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…
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