| Popis: |
Insufflation and arteficial aeration of the lungs are referenced in biblical times. Pneuma in its double meaning as air(oxygen) and soul have been inseparable since then. Induced and obstacle-free positive and negative intrapulmonary air flow challenged generations of surgeons from the late 19th century. Following a transient dominance of the extrathoracic negative pressure approach (Sauerbruch’s negative pressure concept) the transtracheal intrapulmonary alternating positive pressure concept won. Medical engineering played a decisive role in developing positive pressure machines. Till the 1950s ventilation and anaesthesia machines were combined and longterm arteficial ventilation was unavailable. The volume regulated Engström ventilator introduced in the 1952-3 polio epidemic was the game changer followed by other concepts, pressure ventilation included. Negative pressure chamber ventilation (iron lung and cuirass) saw a renaissance in the 1950s only to be replaced by intratratcheal ventilation by the end of the decade. Invasive ventilation became the norm till just recently when noninvasive breath support saw the second renaissance. COVID-19, a medico-political pandemic 2019-20 posed a new challenge to the intensive therapist, necessitating the review and maybe resuscitation of bygone philosophies and methods. |
