Cuirass ventilation: a review and update.
OBJECTIVE
This review highlights the development and application of modern chest wall cuirass ventilators.


METHODS
Initial animal studies and subsequent publications of applications of various modes of noninvasive cuirass ventilation are recorded.


RESULTS
Use of the modern cuirass ventilator in continuous negative, intermittent negative or biphasic (negative and positive) modes is described. Techniques of synchronisation of the cuirass ventilation to the patient's inspiratory and expiratory demands, or even to the patient's cardiac cycle are described. Use of noninvasive cuirass ventilation at normal physiological respiratory rates and at high frequency is highlighted in published studies and in the authors' clinical practice in intensive care. Case reports of patients with cardiac, respiratory and neurological diseases having been successfully managed are used in the review to highlight the desirability, versatility and safety of noninvasive cuirass ventilation for optimal patient care in selected cases.


CONCLUSIONS
Cuirass ventilation is a valid and valuable method of ventilation in a subset of patients as illustrated by the case reports in this review. Future possibilities for the use of noninvasive cuirass ventilation including in emergency situations where expertise for endotracheal intubation is unavailable; or where physicians or paramedics are unlikely to be able to intubate unconscious/paralysed patients quickly enough to save their lives (e.g. in biological or chemical warfare situations).
Medical Intensive Care Unit, Department of Medicine, Hadassah University Hospital, Jerusalem, Israel. dlinton@hadassah.org.il
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