Abstract
This chapter deals with the novelties concerning the positive and negative mechanical ventilation modes in its various combinations.
Positive pressure ventilation is definitely better known and is widely used due to the relative ease of its administration and to the numerous modes of ventilation. Negative ventilation, on the other hand, after a long period of relative abandonment, has only been re-evaluated in recent years. This happened after the “assisted” mode was introduced and when it was necessary to find a noninvasive ventilatory alternative to patients with facial lesions created by prolonged ventilation in a facial mask.
A further step forward has been made with the possibility of interfacing two ventilation modes, both noninvasive, combined with each other: the first (NPPV) acting directly in the airways through facial masks and the second (NPV) acting extrathoracically via an intermittent negative pressure. The possibility of using both modes of mechanical ventilation, in a synchronized manner, has allowed to increase the transpulmonary pressure and efficiency without increasing the pressures in the airways. The results of a first study (unique in the world for now) carried out on COPD patients, elderly, and suffering from respiratory failure are analyzed and reported here. This study compares the new double of noninvasive ventilation (double NIV or DNIV) with noninvasive positive pressure ventilation (NPPV) and noninvasive negative pressure ventilation (NPV). The significant and obvious positive results of DNIV are reported after only 1 h of treatment.
This chapter also analyzes other ways of combining positive pressure ventilation with negative pressure ventilation.
These studies concern new ventilatory approaches to subjects suffering from ARDS, but, for now, most of them concern experiments carried out on animals (pigs), while only one concerns the treatment of a man with ARDS. Almost all of them combine continuous negative pressure mechanical ventilation on the abdomen with traditional invasive positive pressure ventilation. All show improvements with the combination of the two ventilatory methods.
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Vincenzi, U. (2020). Alternative Positive and Negative Noninvasive Ventilation. In: Esquinas, A.M., et al. Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-42998-0_6
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DOI: https://doi.org/10.1007/978-3-030-42998-0_6
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