and chronic respiratory failure. NIV has been successfully used in pediatric patients with end-stage cystic fibrosis and hypercapnic respiratory failure, as a bridge to lung transplant, as a bridge to liberation from invasive mechanical ventilation, in children with transient upper airway obstruction, in hypoxemic respiratory insufficiency associated with pneumonia, in acute chest syndrome in patients with sickle cell disease, and for exacerbation of reactive airway disease. It may be particularly useful in patients whose underlying conditions warrant avoidance of tracheal intubation, especially patients who are immune-compromised. As in a review of any technology, potential and reported complications of NIV are discussed, and pediatric indications and relative contraindications are outlined. Clin Pulm Med 2000;7(4):199-207

Negative pressure ventilation as haemodynamic rescue following surgery for congenital heart disease.

A low cardiac output state is an important cause of morbidity and mortality following repair of tetralogy of Fallot (ToF). This is often refractory to conventional measures. The cardiac output of these patients is highly dependent on diastolic pulmonary arterial flow which is enhanced during spontaneous respiration, but much reduced by intermittent positive pressure ventilation (IPPV). We report the successful use of negative pressure ventilation (NPV) as haemodynamic therapy in three children with a low output secondary to restrictive right ventricular (RV) physiology following ToF repair. NPV produced a significant haemodynamic improvement, with increases in cardiac output of greater than 100 % in two of the children. By augmenting pulmonary blood flow, and hence cardiac output, NPV has a role as adjunctive haemodynamic therapy in patients with a low output secondary to diastolic RV dysfunction, in whom early extubation is not possible.

Breathing Pattern and Arterial Blood Gases During Nd-YAG Laser Photoresection of Endobronchial Lesions Under General Anesthesia: Use of Negative Pressure Ventilation: A Preliminary Study

To evaluate the efficacy of negative pressure ventilation (NPV) in avoiding or reducing apneas and related hypoxemia and respiratory acidosis during laser therapy (LT) of endobronchial lesions. A prospective, controlled, randomized study. An operating theater of a respiratory endoscopy and laser therapy unit. POPULATION AND INTERVENTION: Twenty-seven consecutive patients referred to LT were entered into the study. Fourteen patients were randomly assigned to LT under general anesthesia and spontaneous assisted ventilation (control group) whereas in 13 cases, NPV by a poncho-wrap ventilator (NPV group) was added to the procedure. The prevalence and the duration of apnea/hypopnea periods assessed by respiratory inductive plethysmography during LT were significantly reduced under NPV, compared to the control group. As compared to baseline, during LT, all control patients developed mild to severe hypercapnia (PaCO2 ranging from 55 to 76 mm Hg) and respiratory acidosis (pH from 7.33 to 7.19), whereas only three patients undergoing NPV (23%) developed hypercapnia (PaCO2 from 52 to 68 mm Hg) and related acidosis (pH from 7.29 to 7.21). Optimal oxygenation was achieved in all of the patients; nevertheless, patients under NPV needed a lower mean oxygen supply; five of them (38%) could be treated at a fraction of inspired oxygen of 0.21 for the whole procedure. NPV may be useful in reducing apneas during laser therapy under general anesthesia, thus reducing hypercapnia, related acidosis, and need of oxygen supplementation.

Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered.

Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure ventilators. Negative pressure ventilators, such as the "iron lung", support ventilation by exposing the surface of the chest wall to subatmospheric pressure during inspiration; whereas, expiration occurs when the pressure around the chest wall increases and becomes atmospheric or greater than atmospheric. In this review, after a description of the more advanced models of tank ventilators and the physiological effects of negative pressure ventilation (NPV), we summarize the recent application of this old technique in the treatment of acute respiratory failure (ARF). Several uncontrolled studies suggest that NPV may have a potential therapeutic role in the treatment of acute on chronic respiratory failure in patients with chronic obstructive pulmonary disease and restrictive thoracic disorders, reducing the need for endotracheal intubation. In the paediatric field, after substantial technical improvement, NPV has been successfully reintroduced for the treatment of ARF due to neonatal distress syndrome and bronchopulmonary dysplasia, and for the weaning from positive pressure ventilation in intubated patients. The positive results of these reports need to be formally confirmed by further prospective and controlled studies before recommending the generalized use of negative pressure ventilation in acute respiratory failure as a standard of care.

Negative Pressure Ventilation: New Uses for an Old Technique

Negative pressure ventilation (NPV), a concept that was used in the 1940s through 1950s to support the victims of the polio epidemic, is regaining popularity. It is being used increasingly to intermittently support respiratory function in patients suffering from a variety of diseases. The use of NPV obviates the need for a surgically placed airway (if the patients' upper airway is intact) and allows the patient to resume many of his or her normal activities. Several types of NPV are available for use and experimentation, and it is strongly recommended that the appropriate type for each patient be chosen. Nursing care of the patient on NPV is essentially the same as that of any chronically ventilator-dependent patient. Issues unique to the patient supported on NPV include: increased potential for aspiration, skin breakdown around the NPV site, and "tank shock." Nursing plays an important role in identifying patients who may be candidates for NPV. Negative pressure ventilation may allow a formally hospital-bound patient the opportunity to be home with family and friends.

Use of negative pressure ventilation to facilitate the return of spontaneous ventilation

Negative pressure ventilation was used to facilitate the return of spontaneous ventilation in 10 patients with severe, chronic respiratory disability. All patients had required tracheal intubation and intermittent positive pressure ventilation, and conventional weaning techniques had failed. Details of the method are described. It permits extubation before spontaneous ventilation can be sustained indefinitely and thus assists the return of normal speech, sleep pattern and nutrition. The lack of flexible control of ventilatory variables and absence of access to the trachea for sputum clearance limit its widespread application.