Medical Policy

This document addresses the use of intermittent abdominal pressure ventilation devices.

Note: For a high-level overview of this document, please see “Summary for Members and Families” below.

Investigational and Not Medically Necessary:

Intermittent abdominal pressure ventilation devices are considered investigational and not medically necessary for all indications.

This document describes clinical studies and expert recommendations, and explains whether intermittent abdominal pressure ventilation (IAPV) devices are appropriate. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

IAPV is a breathing support method that uses a belt or corset device to press on the abdomen and help move air in and out of the lungs. It may be used for people who cannot breathe well on their own, such as those with muscle or nerve conditions. One possible benefit is that it allows speaking and eating more easily than mask-based devices. However, it requires the person to stay upright and may not work for everyone. At this time, IAPV is not considered clinically appropriate for any use because studies have not shown that it improves health compared to standard breathing support methods.

What the Studies Show

IAPV works by inflating a device around the abdomen, which pushes the diaphragm upward to help with breathing out. When the device deflates, air flows back into the lungs. It is sometimes used as an option for people who cannot tolerate face masks used in other breathing devices. It may be more comfortable for daytime use and allows more freedom for speaking and eating.

Research on IAPV is limited and mostly based on small studies without strong comparison groups. Some studies show short-term improvements in breathing measures, such as oxygen and carbon dioxide levels. However, these studies include small numbers of people and do not compare IAPV directly with standard treatments. Other findings show that IAPV may become less effective over time, and some people needed to switch to other breathing support methods. There are also safety concerns, such as skin sores, risk of vomiting if used after eating, and limits for people who cannot sit upright or who have certain body types or spine conditions. Better studies are needed to know if IAPV improves health.

When is IAPV Clinically Appropriate?

IAPV is not clinically appropriate because it has not been proven to improve health. The available studies are mostly small and do not clearly show that this method works as well as or better than standard breathing support. Better studies are needed to know if this treatment improves health. There are also risks, including skin injury, reduced effectiveness over time, and possible complications in certain people, such as those who cannot sit upright or who have certain body conditions.

(Return to Description/Scope)

Summary

Currently available published evidence does not permit reasonable conclusions concerning the effect of intermittent abdominal pressure ventilation( IAPV) on health outcomes in relation to the effects of more standard assisted-breathing techniques. Many of the current peer-reviewed publications regarding IAPV are uncontrolled case series studies with limited utility in understanding the appropriate use for such devices (Bach, 2019; Banfi, 2019; Pierucci, 2021; Puricelli, 2021). Additionally, body habitus issues that could be considered contraindications to IAPV have not been fully evaluated in clinical studies. These include severe scoliosis, obesity or extremely lean individuals, and inability to maintain a sitting position. Efficacy of IAPV can decline over time. However, the current evidence has not investigated this issue adequately.

Discussion

Independent breathing may not be possible for those with severe thoracic restriction or paralysis. These individuals may require assisted breathing via external ventilators. IAPV uses abdominal compression to produce positive pressure ventilation. These “abdominal respirators” move the abdominal contents to increase the movement of the thoracic diaphragm during breathing.

A 1991 study by Bach and colleagues reported on 54 individuals who used the IAPV for long-term ventilatory support. Diagnoses included polio, spinal cord injury, myopathy, Duchenne muscular dystrophy, and other motor neuron diseases. None of the participants had tracheostomies. There were 48 participants who used the IAPV for daytime support for a mean of 12.9 ± 11.5 years. There was 1 participant who used IAPV for nocturnal ventilatory support for 6 months but switched to nocturnal nasal intermittent positive pressure ventilation (IPPV) in order to be able to lie supine. The other 5 participants used IAPV for ventilatory support 24 hours a day for a mean of 13.4 ± 11.2 years. There were 11 participants who died while using IAPV after a mean of 9.3 ± 4.4 years of use. Causes of death were lung cancer, myocardial infarction, sepsis from decubitus, motor vehicle accident, drug abuse, pneumonia, seizures, inadequate nocturnal ventilatory support while using a rocking bed, and two causes unknown. Of the 5 participants using the IAPV for 24 hours, 2 developed sacral decubiti with 1 death. After 12.3 ± 9.5 years, IAPV became ineffective for 12 participants, and they switched to daytime mouth IPPV.

A 2021 study by Fiorentino and colleagues reported on 8 individuals with neuromuscular diseases who used IAPV. Diagnoses included congenital myopathy (n=1), Duchenne muscular dystrophy (n=3), and amyotrophic lateral sclerosis (n=4). Participants had previously rejected or had poor compliance with noninvasive mechanical ventilation due to claustrophobia or poor tolerance of the mask. All participants had a baseline functional respiratory assessment performed during spontaneous breathing and while using the IAPV. Baseline mean spontaneous tidal volume was 316.375 ± 146.80 mL which increased to 678 ± 334mL using the IAPV. Baseline peak expiratory flow was 29.5 ± 10.9 mL with an average of 54 ± 18.04 mL during IAPV. With 3 years of follow-up, all participants continued to use IAPV with 3 participants relying on IAPV as their sole method of respiratory support 24 hours/day. After 2 years, IAPV became ineffective as the sole means of ventilatory support and 2 participants switched to daytime IAPV and nocturnal positive pressure ventilation with nasal mask.

A 2022 narrative review by Pierucci and colleagues reported on 10 studies in which IAPV was used for ventilatory support. Many of the studies were clinical series for which statistical analyses were not possible due to limited and heterogenous data. Most of the studies were published prior to 2017 as this technology has been used less frequently over the years due to the increasing use of tracheotomies. The authors propose that IAPV is becoming more prevalent with a paradigm shift back to non-invasive ventilatory (NIV) management and improvements in the portability and convenience NIV devices. The authors concluded “The paucity of long-term follow-up studies underlines the need for more clinical studies on larger patient populations with longer observation times.”

A retrospective pilot study by Volpi and colleagues in 2023 reported the practicability and efficacy of IAPV for those with neuromuscular diseases. With a sample size of 28 persons, the study’s inclusion criteria required at least one of the following: a diagnosis of neuromuscular disease, an ongoing non-invasive interface intolerance, or clinical stability, age ≥18 years, and having been on non-invasive ventilator support >16 h/day for at least 1 year. Primary outcomes included the change in respiratory parameters (defined as an improvement in hypoxemia of at least 5mmHg and the normalization of hypercapnia) during use of IAPV. Neuromuscular diagnoses included amyotrophic lateral sclerosis (n=19), Duchenne muscular dystrophy (n=5), Pompe disease (n=2), limb girdle muscular dystrophy (n=1) and mitochondrial myopathy (n=1). Data were collected at baseline, after 2 hours of ventilation, at 3 months, and at 6 months. Baseline blood gas results were as follows: pH 7.41, PaCO₂ (partial pressure of carbon dioxide) 50.1, PaO₂ (partial pressure of oxygen) 62.6, HCO₃ (bicarbonate) 32.3. The 6-month blood gas results are as follows: pH 7.40, PaCO₂ 42.85, PaO₂ 72.32, HCO₃ 28.53. One limitation was this study’s lack of a randomized comparison to non-invasive ventilator support. The authors conclude “Further research in this emerging field is strongly warranted to further improve the quality of life and breathing of neuromuscular patients.”

Annunziata (2023) conducted a 3-step modified Dephi process to establish consensus among physicians regarding the use of IAPV in the treatment of individuals with neuromuscular diseases. There were 14 physicians who participated and considered 5 topics: indications for IAPV, parameter settings for IAPV, potential limitations, contraindications and complications for IAPV, monitoring during IAPV, and long-term follow-up. Initially, a systematic review of existing research was done, and then recommendations were shared for voting by the doctors. The physician participants agreed IAPV may be indicated for those with neuromuscular conditions, those with kyphoscoliosis after spinal correction surgery, spinal cord injury, and those who require many hours of ventilation during the day or who have intolerance to interfaces for negative pressure ventilation. The physician participants agreed an IAPV machine setup should be personalized to everyone’s needs and preferences. In terms of potential limitations, contraindications and complications, the physician participants agreed the IAPV should be used on an empty stomach to avoid vomiting or regurgitation. Participants should be able to maintain a sitting position. It should not be used at night and a potential contraindication is a severe hiatal hernia with the presence of regurgitation during meals. Arterial blood gas (ABGs) should be evaluated yearly, peripheral oxygen saturation (SpO₂) and transcutaneous/exhaled carbon dioxide (CO₂) monitoring should be done to assess hypoventilation and peak cough flow should be measured to evaluate cough efficacy. In terms of long-term follow-up, IAPV may become ineffective over time due to progressive deterioration of respiratory function, hypercapnia, weight loss or complications such as decubitus ulcer or intolerance. Physical exam and evaluation of respiratory function should be completed every 6 months. Although the panel reached a consensus, the findings are mainly based on observation and case studies, not rigorous trials or established guidelines.

Intermittent abdominal pressure ventilation (IAPV) is a system of noninvasive respiratory care. Individuals wear a corset- or belt-type device placed on the body at the level of the thoracic diaphragm. Inside the corset is an inflatable sac or bladder which, when connected to a portable positive pressure ventilator, inflates the sac. This inflation compresses the abdomen which elevates the diaphragm causing forced exhalation. When the sac deflates, the diaphragm returns to the normal resting position and causes passive inhalation of air into the lungs. IAPV may make speaking or eating more convenient since there is no nasal or face mask involved. It has been proposed as an alternative to noninvasive mechanical ventilation particularly during the day when a person is in an upright position.

Ventilator: A mechanical device capable of providing pressurized air with or without supplemental oxygen and two or more of the following features: pressure support, rate support, volume support or various combinations of pressure, rate, and volume support.

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services are Investigational and Not Medically Necessary:
For the following procedure code, or when the code describes a procedure indicated in the Position Statement section as investigational and not medically necessary.

Peer Reviewed Publications:

1. Annunziata A, Pierucci P, Banfi P, et al. Intermittent abdominal pressure ventilation management in neuromuscular diseases: a Delphi panel consensus. Expert Rev Respir Med. 2023; 17(6):517-525.
2. Bach JR, Alba AS. Intermittent abdominal pressure ventilator in a regimen of noninvasive ventilatory support. Chest. 1991; 99(3):630-636.
3. Bach JR, Radbourne M, Potpally N, Chiou M. A mechanical intermittent abdominal pressure ventilator. Am J Phys Med Rehabil. 2019; 98(12):e144-e146.
4. Banfi P, Volpato E, Bach JR. Efficacy of new intermittent abdominal pressure ventilator for post-ischemic cervical myelopathy ventilatory insufficiency. Multidiscip Respir Med. 2019; 14:4.
5. Fiorentino G, Annunziata A, Coppola A, et al. Intermittent Abdominal pressure ventilation: an alternative for respiratory support. Can Respir J. 2021; 2021:5554765.
6. Pierucci P, Bach JR, Di Leece V, et al. Daytime non-invasive ventilatory support via intermittent abdominal pressure for a patient with Pompe disease. Pulmonology. 2021; 27(2):182-184.
7. Pierucci P, Di Lecce V, Carpagnano E, et al. The intermittent abdominal pressure ventilator as an alternative modality of noninvasive ventilatory support: a narrative review. Am J Phys Med Rehabil. 2022; 101(2):179-183.
8. Puricelli C, Volpato E, Sciurello S, et al. Intermittent abdominal pressure ventilation: feasibility and efficacy in neuromuscular disease. A case report. Monaldi Arch Chest Dis. 2021; 91(4).
9. Volpi V, Volpato E, Compalati E, et al. Is intermittent abdominal pressure ventilation still relevant? A multicenter retrospective pilot study. J Clin Med. 2023; 12(7):2453.
10. Witham D, Kunz JV, Krebs AC, et al. Active expiration reduces hypercapnia in lung failure - results of the prospective interventional ActiveEx study and development of a prototype device for automated application. PLoS One. 2025; 20(10):e0333579.

1. International Ventilator Users Network. Home mechanical ventilation: the basics. 2024. Available at: https://www.ventnews.org/m-hmv-the-basics. Accessed on March 18, 2026.

Luna belt
PBAir^™ corset
Pneumobelt

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Federal and State law, as well as contract language, including definitions and specific contract provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. The member’s contract benefits in effect on the date that services are rendered must be used. Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically.

No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan.

© CPT Only – American Medical Association