Fifty Years of Mechanical Ventilation—1970s to 2020

 

Fifty Years of Mechanical Ventilation—1970s to 2020

 

by MacIntyre, Neil; Rackley, Craig; Khusid, Felix 

 

Critical Care Medicine: April 2021 - Volume 49 - Issue 4 - p 558-574

 

Positive-pressure ventilation (PPV) has been a mainstay of respiratory life support for over a century. The goals of PPV are to safely provide adequate alveolar ventilation and maintain lung recruitment. Current approaches to delivering PPV are generally patterned after the normal breathing pattern in which tidal volumes (VTs) are delivered at a certain respiratory rate (RR), often on the top of an elevated baseline airway pressure (positive end-expiratory pressure [PEEP]). Modern devices are also equipped with sophisticated monitoring/alarm systems, feedback controls enhancing patient-ventilator synchrony and safe ventilatory patterns, data storage capabilities with interfaces to electronic health records, and decision support systems.

Many of these PPV features have emerged over the last 50 years and are the result of technical advances and the translation of extensive basic and applied clinical research into clinical practice—much of which has been published in Critical Care Medicine over its 50 years of existence. This review looks back on these last 5 decades and has grouped the discussions into the decade in which a development first had real impact. It is an attempt to chronicle the important innovations, discoveries, and randomized trials that have transformed the simple concept of “in goes the good air, out goes the bad air” into the sophisticated life support system in common use today…