Advanced Modalities in Negative-Pressure Ventilation

  • V. Antonaglia
  • S. Pascotto
  • F. Piller


Several devices that ensure oxygenation and correct chest-wall motion can support the ventilation of patients with acute respiratory failure (ARF). Ventilation is performed either by the introduction of a flow, and therefore a positive inspiratory pressure into the airways, or by the creation of a negative inspiratory pressure around the thorax and abdomen, which allows the airflow to enter the airways. This latter approach is referred to as external negative-pressure ventilation (NPV).


Chronic Obstructive Pulmonary Disease Continuous Positive Airway Pressure Chronic Obstructive Pulmonary Disease Patient Acute Respiratory Failure Severe Chronic Obstructive Pulmonary Disease 
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  1. 1.
    Drinker P, Shore LA (1929) An apparatus for the prolonged administration of artificial respiration. J Clin Invest 7:229PubMedCrossRefGoogle Scholar
  2. 2.
    Miller FL, Zerbi-Ortiz A, Elkins JT (1960) Use of the tank respirator in overwhelming bacterial pneumonia. N Engl J Med 262:1264–1266PubMedCrossRefGoogle Scholar
  3. 3.
    Torres A, Aznar R, Gatell JM et al (1990) Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 142(3):523–528PubMedGoogle Scholar
  4. 4.
    Slutsky AS, Ranieri VM (2000) Mechanical ventilation: lessons from the ARDSNet trial. Respir Res l(2):73–77CrossRefGoogle Scholar
  5. 5.
    Corrado A, Gorini M (2002) Negative-pressure ventilation: is there still a role? Eur Respir J 20:187–197PubMedCrossRefGoogle Scholar
  6. 6.
    Wisocki M (1998) Being more positive about negative pressure ventilation. Eur Respir J 12:515–516CrossRefGoogle Scholar
  7. 7.
    Schiavina M, Fabiani A, Gunella G (1994) External negative pressure ventilations techniques. Monaldi Arch Chest Dis 49(6):516–521PubMedGoogle Scholar
  8. 8.
    Levine S, Henderson D (1994) Negative pressure ventilation. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 393–411Google Scholar
  9. 9.
    Bach JR (1994) Update and perspectives on noninvasive respiratory muscle aids. Part 1: the inspiratory aid. Chest 105:1230–1240PubMedCrossRefGoogle Scholar
  10. 10.
    Hill NS (1986) Clinical application of body ventilators. Chest 90(6):897–905PubMedCrossRefGoogle Scholar
  11. 11.
    Corrado A, Gorini M, Villella G et al (1996) Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered. Eur Respir J 9:1531–1544PubMedCrossRefGoogle Scholar
  12. 12.
    Gorini M, Villella G, Ginanni R et al (2002) Effect of assist negative pressure ventilation by microprocessor based iron lung on breathing effort. Thorax 57:258–262PubMedCrossRefGoogle Scholar
  13. 13.
    Nishino T, Sino S, Ide T (1998) Effects of negative pressure assisted ventilation on dyspnoeic sensation and breathing pattern. Eur Respir J 12:1278–1283PubMedCrossRefGoogle Scholar
  14. 14.
    Shepard FM (1970) A negative-pressure tank-type respirator for the neonate. Anesth Analg 49:413–419PubMedCrossRefGoogle Scholar
  15. 15.
    Smith IE, King MA, Shneerson JM (1995) Choosing a negative pressure ventilation pump: are there any important differences? Eur Respir J 8(10):1792–1795PubMedCrossRefGoogle Scholar
  16. 16.
    Drinker PA, McKhann CF (1986) The iron lung: first practical means of respiratory support. JAMA 255:1476–1480PubMedCrossRefGoogle Scholar
  17. 17.
    Glérant JC, Jounieaux V, Parriera VF et al (2002) Effects of intermittent negative pressure ventilation on effective ventilation in normal awake subjects. Chest 122:99–107PubMedCrossRefGoogle Scholar
  18. 18.
    Zibrak JD, Hill NS, Federman EC et al (1988) Evaluation of intermittent long-term negative-pressure ventilation in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 138(6):1515–1518PubMedGoogle Scholar
  19. 19.
    Gorini M, Corrado A, Villella G et al (2001) Physiologic effects of negative pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163(7):1614–1618PubMedGoogle Scholar
  20. 20.
    Nava S, Ambrosino N, Zocchi L et al (1990) Diaphragmatic rest during negative pressure ventilation by pneumowrap: assessment in normal and COPD patients. Chest 98:857–865PubMedCrossRefGoogle Scholar
  21. 21.
    Fernandez E, Weiner P, Meltzer E et al (1991) Sustained improvement in gas exchange after negative pressure ventilation for 8 hours per day on 2 successive days in chronic airflow limitation. Am Rev Respir Dis 144(2):390–394PubMedGoogle Scholar
  22. 22.
    Belman MJ, Soo Hoo GW, Kuei JH, Shadmehr R (1990) Efficacy of positive vs. negative pressure ventilation in unloading the respiratory muscles. Chest 98(4):850–856PubMedCrossRefGoogle Scholar
  23. 23.
    Levy RD, Bradley TD, Newman SL et al (1989) Negative pressure ventilation. Effects on ventilation during sleep in normal subjects. Chest 95(1):95–99PubMedCrossRefGoogle Scholar
  24. 24.
    Levy RD, Cosio MG, Gibbons L et al (1992) Induction of sleep apnoea with negative pressure ventilation in patients with chronic obstructive lung disease. Thorax 47(8):612–615PubMedGoogle Scholar
  25. 25.
    Bach JR, Penek J (1991) Obstructive sleep apnoea complicating negative-pressure ventilatory support in patients with chronic paralytic/restrictive ventilatory dysfunction. Chest 99(6): 1386–1393PubMedCrossRefGoogle Scholar
  26. 26.
    Series F, Marc I (1994) Influence of lung volume dependence of upper airway resistance during continuous negative airway pressure. J Appl Physiol 77(2):840–844PubMedGoogle Scholar
  27. 27.
    Series F, Marc I (1993) Effects of continuous negative airway pressure-related lung deflation on upper airway collapsibility. J Appl Physiol 75(3): 1222–1225PubMedGoogle Scholar
  28. 28.
    Sanna A, Veriter C, Stanescu D (1993) Upper airway obstruction induced by negative-pressure ventilation in awake healthy subjects. J Appl Physiol 75:546–552PubMedGoogle Scholar
  29. 29.
    Sanna A, Veriter C, Kurtansky A, Stanescu D (1994) Contraction and relaxation of upper airway muscles during expiratory application of negative pressure at the mouth. Sleep 17(3):220–225PubMedGoogle Scholar
  30. 30.
    Goldstein RS, Molotiu N, Skrastins R et al (1987) Reversal of sleep-induced hypoventilation and chronic respiratory failure by nocturnal negative pressure ventilation in patients with restrictive ventilatory impairment. Am Rev Respir Dis 135(5):1049–1055PubMedGoogle Scholar
  31. 31.
    Van Lunteren E, Van de Graaff WB, Parker DM et al (1984) Nasal and laryngeal reflex responses to negative upper airway pressure. J Appl Physiol 56(3):746–752PubMedCrossRefGoogle Scholar
  32. 32.
    Kinnear W, Petch M, Taylor Get al (1988) Assisted ventilation using cuirass respirators. Eur Respir J 1:198–203PubMedGoogle Scholar
  33. 33.
    Corrado A, Gorini M (2002) Long-term negative pressure ventilation. Respir Care Clin 8:545–557CrossRefGoogle Scholar
  34. 34.
    Lockhat D, Langleben D, Zidulka A (1992) Hemodynamic differences between continual positive and two type of negative pressure ventilation. Am Rev Respir Dis 146:677–680PubMedGoogle Scholar
  35. 35.
    Torelli L, Zoccali G, Dalla Zuanna F et al (1995) Comparative evaluation of the haemodynamic effects of continuous negative external pressure (CNEP) and positive end-expiratory pressure (PEEP) in mechanically ventilated trauma patients. Intensive Care Med 21:67–70PubMedCrossRefGoogle Scholar
  36. 36.
    Skaburskis M, Helal R, Zidulka A (1987) Hemodynamic effects of external continuous negative pressure ventilation compared with those of continuous positive pressure ventilation in dogs with acute lung injury. Am Rev Respir Dis 136(4):886–891PubMedGoogle Scholar
  37. 37.
    Borelli M, Benini A, Denkewitz T et al (1998) Effects of continuous negative extrathoracic pressure versus positive end-expiratory pressure in acute lung injury patients. Crit Care Med 26(6):1025–1031PubMedCrossRefGoogle Scholar
  38. 38.
    Montserrat JM, Martos JA, Alarcon A et al (1991) Effect of negative pressure ventilation on arterial blood gas pressures and inspiratory muscle strength during an exacerbation of chronic obstructive lung disease. Thorax 46(1):6–8PubMedGoogle Scholar
  39. 39.
    Shapiro SH, Ernst P, Gray-Donald K et al (1992) Effect of negative pressure ventilation in severe chronic obstructive pulmonary disease. Lancet 340(8833): 1425–1429PubMedCrossRefGoogle Scholar
  40. 40.
    Corrado A, Gorini M, De Paola E et al (1994) Iron lung treatment for acute on chronic respiratory failure: 16 years of experience. Monaldi Arch Chest Dis 49(6):552–555PubMedGoogle Scholar
  41. 41.
    Corrado A, Bruscoli G, Messori A et al (1992) Iron lung treatment of subjects with COPD in acute respiratory failure. Evaluation of short and long-term prognosis. Chest 101:692–696PubMedCrossRefGoogle Scholar
  42. 42.
    Corrado A, De Paola E, Gorini M et al (1996) Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency. Thorax 51:1077–1082PubMedCrossRefGoogle Scholar
  43. 43.
    Corrado A, Gorini M, Ginanni R et al (1998) Negative pressure ventilation versus conventional mechanical ventilation in the treatment of acute respiratory failure in COPD patients. Eur Respir J 12:519–525PubMedCrossRefGoogle Scholar
  44. 44.
    Corrado A, Confalonieri M, Marchese S et al (2002) Iron lung vs. mask ventilation in the treatment of acute on chronic respiratory failure in COPD patients. Chest 121:189–195PubMedCrossRefGoogle Scholar
  45. 45.
    Bellemare F, Grassino A (1983) Force reserve of the diaphragm in patients with chronic obstructive pulmonary disease. J Appl Physiol 55:8–15PubMedGoogle Scholar
  46. 46.
    Rochester DF, Braun NMT, Arora NS (1979) Respiratory muscle strength in chronic obstructive pulmonary disease. Am Rev Respir Dis 119:151–154PubMedGoogle Scholar
  47. 47.
    Gutierrez M, Beroiza T, Contreras G et al (1988) Weekly cuirass ventilation improves blood gases and inspiratory muscle strength in patients with chronic air-flow limitation and hypercarbia. Am Rev Respir Dis 138(3):617–623PubMedGoogle Scholar
  48. 48.
    Cropp A, DiMarco AF (1987) Effects of intermittent negative pressure ventilation on respiratory muscle function in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 135(5):1056–1061PubMedGoogle Scholar
  49. 49.
    Celli B, Lee H, Criner B et al (1989) Controlled trial of external negative pressure ventilation in patients with severe chronic airflow obstruction. Am Rev Respir Dis 140:1251–1256PubMedGoogle Scholar
  50. 50.
    Levine S, Levy SF, Henson DJ (1992) Effect of negative pressure ventilation on ventilatory muscle endurance in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 146:722–729PubMedGoogle Scholar
  51. 51.
    Garay SM, Turino GM, Goldring RM (1981) Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes. Long-term maintenance with noninvasive nocturnal mechanical ventilation. Am J Med 70(2):269–274PubMedCrossRefGoogle Scholar
  52. 52.
    Schiavina M, Fabiani A (1993) Intermittent negative pressure ventilation in patients with restrictive respiratory failure. Monaldi Arch Chest Dis 48(2): 169–175PubMedGoogle Scholar
  53. 53.
    Jackson M, Kinnear W, King M et al (1993) The effects of five years of nocturnal cuirassassisted ventilation in chest wall disease. Eur Respir J 6(5):630–635PubMedGoogle Scholar
  54. 54.
    Frederick C (1994) Noninvasive mechanical ventilation with the iron lung. Crit Care Nurs Clin North Am 6(4):831–840PubMedGoogle Scholar
  55. 55.
    Baydur A, Layne E, Aral H (2000) Long term non-invasive ventilation in the community for patients with musculoskeletal disorders: 46 year experience and review. Thorax 55:4–11PubMedCrossRefGoogle Scholar
  56. 56.
    Bach JR (1993) A comparison of long-term ventilatory support alternatives from the perspective of the patient and care giver. Chest 104(6): 1702–1706PubMedCrossRefGoogle Scholar
  57. 57.
    Shneerson JM, Simonds AK (2002) Noninvasive ventilation for chest wall and neuromuscular disorders. Eur Respir J 20(2):480–487PubMedCrossRefGoogle Scholar
  58. 58.
    Donald I, Lord J (1953) Augmented respiration. Studies in atelectasis neonatorum. Lancet 1:9–16PubMedCrossRefGoogle Scholar
  59. 59.
    Samuels MP, Raine J, Wright T et al (1996) Continuous negative extrathoracic pressure in neonatal respiratory failure. Pediatrics 98(6 Pt 1):1154–1160PubMedGoogle Scholar
  60. 60.
    Thomson A (1997) The role of negative pressure ventilation. Arch Dis Child 77:454–458PubMedGoogle Scholar
  61. 61.
    Klonin H, Bowman B, Peters M et al (2000) Negative pressure ventilation via chest cuirass to decrease ventilator-associated complications in infants with acute respiratory failure: a case series. Respir Care 45(5):486–490PubMedGoogle Scholar
  62. 62.
    Sills JH, Cvetnic WG, Pietz J (1989) Continuous negative pressure in the treatment of infants with pulmonary hypertension and respiratory failure. J Perinatal 9(1):43–48Google Scholar
  63. 63.
    Cvetnic WG, Shoptaugh M, Sills JH (1992) Intermittent mandatory ventilation with continuous negative pressure compared with positive end-expiratory pressure for neonatal hypoxemia. J Perinatal 12(4):316–324Google Scholar
  64. 64.
    Hartmann H, Jawad MH, Noyes J et al (1994) Negative extrathoracic pressure ventilation in central hypoventilation syndrome. Arch Dis Child 70(5):418–423PubMedGoogle Scholar
  65. 65.
    Russell-Jones DL, Treacher DF, Lenicker HMet al (1989) Central hypoventilation in a seven year old child following pertussis treated with negative pressure ventilation. Postgrad Med J 65:768–770PubMedGoogle Scholar
  66. 66.
    Shekerdemian LS, Bush A, Lincoln C et al (1997) Cardiopulmonary interaction in healthy children and children after simple cardiac surgery: the effects of positive and negative pressure ventilation. Heart 78(6):587–593PubMedGoogle Scholar
  67. 67.
    Shekerdemian LS, Bush A, Shore DF et al (1997) Cardiopulmonary interactions after fontan operations. Augmentation of cardiac output using negative pressure ventilation. Circulation 96:3934–3942PubMedGoogle Scholar
  68. 68.
    Shekerdemian LS, Bush A, Shore DF et al (1999) Cardiorespiratory responses to negative pressure ventilation after tetralogy of Fallot repair: a hemodynamic tool for patients with low-output state. J Am Coll Cardiol 33(2):549–555PubMedCrossRefGoogle Scholar
  69. 69.
    Morris AH, Elliott CG (1985) Adult respiratory distress syndrome: successful support with continuous negative extrathoracic pressure. Crit Care Med 13(11):989–990PubMedCrossRefGoogle Scholar
  70. 70.
    Ambrosino N, Rubini F, Callegari G et al (1994) Noninvasive mechanical ventilation in the treatment of acute respiratory failure due to infectious complications of lung transplantation. Monaldi Arch Chest Dis 49(4):311–314PubMedGoogle Scholar
  71. 71.
    Hartke RH Jr, Block AJ (1992) External stabilisation of flail chest using continuous negative extrathoracic pressure. Chest 102(4): 1283–1285PubMedCrossRefGoogle Scholar
  72. 72.
    Sawicka EH, Spencer GT, Branthwaite MA (1986) Management of respiratory failure complicating pregnancy in severe kyphoscoliosis: a new use for an old technique? Br J Dis Chest 80(2):191–196PubMedCrossRefGoogle Scholar
  73. 73.
    Simonds AK, Sawicka EH, Carroll N et al (1988) Use of negative pressure ventilation to facilitate the return of spontaneous ventilation. Anaesthesia 43(3):216–219PubMedCrossRefGoogle Scholar
  74. 74.
    Chen JC, Brenner M, Milliken J et al (1997) Successful management of a complex tracheal injury with the iron lung. J Trauma 43(2):362–364PubMedGoogle Scholar
  75. 75.
    Hayek Z, Sohar E (1993) External high frequency oscillation. Concept and practice. Intensive Care World 10:36–40PubMedGoogle Scholar
  76. 76.
    Fink JB, Mahlmeister MJ (2002) High-frequency oscillation of the airway and chest wall. Respir Care 47(7):797–807PubMedGoogle Scholar
  77. 77.
    Dolmage TE, DeRosie JA, Avendano MA et al (1995) Effect of external chest wall oscillation on gas exchange in healthy subjects. Chest 107:433–439PubMedCrossRefGoogle Scholar
  78. 78.
    Hardinge FM, Davies RJ, Stradling JR (1995) Effects of short term high frequency negative pressure ventilation on gas exchange using the Hayek oscillator in normal subjects. Thorax 50(1):44–49PubMedGoogle Scholar
  79. 79.
    Spitzer SA, Fink G, Mittelman M (1993) External high-frequency ventilation in severe chronic obstructive pulmonary disease. Chest 104:1698–1701PubMedCrossRefGoogle Scholar
  80. 80.
    Al-Saady NM, Fernando SS, Petros AJ et al (1995) External high frequency oscillation in normal subjects and in patients with acute respiratory failure. Anaesthesia 50(12):1031–1035PubMedCrossRefGoogle Scholar
  81. 81.
    Dolmage TE, Heisenberg HA, Davis LL et al (1996) Chest wall oscillation at 1 Hz reduces spontaneous ventilation in healthy subjects during sleep. Chest 110:128–135PubMedCrossRefGoogle Scholar
  82. 82.
    Sideno B, Vaage J (1997) Ventilation by external high-frequency oscillations improves cardiac function after coronary artery bypass grafting. Eur J Cardiothorac Surg 11(2):248–257PubMedCrossRefGoogle Scholar
  83. 83.
    Shiga T, Takeda S, Nakanishi K et al (1998) Transesophageal echocardiograph evaluation during negative-pressure ventilation using the Hayek oscillator. J Cardiothorac Vasc Anesth 12(5):527–532PubMedCrossRefGoogle Scholar
  84. 84.
    Dilkes MG, McNeill JM, Hill AC et al (1993)The Hayek oscillator: a new method of ventilation in microlaryngeal surgery. Ann Otol Rhinol Laryngol 102:455–458PubMedGoogle Scholar
  85. 85.
    Monks PS, Broomhead CJ, Dilkes MG et al (1995) The use of the Hayek Oscillator during microlaryngeal surgery. Anaesthesia 50(10):865–869PubMedCrossRefGoogle Scholar
  86. 86.
    Sutcliffe N, Remington SA, Ramsay TM et al (1995) Severe tracheal stenosis and operative delivery. Anaesthesia 50(1):26–29PubMedCrossRefGoogle Scholar
  87. 87.
    Broomhead CJ, Dilkes MG, Monks PS (1995) Use of the Hayek oscillator in a case of failed fibreoptic intubation. Br J Anaesth 74:720–721PubMedCrossRefGoogle Scholar
  88. 88.
    Natalini G, Cavaliere S, Seramondi V et al (2000) Negative pressure ventilation vs. external high-frequency oscillation during rigid bronchoscopy. A controlled randomised trial. Chest 118:18–23PubMedCrossRefGoogle Scholar
  89. 89.
    Takeda S, Nakanishi K, Takano T et al (1997) The combination of external high-frequency oscillation and pressure support ventilation in acute respiratory failure. Acta Anaesthesiol Scand 41(6):670–674PubMedGoogle Scholar
  90. 90.
    Plein S, Bulugahapitiya S, Jones TR et al (2003) Cardiac RM imaging with external respirator: sinchronizing cardiac and respiratory motion. Radiology 227:877–882PubMedCrossRefGoogle Scholar
  91. 91.
    Marraro GA (2003) Innovative practices of ventilatory support with pediatric patients. Pediatr Crit Care Med 4:8PubMedCrossRefGoogle Scholar
  92. 92.
    Marraro GA, Lucchetti M, Cereda G et al (2003) Non-invasive ventilation of acute respiratory failure in infants with spinal muscular atrophy (SMA) tipe 1. PCCM J, Abstracts’ BookGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  • V. Antonaglia
    • 1
  • S. Pascotto
    • 1
  • F. Piller
    • 1
  1. 1.Biomechanics Laboratory, Department of Perioperative Medicine, Intensive Care and EmergencyAzienda Ospedaliera-UniversitariaTriesteItaly

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