Use of Extrathoracic Negative Pressure Ventilation in Weaning COPD and Kyphoscoliotic Patients from Mechanical Ventilation

Abstract

Introduction

The process of weaning from mechanical ventilation remains extremely difficult when only conventional methods are used after acute respiratory failure in patients with severe chronic pulmonary disease. We have enlisted extrathoracic negative pressure ventilation (ENPV), using an iron lung, to facilitate the return of spontaneous breathing in such patients.

Patients & Methods

We report weaning trials with the iron lung in 19 patients recovering from acute ventilatory failure secondary to COPD or serious thoracic deformations. All patients were intubated and initially ventilated with intermittent positive pressure ventilation. After some unsuccessful attempts at weaning with traditional methods (eg, T-piece, SIMV, PSV, CPAP), ENPV was begun using an iron lung.

Results

17 of the 19 patients whose tubes were removed during ENPV were successfully weaned from positive pressure mechanical ventilation; two patients died. The 17 patients who were liberated from mechanical ventilation were discharged from our ICU within a few weeks and, 10 to 15 months later, are still living.

Conclusions

In COPD or kyphoscoliotic patients, noninvasive ENPV can be used successfully during weaning to support the patient's ventilation after the tube has been removed, until spontaneous breathing is completely restored. The favorable results that have been achieved in our ICU indicate that the use of the iron lung to facilitate weaning deserves further study.