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Intensive Care Medicine

, Volume 38, Issue 5, pp 879–885 | Cite as

Relative effects of negative versus positive pressure ventilation depend on applied conditions

  • Doreen Engelberts
  • Atul Malhotra
  • James P. Butler
  • George P. Topulos
  • Stephen H. Loring
  • Brian P. KavanaghEmail author
Experimental

Abstract

Purpose

Comparisons of negative versus positive pressure ventilation have imperfectly matched the pressure–time profile or the lung volume history, or have incompletely applied in vivo negative pressure to include the complete thoracic wall and abdomen.

Hypothesis

Negative pressure exerts the same pattern of lung distension as positive pressure when the pressure–time and volume history profiles are identical and the application of negative pressure is over the whole lung.

Methods

(1) In isolated (ex vivo) and (2) intact (in vivo) mouse lungs (n = 4/group) (sealed chamber enclosing either the whole lung or whole mouse except for external airway opening), identical and inverse-tidal, square-wave pressure–time profiles were obtained with positive and negative pressure ventilation. (3) Following an identical volume history, surfactant-depleted rabbits (n = 7) were randomly assigned to sustained, static equivalent positive versus negative pressures. (4) Surfactant-depleted anesthetized rabbits (n = 10) with identical volume histories were randomized to positive versus negative ventilation with identical pressure–time characteristics.

Results

Matched positive and negative pressure time profiles in ex vivo and in vivo mice resulted in identical tidal volumes. Identical (negative vs. positive) sustained static pressures resulted in similar PaO2 and end expiratory lung volumes. Positive and negative ventilation with identical volume histories and pressure time characteristics showed no difference in oxygenation or lung volumes. Historical comparisons suggested better oxygenation with negative pressure when the volume history was not identical.

Conclusions

These data do not support major biological differences between negative and positive pressure ventilation when waveforms and lung volume history are matched.

Keywords

Negative pressure ventilation Positive pressure ventilation Mechanical ventilation Transpulmonary pressure 

Supplementary material

134_2012_2512_MOESM1_ESM.docx (178 kb)
Supplementary material (177 KB)

References

  1. 1.
    Borelli M, Benini A, Denkewitz T, Acciaro C, Foti G, Pesenti A (1998) Effects of continuous negative extrathoracic pressure versus positive end-expiratory pressure in acute lung injury patients. Crit Care Med 26:1025–1031PubMedCrossRefGoogle Scholar
  2. 2.
    Lockhat D, Langleben D, Zidulka A (1992) Hemodynamic differences between continual positive and two types of negative pressure ventilation. Am Rev Respir Dis 146:677–680PubMedGoogle Scholar
  3. 3.
    Shekerdemian LS, Schulze-Neick I, Redington AN, Bush A, Penny DJ (2000) Negative pressure ventilation as haemodynamic rescue following surgery for congenital heart disease. Intensive Care Med 26:93–96PubMedCrossRefGoogle Scholar
  4. 4.
    Easa D, Mundie TG, Finn KC, Hashiro G, Balaraman V (1994) Continuous negative extrathoracic pressure versus positive end-expiratory pressure in piglets after saline lung lavage. Pediatr Pulmonol 17:161–168PubMedCrossRefGoogle Scholar
  5. 5.
    Corrado A, Ginanni R, Villella G, Gorini M, Augustynen A, Tozzi D, Peris A, Grifoni S, Messori A, Nozzoli C, Berni G (2004) Iron lung versus conventional mechanical ventilation in acute exacerbation of COPD. Eur Respir J 23:419–424PubMedCrossRefGoogle Scholar
  6. 6.
    Grasso F, Engelberts D, Helm E, Frndova H, Jarvis S, Talakoub O, McKerlie C, Babyn P, Post M, Kavanagh BP (2008) Negative-pressure ventilation: better oxygenation and less lung injury. Am J Respir Crit Care Med 177:412–418PubMedCrossRefGoogle Scholar
  7. 7.
    Green M, Mead J (1974) Time dependence of flow-volume curves. J Appl Physiol 37:793–797PubMedGoogle Scholar
  8. 8.
    Corrado A, Gorini M, Villella G, De Paola E (1996) Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered. Eur Respir J 9:1531–1544PubMedCrossRefGoogle Scholar
  9. 9.
    Jackson M, Kinnear W, King M, Hockley S, Shneerson J (1993) The effects of five years of nocturnal cuirass-assisted ventilation in chest wall disease. Eur Respir J 6:630–635PubMedGoogle Scholar
  10. 10.
    Valenza F, Bottino N, Canavesi K, Lissoni A, Alongi S, Losappio S, Carlesso E, Gattinoni L (2003) Intra-abdominal pressure may be decreased non-invasively by continuous negative extra-abdominal pressure (NEXAP). Intensive Care Med 29:2063–2067PubMedCrossRefGoogle Scholar
  11. 11.
    Jaecklin T, Engelberts D, Otulakowski G, O’Brodovich H, Post M, Kavanagh BP (2011) Lung-derived soluble mediators are pathogenic in ventilator-induced lung injury. Am J Physiol Lung Cell Mol Physiol 300:L648–L658PubMedCrossRefGoogle Scholar
  12. 12.
    Murphy DB, Cregg N, Tremblay L, Engelberts D, Laffey JG, Slutsky AS, Romaschin A, Kavanagh BP (2000) Adverse ventilatory strategy causes pulmonary-to-systemic translocation of endotoxin. Am J Respir Crit Care Med 162:27–33PubMedGoogle Scholar
  13. 13.
    Helm E, Talakoub O, Grasso F, Engelberts D, Alirezaie J, Kavanagh BP, Babyn P (2009) Use of dynamic CT in acute respiratory distress syndrome (ARDS) with comparison of positive and negative pressure ventilation. Eur Radiol 19:50–57PubMedCrossRefGoogle Scholar
  14. 14.
    Dreyfuss D, Saumon G (1993) Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis 148:1194–1203PubMedGoogle Scholar
  15. 15.
    Morris AH, Elliott CG (1985) Adult respiratory distress syndrome: successful support with continuous negative extrathoracic pressure. Crit Care Med 13:989–990PubMedCrossRefGoogle Scholar
  16. 16.
    Valenza F, Irace M, Guglielmi M, Gatti S, Bottino N, Tedesco C, Maffioletti M, Maccagni P, Fossali T, Aletti G, Gattinoni L (2005) Effects of continuous negative extra-abdominal pressure on cardiorespiratory function during abdominal hypertension: an experimental study. Intensive Care Med 31:105–111PubMedCrossRefGoogle Scholar
  17. 17.
    Skaburskis M, Helal R, Zidulka A (1987) Hemodynamic effects of external continuous negative pressure ventilation compared with those of continuous positive pressure ventilation in dogs with acute lung injury. Am Rev Respir Dis 136:886–891PubMedCrossRefGoogle Scholar
  18. 18.
    Perlman CE, Lederer DJ, Bhattacharya J (2011) Micromechanics of alveolar edema. Am J Respir Cell Mol Biol 44:34–39PubMedCrossRefGoogle Scholar
  19. 19.
    Lai-Fook SJ, Hyatt RE, Rodarte JR (1978) Effect of parenchymal shear modulus and lung volume on bronchial pressure-diameter behavior. J Appl Physiol 44:859–868PubMedGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Doreen Engelberts
    • 1
  • Atul Malhotra
    • 3
  • James P. Butler
    • 3
  • George P. Topulos
    • 4
  • Stephen H. Loring
    • 5
  • Brian P. Kavanagh
    • 1
    • 2
    • 6
    Email author
  1. 1.Program in Physiology and Experimental MedicineHospital for Sick ChildrenTorontoCanada
  2. 2.Department of Critical Care MedicineUniversity of Toronto, Hospital for Sick ChildrenTorontoCanada
  3. 3.Divisions of Pulmonary and Critical Care and Sleep MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  4. 4.Department of Anesthesia, Perioperative and Pain MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  5. 5.Department of Anesthesia, Critical Care and Pain MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  6. 6.Department of AnesthesiaUniversity of Toronto, Hospital for Sick ChildrenTorontoCanada

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