L'histoire de la ventilation mécanique : des machines et des hommes

Abstract

From the mid-1500s until the early 1900s attempts to resuscitate apparently dead humans by applying artificial ventilation with a bellows trough a tracheal tube were time to time recorded. In 1876 E Woillez presented the Spirophore that was the first negative pressure tank ventilator. The Pulmotor designed in 1906 by H Dräger was the first preset pressure ventilator. The first ventilator to be used successfully for long term mechanical ventilation was the Drinker-Shaw iron lung (1928) that saved many lives during the poliomyelitis epidemics. All the senior critical care physicians keep in mind the Engtröm 150 (1954) as the first electrically powered ventilator which contributed to the development of critical care. In 1959 Frumin demonstrated that the immersion of the exhalation limb under few centimetres of water was an efficient method to improve gas exchange. This simple method to improve gas exchange was promoted by Asbaugh and Petty and termed continuous positive airway pressure then positive end expiratory pressure (PEEP). Produced by Siemens the “Servo 900 A” (1970) was the first electronically device equipped with a PEEP valve and offering the possibility to monitor gas flow and airway pressure. Since 1980 the introduction of servo controlled valves have made possible the synchronisation between the patient inspiratory effort and the delivered gas flow. Assisted Spontaneous Breathing, a mode that will be termed later Pressure Support Ventilation, was the first pressure preset mode. Recent advances mainly focused on ergonomic and undesirable secondary effects of mechanical ventilation.