Combined high flow nasal cannula and negative pressure ventilation as a novel respiratory approach in a patient with acute respiratory failure and limb-girdle muscular dystrophy

We describe the case of a 56-year-old-man with limb-girdle muscular dystrophy affected by acute hypercapnic failure secondary to pneumonia treated with high flow nasal cannula, intermittent abdominal ventilation, and negative pressure ventilation. The patient did not tolerate noninvasive positive pressure ventilation and refused invasive ventilation and tracheostomy. We successfully experienced a novel approach combining high flow nasal cannula with cycles of intermittent abdominal pressure ventilation and negative pressure ventilation.