Historical perspectives on the development and use of mechanical ventilation

Contemporary advancements in cardiothoracic and abdominal surgical procedures have been historically dependent on the development and adoption of controlled airway management, specifically endotracheal intubation, controlled positive-pressure ventilation, and the use of automatic positive-pressure mechanical ventilators. More than 400 years elapsed before the 16th Century theories of Paracelsus and the demonstrations of Vesalius were routinely adopted to solve the "pneumothorax problem" that prevented complicated or prolonged surgical procedures within the pleural cavity. Acceptance and implementation of controlled positive-pressure ventilation was impeded for decades by the inability to maintain and protect the airway. Consequently, emphasis on the development of mechanical ventilation was directed toward machinery that provided safer negative-pressure respiratory support. The introduction of curare into European anesthesia practice and the adoption of protective airway practices during the poliomyelitis epidemics led to routine use of controlled positive-pressure ventilation and construction of dependable machinery. Laboratory investigations, exploring complications from cardiothoracic surgery, brought about American acceptance and established controlled positive-pressure mechanical ventilation as an indispensable part of conventional intraoperative management.