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Introduction

The first known use of positive-pressure ventilation (PPV) as a medical intervention dates back to the 16th century, as described in Vesalius’ de Humani Corporis Fabrica:

“But that life may in a manner of speaking be restored to the animal, an opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the lung may rise again and the animal take in air. Indeed with the slight breath in the case of the living animal, the lung will swell to the full extent of the thoracic cavity, and the heart become strong… . for when the lung, long flaccid, has collapsed, the beat of the heart and arteries appears wavy, creepy, twisting; but when the lung is inflated at intervals, the motion of the heart and arteries does not stop.”1

Vesalius apparently resuscitated a Spanish nobleman by inflating his lungs through the trachea, resulting in resumption of cardiac activity and nearly in Vesalius’ death at the hands of the inquisitors. Vesalius, an excellent anatomist who disproved many of the cherished teachings of Galen that had been accepted as absolute truth for 13 centuries, was viewed as a heretic by his peers. In fact, one described him as “an impious madman who is poisoning all of Europe with his vaporings.”

Because of the lack of enthusiasm in response to Vesalius’ findings and writings, a 100-year hiatus attended the next attempt at endotracheal ventilation. In 1667, Robert Hooke, a prominent mathematician, geologist, and paleontologist kept a dog alive by intermittently insufflating air into its trachea using a set of bellows. One century later, in 1744, John Fothergill, one of the founders of the British Humane Society, described successful mouth-to-mouth resuscitation.

Because of concerns over development of emphysema and tension pneumothorax as complications of PPV (which was recognized as early as 1827), research on artificial ventilation in the nineteenth and early twentieth centuries focused primarily on negative-pressure ventilation (NPV). Iron lungs, tank ventilators, cuirass ventilators, and a variety of strange and remarkable differential pressure chambers and boxes were developed in the United States and Europe. The devices were powered by hand, water, steam, or electricity, and, in some cases, by the patient himself. However, PPV became incorporated into the resuscitation strategy of the Dutch Humane Society, which advocated mouth-to-mouth ventilation in conjunction with external thoracic and abdominal compression. In 1776, John Hunter described an apparatus that blew fresh air into the lungs with one set of bellows and sucked “bad” air out with a second set.

By the end of the nineteenth century, a surge in the evolution of thoracic surgery led to the use of tracheal intubation and PPV through cuffed tubes as acceptable components of medical care. An American surgeon, Joseph O’Dwyer, designed a series of metal tubes that were ...

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