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February 26, 2003

Negative-Pressure VentilationNegative-Pressure Ventilation

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(8):983. doi:10.1001/jama.289.8.983a

In Reply: Dr Lyons makes a plea to bring back the iron lung and describes the many advantages that the Drinker ventilator (described by Philip Drinker in 1929) could offer.1-3 There is no doubt that negative-pressure ventilators can achieve several of the goals of mechanical ventilation, and that they have saved many lives. They also share several limitations of NIV in general, including the lack of airway protection. They may also put patients at risk of obstructive apnea in particular cases, because they generate a negative pressure around the chest that may favor collapse of the extrathoracic upper airway.4 Their major limitation, however, is probably their cumbersome nature and the limited access to patient's body. The use of this technique, however, is also limited by the lack of rigorous scientific evaluation, although recent retrospective case-control studies5,6 have shown some clinical advantages compared with endotracheal intubation and PPV. They also suggest that NPV can have similar efficacy as face mask ventilation in preventing the need for endotracheal intubation for patients with acute-on-chronic respiratory failure.