Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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
Brochard L. Negative-Pressure VentilationNegative-Pressure Ventilation. JAMA. 2003;289(8):983. doi:10.1001/jama.289.8.983a
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