Biphasic cuirass ventilation (BCV) has re-emerged as an innovative noninvasive respiratory support modality, offering a promising alternative to conventional positive pressure ventilation (PPV) in the management of hypoxemic respiratory failure. This chapter provides a comprehensive exploration of BCV, from its historical roots in negative pressure ventilation to its modern technological evolution. We begin by outlining the pathophysiology of hypoxemic respiratory failure, emphasizing the complex interplay between alveolar damage, ventilation-perfusion mismatch, and intrapulmonary shunt that culminates in impaired systemic oxygenation. Against this backdrop, BCV stands out as a technology that respects physiological principles of breathing by applying external negative pressure during inspiration and positive pressure during expiration. This biphasic approach not only promotes more uniform alveolar recruitment but also preserves cardiovascular dynamics and respiratory muscle activity, features that can be compromised in traditional PPV. We detail the mechanisms by which BCV improves gas exchange, highlighting its effects on respiratory muscle strength and ventilation/perfusion distribution. The chapter reviews current evidence for BCV’s clinical application in various scenarios: acute respiratory failure, acute respiratory distress syndrome (ARDS), weaning from invasive mechanical ventilation, and even in selected patients with COVID-19-related pneumonia. Although these studies are primarily observational and limited in scope, they consistently demonstrate improvements in oxygenation, tidal volume, and patient tolerance. Patient selection, configuration parameters, and monitoring strategies are also discussed, with an emphasis on balancing efficacy and minimizing complications such as skin injuries and device intolerance. We address the current gaps in evidence, noting the lack of large randomized clinical trials and the absence of standardized protocols for pressure titration and patient selection. In conclusion, this chapter situates BCV as a compelling, physiologically grounded alternative for specific patient populations with hypoxemic respiratory failure. Its unique advantages in cardiovascular stability and respiratory muscle preservation offer a fresh perspective on mechanical ventilation. However, further research is imperative to refine its indications and to establish its role within modern respiratory care. This work underscores the potential of BCV to complement or even challenge existing paradigms in noninvasive ventilation, inviting renewed interest and deeper investigation into its clinical utility.

Biphasic Cuirass Ventilation in Hypoxemic Respiratory Failure

章节
发表日期：

2026年

查看全文

Munir Mohamed Mimun

摘要

Biphasic cuirass ventilation (BCV) has re-emerged as an innovative noninvasive respiratory support modality, offering a promising alternative to conventional positive pressure ventilation (PPV) in the management of hypoxemic respiratory failure. This chapter provides a comprehensive exploration of BCV, from its historical roots in negative pressure ventilation to its modern technological evolution. We begin by outlining the pathophysiology of hypoxemic respiratory failure, emphasizing the complex interplay between alveolar damage, ventilation-perfusion mismatch, and intrapulmonary shunt that culminates in impaired systemic oxygenation. Against this backdrop, BCV stands out as a technology that respects physiological principles of breathing by applying external negative pressure during inspiration and positive pressure during expiration. This biphasic approach not only promotes more uniform alveolar recruitment but also preserves cardiovascular dynamics and respiratory muscle activity, features that can be compromised in traditional PPV. We detail the mechanisms by which BCV improves gas exchange, highlighting its effects on respiratory muscle strength and ventilation/perfusion distribution. The chapter reviews current evidence for BCV’s clinical application in various scenarios: acute respiratory failure, acute respiratory distress syndrome (ARDS), weaning from invasive mechanical ventilation, and even in selected patients with COVID-19-related pneumonia. Although these studies are primarily observational and limited in scope, they consistently demonstrate improvements in oxygenation, tidal volume, and patient tolerance. Patient selection, configuration parameters, and monitoring strategies are also discussed, with an emphasis on balancing efficacy and minimizing complications such as skin injuries and device intolerance. We address the current gaps in evidence, noting the lack of large randomized clinical trials and the absence of standardized protocols for pressure titration and patient selection. In conclusion, this chapter situates BCV as a compelling, physiologically grounded alternative for specific patient populations with hypoxemic respiratory failure. Its unique advantages in cardiovascular stability and respiratory muscle preservation offer a fresh perspective on mechanical ventilation. However, further research is imperative to refine its indications and to establish its role within modern respiratory care. This work underscores the potential of BCV to complement or even challenge existing paradigms in noninvasive ventilation, inviting renewed interest and deeper investigation into its clinical utility.