Negative pressure ventilator: advances in engineering, application and treatment

Area of Science:

• Pulmonary and Critical Care Medicine
• Biomedical Engineering
• Respiratory Physiology

Background:

• Negative Pressure Ventilation (NPV) mimics natural breathing, offering a physiological alternative to Positive Pressure Ventilation (PPV).
• NPV inherently reduces the risk of ventilator-induced lung injury (VILI) by avoiding direct airway pressure application.
• Despite historical use, NPV declined due to device bulkiness but is experiencing a resurgence driven by technological progress.

Purpose of the Study:

• To review the historical evolution and recent advancements in Negative Pressure Ventilation (NPV) technology.
• To highlight NPV's potential as a therapeutic modality for limiting VILI and enhancing hemodynamic stability.
• To identify key challenges and future directions for broader clinical adoption of NPV.

Main Methods:

• A narrative review of literature on negative pressure ventilators.
• Literature search conducted across PubMed and Web of Science databases.
• Inclusion of peer-reviewed research and reviews in English and Chinese up to September 2024, using keywords like 'negative pressure ventilation,' 'iron lung,' 'cuirass ventilator,' and 'VILI.'

Main Results:

• NPV is an underutilized method with significant potential to mitigate VILI and improve hemodynamic stability.
• Recent technological advancements have overcome previous limitations of NPV devices.
• Key challenges for NPV include enhancing portability, ensuring effective body-seal, and achieving precise synchronization.

Conclusions:

• Negative Pressure Ventilation (NPV) presents a promising, physiological approach to mechanical ventilation with reduced VILI risk.
• Addressing challenges in portability, sealing, and synchronization is crucial for NPV's wider implementation.
• NPV is poised for increased adoption in intensive care and remote monitoring settings with continued innovation.