Abstract Rationale Biphasic Cuirass Ventilation (BCV) is a non-invasive ventilation strategy delivering negative inspiratory pressure during inhalation and positive airway pressure during exhalation, used as an alternative for patients with acute respiratory failure (ARF) who cannot tolerate conventional non-invasive ventilation (NIV). Our objective was to evaluate the feasibility, physiological effects, and clinical outcomes of BCV in patients with ARF and during upper airway surgical procedures across multiple international centers. Methods In this multicenter observational study, adults with ARF requiring ventilatory support were enrolled. Exclusion criteria included recent thoracic surgery, obesity, and obstructive sleep apnea. BCV (Hayek® cuirass system) settings were individualized (mean IPAP 20±5 cmH2O, EPAP 5±2 cmH2O; two cases received continuous negative extrathoracic pressure at -24 cmH2O), and sessions lasted a median of 3±1 days (intraoperative use ∼38±11 min). Clinical status, arterial blood gases, and oxygen saturation were recorded immediately before and one hour after each BCV session. Results Forty patients were treated (80% male; mean APACHE II 24±4; 45% with COPD). BCV was applied in varied contexts: most commonly to support weaning (post-extubation ARF, n = 14), post-bronchoscopy ARF (n = 2), post-decannulation ARF (n = 2), atelectasis (n = 2), post-COVID fibrosis (n = 1), do-not-intubate ARF (n = 2), and NIV-intolerance (n = 2). Fifteen patients received BCV intraoperatively (e.g. during microlaryngoscopy), and 25 received dual therapy (BCV + high-flow nasal oxygen HFNO). Most patients (95%) tolerated BCV well; only 2 patients discontinued due to discomfort and 1 required intubation for intraoperative airway obstruction. One hour post-BCV, arterial blood gases improved: mean pH increased and PaCO2 decreased, and mean PaO2/FiO2 ratio increased, indicating better ventilation and oxygenation. Conclusion BCV appears to be a safe and effective non-invasive support modality in selected ARF patients and during airway surgery. It significantly improves gas exchange, facilitates weaning from mechanical ventilation, and provides a de-escalation strategy for patients intolerant of NIV. The addition of HFNO further enhanced oxygenation and reduced intubation need. These results suggest BCV’s feasibility and clinical value; further studies should define long-term outcomes and optimal patient selection. This abstract is funded by: None
Zimnoch et al. (Fri,) studied this question.