Negative Pressure Noninvasive Ventilation (NPNIV): History, Rationale, and Application

Man has recognized the vital role of breathing since antiquity, beginning with archeological findings depicting inhalation therapy using herbs, oils, and other substances since 6000 BC. Man has taken the automaticity of breathing for granted, expecting its adequacy for all activities whether awake or asleep. Dickinson W. Richards, MD, Nobel Laureate, said in 1962: “Breathing is that essential physiologic function that is straddled between the conscious & the unconscious and subject to both.” The understanding of the components of this critical physiologic function that starts at birth, and must be continuous and widely adaptable to support all levels of physical, metabolic, and functional needs, has evolved slowly over the millennia by many brilliant scientists from a combination of keen observation, imagination, daring experimentation, trial and error, and necessity, while overcoming dogma, religious inhibitions, and politics. It is this gradual chronologic process, still evolving, which guides what we do for patients today.