5/1/2017 Chapter16.

NegativePressureVentilation|PrinciplesandPracticeofMechanicalVentilation,3e|AccessMedicine|McGrawHillMedical

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Chapter16

Chapter16.NegativePressureVentilation
AntonioCorradoMassimoGorini

Conventionalmechanicalventilationviaendotrachealintubationortracheostomyinthetreatmentofacuterespiratoryfailure(ARF)isalifesavingprocedure.Yetit
exposespatientstoseverecomplications,includingupperairwaytraumaandnosocomialpneumonia,andmayprolongthelengthofstayintheintensivecareunit
(ICU)andhospitalbecauseadditionaltimemaybenecessaryforweaning.14

Negativepressureventilation(NPV)worksbyexposingthesurfaceofthethoraxtosubatmosphericpressureduringinspiration.Thispressurecausesthoracic
expansionandadecreaseinpleuralandalveolarpressures,creatingapressuregradientforairtomovefromtheairwayopeningintothealveoli.Whenthe
pressuresurroundingthethoraxincreasesandbecomesatmosphericorgreater,expirationoccurspassivelyowingtotheelasticrecoiloftherespiratorysystem.
TheinspiratorychangeswithNPV,inpleuralandalveolarpressures,replicatethoseduringspontaneousbreathing.Onthecontrary,positivepressureventilation
(PPV)causesanincreaseinintrathoracicpressuresduringinspiration(Fig.161).

FIGURE161

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Airwayandintrathoracicpressuresduringpositivepressureventilation(upperpanel)andduringnegativepressureventilation(bottompanel).Palv,AlveolarpressurePCW,elasticrecoil
pressureofthechestwallPL,elasticrecoilpressureofthelungPaw,airwaypressurePmus,musclepressurePpl,pleuralpressurePtank,tankventilatorpressure.

AllNPVshavetwomajorcomponents:anairtight,rigidchamberthatenclosestheribcageandabdomenandapumpthatgeneratespressurechangesinthe
chamber.5,6

NegativePressureVentilators
TankVentilator
Tankventilatorsenclosethebodyuptotheneck.Theadvantageisthatchestwallexpansionisnotlimitedbycontactwiththesidesofthechamber,andonlyone
airtightsealisrequiredaroundtheneck.Mostmoderntankventilatorsareconstructedofaluminiumandplasticandarelighterthanpreviously.Thepatientsbody
restsonathinmattress,andtheheadprotrudesthroughaportholeatoneendoftheventilator.Aheadandneckrestisprovidedinmostdesignstoensurecomfort
andtopreventupperairwaycollapse.Mosttankventilatorshavewindowsallowingpatientobservationandportholesforcathetersandmonitorleadsandwhere
procedurescanbeperformed(Fig.162).7

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5/1/2017 Chapter16.NegativePressureVentilation|PrinciplesandPracticeofMechanicalVentilation,3e|AccessMedicine|McGrawHillMedical
FIGURE162
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Microprocessorbasedironlung(CoppaCA1001,Coppa,Biella,Italy).

JacketVentilator(PulmoWrap,PonchoWrap)
Thisventilatorisawindproof,waterpermeablenylonparkasuspendedoverarigidgridthatincludestheribcageandabdomen.Itallowstheapplicationofnegative
pressureovertheanteriorportionofthechestwall.8Airtightsealsaroundtheneck,arms,andhipsarerequiredtopreventairleakage.Thejacketsdonotrestrain
expansionoftheribcageand...

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