A brief introduction to the history of mechanical ventilation

During the Roman Empire, Galen, a famous doctor, recorded that if reeds in the throat of dead animals were blown into the trachea, the lungs of animals could be expanded to the maximum extent. 1543, during vivisection in Visalli, a method similar to that introduced by Galen was adopted to restore the collapsed animal lungs after thoracotomy. 1664, Hooke put an airway into the trachea and ventilated it through a pair of bellows, and found that the dog could survive for more than an hour. In 1774, Tossach successfully resuscitated a patient through mouth-to-mouth resuscitation for the first time. Fothergill also suggested that when mouth-to-mouth breathing can't blow enough gas, bellows can be used instead of blowing. Soon after, with the support of the Royal Charity Association, the first aid method based on this bellows technology was recommended for the resuscitation of drowning patients and was widely accepted in Europe. However, during the period of 1827- 1828, Leroy proved through a series of studies that the bellows technology could produce fatal pneumothorax (but it was later confirmed that the pressure used in the above research could not be realized in practical application), so the French Academy of Sciences began to restrict the application of this technology, and the Royal Charity Association also gave up this technology. Early mechanical ventilation was essentially positive pressure ventilation, but limited by the level of understanding and technical conditions at that time, it developed relatively slowly for a long time until it entered the 20th century. Dalzell, a Scotsman, made the molded negative pressure respirator for the first time in 1832. The patient sat in a closed box with his head and neck exposed outside the box, and the bellows built in the box operated outside the box to generate negative pressure to assist ventilation. 1864, American Jones applied for the first patent of negative pressure ventilator, and its design was similar to that of Dalzell. Since then, various more exquisite and compact negative pressure ventilators have appeared one after another, which is more convenient for patient care. However, the negative pressure ventilator that really successfully entered the clinic and was widely used was the "iron lung" developed by Driker-Shaw in 1928. The use of this ventilator greatly reduced the mortality rate of polio at that time. Due to the prevalence of polio at that time, the widespread application of "iron lung" and the development of negative pressure ventilation were objectively promoted until the rise of positive pressure ventilation in the 1950 s. Before 1950s, positive pressure ventilation technology, especially artificial airway technology, had made great progress, but it was only used for patients in anesthesiology and surgery. The epidemic of polio in Europe and America in 1930s and 1940s challenged negative pressure ventilation represented by "iron lung" and provided an opportunity for the re-emergence of positive pressure ventilation. 1952 In the summer of Copenhagen, the first batch of 3/kloc-0 patients who were treated for respiratory muscle paralysis caused by poliomyelitis died within three days, and invited the anesthesiologist Ibsen for consultation. He suggested giving up negative pressure ventilation, performing tracheotomy, and using compressed air bag gap positive pressure ventilation for anesthesia. It turns out that this practice is so successful that many medical students and technicians passively go to the hospital to operate airbags to complete manual positive pressure ventilation. The successful experience of Copenhagen has greatly promoted the development of positive pressure ventilation. Since then, positive pressure ventilation has been increasing and improving, while negative pressure ventilation has almost been eliminated. In recent years, negative pressure ventilation has been paid more and more attention, especially in long-term night and home mechanical ventilation of neuromuscular diseases.