Negative-pressure ventilation.

In this review, we make the following major points: (1) Canine experiments indicate that in an experimental model of ARDS, cyclic NPV plus NEEP is as effective as cyclic PPV plus PEEP in treating arterial hypoxemia. Because cyclic NPV plus NEEP does not depress cardiac output as much as cyclic PPV plus PEEP, further study of this potential therapy is warranted. (2) At the present time, NPV has little use in neonatal medicine. (3) However, in adult medicine, NPV is efficacious for providing chronic ventilatory support in patients with neuromuscular and chest wall diseases. Additionally, the role of NPV in postoperative weaning warrants further study. (4) Some data in the literature suggest that some subsets of patients with CAL may benefit from chronic intermittent NPV therapy. However, criteria for identifying these patients have not been established. (5) Some investigators have recently demonstrated that PPV delivered via the nares can elicit VMR. Because this technique provides us with the opportunity to elicit VMR by a method other than NPV, nasal PPV provides us with a method to directly validate our presumption that improvements in COPD patients are related to VMR per se.