Negative pressure ventilation protects the brain

door | feb 7, 2025 | Introductory articles, Publications

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Dear Editor,

With great interest we have read the recent paper in the journal ‘Critical Care,’ titled: ‘The future of intensive care: delirium should no longer be an issue,’ by Kotfis et al. 1. Kotfis et al. state that the major factor to prevent delirium on an intensive care unit (ICU) is an awake, non-sedated patient1. However, the standard mechanical ventilation support on the ICU is through positive pressure ventilation (PPV), and in the cases that this ventilation support requires intubation of the patient, sedatives are frequently administered. Sedation is a major risk factor to develop delirium 2,3. Delirium is harmful for the brain as it is associated with long-term cognitive impairment3.

Kotfis et al. recommend that new technologies should be implemented for delirium prevention1. In response to that suggestion, we would like to draw the attention of the ICU community to the reintroduction of negative pressure respiratory support4,5. Patients receiving ventilation support by negative pressure ventilation (NPV) do not require intubation, so the need for sedation is greatly reduced. Therefore, NPV will avoid one of the major risk factors for delirium: sedatives. Moreover, since patients remain conscious during negative pressure ventilation support, the medical staff and family can continue to communicate with the patients. This diminishes the risk of developing a post-intensive care syndrome (PICS), which includes not only cognitive decline but also psychiatric symptoms like depression and post-traumatic stress disorder (PTSD)1,2.

By avoiding the use of sedatives negative pressure respiratory support protects the brain. NPV may prove to be a worthy addition to the current range of respiratory support strategies4,5.

References.

  1. Kotfis K, van Diem-Zaal I, Roberson SW, Sietnicki M, van den Boogaard M, Shehabi Y, Ely EW. The future of intensive care: delirium should no longer be an issue. Crit Care. 2022;6(1):200. https://doi.org/10.1186/s13054-022-04077-y. ↩︎
  2. Schwab K, Schwitzer E, Qadir N. Postacute Sequelae of COVID-19 Critical Illness. Crit Care Clin. 2022;38(3):455–72. https://doi.org/10.1016/j.ccc.2022.01.001. ↩︎
  3. Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, Gordon SM, Canonico AE, Dittus RS, Bernard GR, Ely EW. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513–20. https://doi.org/10.1097/CCM.0b013e3181e47be1. ↩︎
  4. Howard D, Coulthard MG, Speight C, Grocott M. Negative pressure ventilation for COVID-19 respiratory failure: a phoenix from the ashes? Arab Board Med J. 2022;23(1):5–13. https://doi.org/10.4103/abmj.abmj_7_22. ↩︎
  5. Exovent Development Group. Exovent: a study of a new negative-pressure ventilatory support device in healthy adults. Anaesthesia. 2021;76(5):623–8. https://doi.org/10.1111/anae.15350. ↩︎