To the Editor: In his Contempo Updates article about noninvasive ventilation (NIV), Dr Brochard1 only briefly mentioned negative-pressure ventilators, the best known of which was the Drinker respirator, also called the iron lung.
The use of this whole-body ventilator subsided with the advent of the positive-pressure ventilator. Although not physiological, it had several advantages: small size, simplicity of operation, and small dedicated floor space. It also facilitated physical access to the patient, allowing closer attention to wounds, pressure points, various catheters, intravenous injections, and bedclothes.
Nonetheless, whole-body negative-pressure ventilation (NPV) has several advantages. It is vastly superior in patient comfort. It is physiological. The patient is able to communicate verbally and needs no sedation relative to the ventilator itself and its operation. Patients on this machine do not deteriorate because of competitive respiratory efforts even though there is no demand feature. The machine with its large capacity readily and comfortably overrides asynchronous respiratory efforts.
Atelectasis is often difficult to manage with positive-pressure ventilation (PPV) due to impaction of secretions within the airways. It requires far more frequent tracheal aspiration and repeated bronchoscopies, often with less than satisfactory results. Considering the complexities of the modern ventilator, difficulties of operation and potential for confusion, the substantial physical space required by contemporary ventilators, the need for endotracheal intubation, poor patient tolerance and discomfort, the ever present threat of barotrauma, and ventilator-associated pneumonia (VAP), I believe whole-body NPV should be resurrected. Managing the patient through the access ports is mainly a matter of familiarity.
Short necks and the presence of a tracheostomy sometimes adds a measure of awkwardness in NPV because of the proximity of the Drinker collar. It is easily managed, however, with replacement of the tracheostomy tube with an endotracheal tube through the tracheostomy site or as an extension to the tracheostomy tube. The old machine was a bit noisy, but I would venture that if built today it could be made much less so.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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