Negative Pressure Ventilation for COVID-19 Respiratory Failure: A Phoenix from the Ashes?

ABSTRACT

Aim: To critically review the clinical question does negative pressure ventilation (NPV) have a role in the management of COVID-19-associated respiratory failure? Background: NPV was commonly used in the management of respiratory failure until the 1950s when positive pressure devices began to be utilized. Physiological responses to NPV differ from responses to positive pressure ventilation, PPV, in a number of ways that may have clinical advantages in the management of respiratory failure in general, and specifically in the care of COVID-19-associated respiratory failure. Design: Narrative review based on systematic literature research. Data sources A search on OVID MEDLINE and EMBASE for NPV provided key publications, which were combined with recent relevant literature related to the present COVID-19 pandemic. Results: A total of 83 papers are included in the review and analysis. NPV has been used for >100 years across a range of clinical conditions including polio, adult respiratory distress syndrome, acute respiratory failure in chronic obstructive pulmonary disease patients, a range of neuromuscular disorders, chest wall disease, and post-cardiothoracic and spinal surgery. The potential benefits of NPV, in comparison the treatment of COVID-19 patients, may include improved ventilation, decreased lung damage, improved hemodynamics, ease of proning, and prevention of escalation to intubation. Conclusions: Historic and recent published evidence from animals and man support the use of NPV in acute respiratory failure in general, and strongly suggests that it may be particularly useful in COVID-19-associated respiratory failure. Clinical evaluation of a new lightweight, cost-effective NPV device is justified as it may result in a safe, effective, and economical solution to COVID-19-associated respiratory failure. It could be useful worldwide, but particularly in low and middle-income countries.