Respiratory intensive care--past, present, future

Major advances have been made in respiratory intensive care over the past three decades. The poliomyelitis epidemics provided the first major impetus for the development of techniques to maintain respiratory support via mechanical means. Principles of bronchial toilet were also established at that time. Development of blood gas electrodes permitted the application of physiologic principles to the management of acute respiratory failure. Recognition of the role of oxygen toxicity and fluid retention allowed a more rational approach to the management of acute respiratory failure. This management in turn was advanced with the introduction of PEEP. Because of the advances made over the last three decades, technology is no longer the limiting factor in survival from acute respiratory failure. If major advances are to be made in the future, a greater understanding of the basic anatomy, biochemistry, and physiology of the lung is necessary.