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In Reply: Dr Lyons makes a plea to bring back the iron lung and describes the many advantages that the Drinker ventilator (described by Philip Drinker in 1929) could offer.^1-3 There is no doubt that negative-pressure ventilators can achieve several of the goals of mechanical ventilation, and that they have saved many lives. They also share several limitations of NIV in general, including the lack of airway protection. They may also put patients at risk of obstructive apnea in particular cases, because they generate a negative pressure around the chest that may favor collapse of the extrathoracic upper airway.⁴ Their major limitation, however, is probably their cumbersome nature and the limited access to patient's body. The use of this technique, however, is also limited by the lack of rigorous scientific evaluation, although recent retrospective case-control studies^5-6 have shown some clinical advantages compared with endotracheal intubation and PPV. They also suggest . . . [Full Text of this Article]

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Negative-Pressure Ventilation
William S. Lyons
JAMA. 2003;289(8):983.
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