Artificial ventilation

History[edit]

The Greek physician Galen may have been the first to describe artificial ventilation: "If you take a dead animal and blow air through its larynx through a reed, you will fill its bronchi and watch its lungs attain the greatest distention."^[17] Vesalius too describes ventilation by inserting a reed or cane into the trachea of animals.^[18]


It wasn't until 1773, when an English physician William Hawes (1736–1808) began publicizing the power of artificial ventilation to resuscitate people who superficially appeared to have drowned. For a year he paid a reward out of his own pocket to any one bringing him a body rescued from the water within a reasonable time of immersion. Thomas Cogan who was another English physician had become interested in the same subject during a stay at Amsterdam.


In the summer of 1774, Hawes and Cogan each brought fifteen friends to a meeting at the Chapter Coffee-house in St Paul's Churchyard, where they founded the Royal Humane Society. Some methods and equipment were similar to methods used today, such as wooden pipes used in the victims nostrils to blow air into the lungs. Or the use of bellows with a flexible tube for blowing tobacco smoke through the anus to revive vestigial life in the victim's intestines, which was discontinued with the eventual further understanding of respiration.^[19]


The work of English physician and physiologist Marshall Hall in 1856 suggested against the use of any type of bellows/positive pressure ventilation. These views that were held for several decades. The introduction of a common method of external manual manipulation in 1858, was the "Silvester Method" invented by Henry Robert Silvester. A method in which a patient is laid on their back and their arms are raised above their head to aid inhalation and then pressed against their chest to aid exhalation. In 1903, another manual technique, the "prone pressure" method, was introduced by Sir Edward Sharpey Schafer.^[20] It involved placing the patient on his stomach and applying pressure to the lower part of the ribs. It was the standard method of artificial respiration taught in Red Cross and similar first aid manuals for decades,^[21] until mouth-to-mouth resuscitation became the preferred technique in mid-century.^[22]


The shortcomings of manual manipulation led doctors in the 1880s to come up with improved methods of mechanical ventilation, which included Dr. George Edward Fell's "Fell method" or "Fell Motor."^[23] It consisted of a bellows and a breathing valve to pass air through a tracheotomy. He collaboratied with Dr. Joseph O'Dwyer to invent the Fell-O'Dwyer apparatus, which is a bellows instrument for the insertion and extraction of a tube down the patients trachea.^[24][25] Such methods were still looked upon as harmful and were not adopted for many years.


In 2020, the supply of mechanical ventilation became a central question for public health officials due to 2019–20 coronavirus pandemic related shortages.