External ventilators are used in the prevention and management of respiratory failure. The chest cuirass has replaced the iron lung and offers a viable alternative to positive-pressure ventilation in selected populations. Patients with chronic respiratory or neuromuscular diseases are the most likely candidates. When the respiratory muscles fatigue, respiratory failure ensues. Mechanical ventilation may become necessary. Positive pressure and negative pressure devices are available, each with advantages and drawbacks. The cuirass is gaining popularity because of its simple application and because no tracheal intubation is needed.
In most institutions, however, the cuirass is still a novelty and presents several nursing challenges. Physical application of the cuirass is relatively easy but management of the cuirassed patient may not be. Typically, the patient has respiratory fatigue and is short of breath, frightened, and anxious. The respiratory status must be continually monitored. Because the chest cuirass is an external appliance, skin care is paramount. Maintaining nutritional status can be a problem until the patient masters the mechanics of proper ingestion. Psychosocial components of care such as anxiety, sleep deprivation, and communication have special implications with the cuirass. Timing activities with the machine in a relaxed manner is the key to success.