The Intermittent Abdominal Pressure Ventilator as an Alternative Modality of Noninvasive Ventilatory Support

Abstract

Noninvasive ventilation has become the initial treatment for symptomatic ventilatory pump failure but, when used at ventilatory support settings, can be an alternative to tracheostomy mechanical ventilation. The intermittent abdominal pressure ventilator, a corset with an internal air sack inflated by a ventilator, allows to increase tidal volumes through the raising of the diaphragm and its consequent passive descent. It has been used for daytime support for more than 70 yrs, but its knowledge among clinicians is scarce. A narrative review was performed by searching PubMed, Medline, and the Cochrane Database of Systematic Reviews using the terms "IAPV" or "pneumobelt." One hundred forty patients were cited using the intermittent abdominal pressure ventilator from 1946 until it went off the market in the 1970s, although many continued to use it. There was only one publication on its use from 2003 to 2017, but three publications from 2017 through 2021. It has been used for full diurnal ventilatory support by some patients for more than 50 yrs and has even been used throughout the labor of a mother with no ventilator-free breathing ability. The intermittent abdominal pressure ventilator is a ventilatory support alternative for patients with ventilatory pump failure. It can be effective and well tolerated and maintain quality of life without facial interfaces. More widespread application is warranted.

Is Intermittent Abdominal Pressure Ventilation Still Relevant? A Multicenter Retrospective Pilot Study

“…While using the IAPV, it is possible to speak, walk and cough more effectively on account of an increased expiratory flow due to abdominal compression, promoting the removal of secretions. It is also useful for constipation [ 3 , 5 ]. In addition, it clears the face and allows the patient to have a more normal sense of smell, eliminating facial or nasal interfaces that can be colonized by pathogenic bacteria.…”

“…IAPV is indicated for neuromuscular disease and has already been tested in some preliminary studies and case reports. A narrative review by Pierucci et al underlined the advantages of IAPV as a useful alternative for daytime support [ 5 ]. IAPV contributes to improved gas exchange, reduced symptoms and improved quality of life by reducing the incidence of pneumonia and avoiding the need for intubation and tracheotomy [ 6 , 7 ].…”

Versatility of Intermittent Abdominal Pressure Ventilation in a Case of Complicated Restrictive Respiratory Failure and COVID-19

“…In fact, IAPV aims at a specific group of restrictive respiratory failure. Neuromuscular diseases, chest wall abnormalities, kyphoscoliosis, paresis, diaphragm weakness, or respiratory muscle paralysis are suggested indications [ 9 , 10 ], especially when other NIV types are impossible. Nevertheless, the presence of concomitant diseases should not discourage its application.…”

Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases: the Italian snapshot

“…Conversely, updated information on current practice, settings, interfaces and modalities of NIV use in RTD is necessary and warranted [10][11][12][13][14][15]. Only a few studies in the literature have tried to assess settings and current NIV practices in RTD [7,[16][17][18][19][20][21][22], the last of which is the ERS REINVENT survey [23]. It represents an international survey to collect NIV users' experience and report current clinical real-world practices for long-term home noninvasive in RTD.…”