Positive-pressure ventilation, spinal anesthesia, and Rudolph Matas: the anesthetic contributions of an inquisitive surgical legend

Dr. Rudolph Matas, in addition to being one of the pioneering and most prestigious vascular surgeons of the 19th century, was an influential figure in the development of anesthesiology in the United States (US). His inquisitive nature and determination to understand medicine were tremendous influences in his development of innovative approaches to solve surgical and medical problems. Driven by such curiosity and determination, Dr. Matas made pivotal contributions in the historical timeline of current anesthesiological practice, including the use of spinal anesthesia and positive-pressure ventilation during thoracotomies.

History and epidemiology of noninvasive ventilation in the acute-care setting

Although noninvasive ventilation (NIV) was first used to treat patients with acute respiratory failure in the 1940s, the history of this mainstay of today's respiratory care armamentarium has mainly been written in the last 20 years. There is now a robust evidence base documenting the efficacy of NIV in exacerbations of chronic obstructive pulmonary disease, cardiogenic pulmonary edema, and acute respiratory failure in immunocompromised patients, and evidence in support of NIV in other settings, such as hypoxemic acute respiratory failure and the management of patients who decline endotracheal intubation, is accumulating rapidly. Efficacy as demonstrated in clinical trials does not necessarily translate to clinical effectiveness in practice, however, and important barriers need to be overcome if NIV is to realize for the average patient the potential it has shown in research studies. However, although the expansion of its use in everyday patient care has lagged behind the growth of its evidence base, an increasing number of studies document the steadily expanding use of NIV in the acute-care setting. This article reviews the history of NIV as applied in acutely ill patients and summarizes the studies of NIV outside the research setting during the last decade.

Notable Australian contributions to the management of ventilatory failure of acute poliomyelitis: with special reference to the Both respirator and Dr. John A. Forbes

When Australia's 1937 epidemic of poliomyelitis created an urgent need for extra ventilating machines to compensate for respiratory paralysis, Edward Both, an innovative Adelaide biomedical engineer, invented a wooden-cabinet respirator capable of being made relatively quickly in sufficient quantity. His device, here called "the Both", alleviated the problem at Adelaide's Northfield Infectious Diseases Hospital and others, and in late 1938 was introduced into England when Both was visiting there. Appreciating its merits, Lord Nuffield financed assembly-line production at the Morris motor works in Cowley, Oxford. Then, through the Nuffield Department of Anaesthetics in Oxford's Radcliffe Infirmary, he had the Both distributed Commonwealth-wide, as a gift for treating ventilatory failure in polio - especially in children. For the 1937 epidemic in Victoria, and to the design of Melbourne University's Professor of Engineering, Aubrey Burstall, nearly 200 of another wooden-cabinet respirator were ultimately built. Some were installed at the Acute Respiratory Unit of the Infectious Diseases Hospital at Fairfield, then others "all over Australia". However, by the early 1950s, the Both had replaced Fairfield Hospital's "Burstall", which had functioned as Victoria's favoured respirator since 1937. Dr John Forbes at Fairfield became the foremost Australian clinician for expertise with the Both. Before the advent of intermittent positive pressure ventilation, the Both's usefulness had seen it tried for ventilatory failure in some non-polio conditions, but uptake of that application was limited. Nonetheless, Nuffield's philanthropy with the (Nuffield-)Both ultimately furthered progress along the 20th century pathway to intensive care medicine.

Pinching, electrocution, ravens' beaks, and positive pressure ventilation: a brief history of neonatal resuscitation

Since ancient times many different methods have been used to revive newborns. Although subject to the vagaries of fashion for 2000 years, artificial respiration has been accepted as the mainstay of neonatal resuscitation for about the last 40. Formal teaching programmes have evolved over the last 20 years. The last 10 years have seen international collaboration, which has resulted in careful evaluation of the available evidence and publication of recommendations for clinical practice. There is, however, little evidence to support current recommendations, which are largely based on expert opinion. The challenge for neonatologists today is to gather robust evidence to support or refute these recommendations, thereby refining this common and important intervention.

[Non-invasive positive pressure mechanical ventilation in acute respiratory failure]

Known for two centuries, positive pressure non invasive mechanical ventilation (VMNPP) has been widely applied in acute respiratory failure (IRA) only in the last ten years. The fact that VMNPP is able to improve gas exchange by avoiding endotracheal intubation and its complications is the most attractive aspect in both general and respiratory intensive care units and in the respiratory ward. Characteristics of VMNPP (interface, ventilator and modality of ventilation), the side where it is performed as well as severity of IRA, underlying disease, and the team's experience are important factors which influence outcome. The addition of VMNPP to conventional medical therapy reduces the need for IE, mortality and hospitalisation in a selected population of BPCO patients in IRA. As there are no available data for comparison between invasive mechanical ventilation (VMI) and VMNPP, the latter has not to be considered as an alternative to VMI but able to prevent it and, even if VMNPP fails, it may be used as a weaning technique. In IRA due to other than BPCO diseases VMNPP seems not to be more effective than standard treatment in avoiding IE but it may give efficient support with fewer complications as compared to VMI. Acute cardiogenic pulmonary edema and "terminal" diseases represent some of the most interesting application fields of VMNPP in non-BPCO patients. According to the latest literature data, in this review history, technique, advantages, limits, indications, nursing and cost of VMNPP are examined.

The history of ventilation in the evolution of thoracic surgery

The intrusion into the pleural space by surgeons was hindered for several hundred years by the realization that there were major pathophysiological alterations in ventilation and in circulation. The nature of this abnormality, although described very early on in history, went unrecognized until the end of the nineteenth century. The performance of thoracic surgery prior to that time and the development of different modes of ventilatory support are testimony to the intuition and inventiveness of the surgeons of that day. It is hard for the modern thoracic surgeon to fully comprehend the challenges that faced the early surgeon back when there was no such thing as positive pressure ventilation or unilateral lung ventilation. This article traces the origins of ventilation in man and their application to the development of thoracic surgery.

[CPAP treatment of newborn infants. A historical review]

Treatment of new-born infants with continuous positive air pressure (CPAP) is reviewed historically on the basis of the available literature. CPAP treatment for this group of patients was introduced just over 20 years ago. Advantages and disadvantages of different methods of use are discussed.

[Joseph O'Dwyer--a pioneer in endotracheal intubation and pressure respiration]

The oro- and nasotracheal intubation has been developed into one of the most important techniques in anaesthesiology. Originally, intubations were carried out for overcoming acute diphteric airway obstruction in children. As late as the end of the 19 century, the only life saving chance was to perform tracheotomy. Although the technique for this operation at that time was well developed, it was very often impossible to save the life of those moribund patients. The famous American paediatrician Joseph O'Dwyer re-initiated the technique of intubation and his excellent results became great success and promoted world-wide use, although it was a well-known procedure at that time. His intubation method - also called the O'Dwyer-Method-was first published in the N. Y. Medical Journal as "Intubation of the Larynx" 100 years ago. Working together with the surgeon George Fell, O'Dwyer designed an apparatus, for artificial respiration. As Fell-O'Dwyer Apparatus it was widely used in cases of asphyxia, - even in those caused by overdosage of anaesthetics. Further developments of the apparatus permitted positive pressure ventilation and the combination with a funnel for narcotics increased the repertory of anaesthesiological possibilities.

A historical account of the "wet lung of trauma" and the introduction of intermittent positive-pressure oxygen therapy in world war II

During World War II, my associates and I observed for the first time in medical history that casualties with severe brain, thoracic, abdominal, and extremity trauma, who had persistent "wet" respiration (wet lung of trauma), were most difficult to resuscitate, withstood operation poorly, and had the highest mortality. The etiology appeared to be ineffectual cough and persistent bronchopulmonary fluid from hemorrhage, pulmonary transudates resulting from anoxia, airway obstruction, and unknown causes secondary to trauma, some of which have been discovered since then. Our treatment consisted of assisting cough, transnasal tracheobronchial aspiration and oxygenation, bronchoscopy, and tracheostomy. To treat the advanced form, pulmonary edema, I devised an effectual hand-operated intermittent positive-pressure oxygen machine, which has been supplanted by elegant automatic volume- and pressure-regulated devices. Through the use of the intermittent positive-pressure breathing machines, most hospitals have developed thriving departments of respiratory therapy. Better physiological monitoring and use of intermittent mandatory ventilation and positive end-expiratory pressure have improved the care, but our basic principles of treatment are still the standards of respiratory therapy.