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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
AllNPVshavetwomajorcomponents:anairtight,rigidchamberthatenclosestheribcageandabdomenandapumpthatgeneratespressurechangesinthe
chamber.5,6
NegativePressureVentilators
TankVentilator
Tankventilatorsenclosethebodyuptotheneck.Theadvantageisthatchestwallexpansionisnotlimitedbycontactwiththesidesofthechamber,andonlyone
airtightsealisrequiredaroundtheneck.Mostmoderntankventilatorsareconstructedofaluminiumandplasticandarelighterthanpreviously.Thepatientsbody
restsonathinmattress,andtheheadprotrudesthroughaportholeatoneendoftheventilator.Aheadandneckrestisprovidedinmostdesignstoensurecomfort
andtopreventupperairwaycollapse.Mosttankventilatorshavewindowsallowingpatientobservationandportholesforcathetersandmonitorleadsandwhere
procedurescanbeperformed(Fig.162).7
http://accessmedicine.mhmedical.com/Content.aspx?bookId=520§ionId=41692256 1/3
5/1/2017 Chapter16.NegativePressureVentilation|PrinciplesandPracticeofMechanicalVentilation,3e|AccessMedicine|McGrawHillMedical
FIGURE162
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JacketVentilator(PulmoWrap,PonchoWrap)
Thisventilatorisawindproof,waterpermeablenylonparkasuspendedoverarigidgridthatincludestheribcageandabdomen.Itallowstheapplicationofnegative
pressureovertheanteriorportionofthechestwall.8Airtightsealsaroundtheneck,arms,andhipsarerequiredtopreventairleakage.Thejacketsdonotrestrain
expansionoftheribcageand...
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