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HistoricalPerspectiveontheDevelopmentofMechanicalVentilation|PrinciplesandPracticeofMechanicalVentilation,3e|AccessMedic

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Chapter1.HistoricalPerspectiveontheDevelopmentofMechanicalVentilation
GeneL.Colice

Thehistoryofmechanicalventilationisintimatelyintertwinedwiththehistoryofanatomy,chemistry,andphysiologyexplorationunderwaterandintheairandof
course,modernmedicine.Anatomistsdescribedthestructuralconnectionsofthelungstotheheartandvasculatureanddevelopedtheearliestinsightsintothe
functionalrelationshipsoftheseorgans.Theyemphasizedtheroleofthelungsinbringingairintothebodyandprobablyexpellingwasteproducts,butshowedlittle
understandingofhowairwasusedbythebody.Chemistsdefinedtheconstituentsofairandexplainedthemetabolicprocessesbywhichthecellsusedoxygen
andproducedcarbondioxide.Physiologistscomplementedthesestudiesbyexploringtherelationshipsbetweenlevelsofoxygenandcarbondioxideintheblood
andventilation.Explorerstestedthetruelimitsofphysiology.Travelintheairandunderwaterexposedhumanstoextremesinventilatorydemandsandprompted
thedevelopmentofmechanicaladjunctstoventilation.Followingthevarioushistoricalthreadsprovidedbytheanatomists,chemists,physiologists,andexplorers
providesausefulperspectiveonthetapestryofatechniquemodernphysiciansacceptcasually:mechanicalventilation.

EarlyGreeks
EarlyGreekphysiciansendorsedEmpedoclesviewthatallmatterwascomposedoffouressentialelements:earth,air,fire,andwater.Eachoftheseelements
hadprimaryqualitiesofheat,cold,moisture,anddryness.1Empedoclesappliedthisglobalphilosophicviewtothehumanbodybystatingthatinnateheat,orthe
soul,wasdistributedfromtheheartviathebloodtovariouspartsofthebody.

TheHippocraticcorpusstatedthatthepurposeofrespirationwastocooltheheart.Airwasthoughttobepumpedbytheatriafromthelungstotherightventricle
viathepulmonaryarteryandtotheleftventriclethroughthepulmonaryvein.2Aristotlebelievedthatbloodwasanindispensablepartofanimalsbutthatbloodwas
foundonlyinveins.Arteries,incontrast,containedonlyair.Thisconclusionprobablywasbasedonhismethodsofsacrificinganimals.Theanimalswerestarved,
tobetterdefinetheirvessels,andthenstrangled.Duringstrangulation,bloodpoolsintherightsideoftheheartandvenouscirculation,leavingtheleftsideofthe
heartandarteriesempty.2Aristotledescribedathreechamberheartconnectedwithpassagesleadinginthedirectionofthelung,buttheseconnectionswere
minuteandindiscernible.3Presumably,thelungscooledthebloodandsomehowsupplieditwithair.4

Erasistratus(bornaround300BC)believedthatairtakeninbythelungswastransferredviathepulmonaryarterytotheleftventricle.Withintheleftventricle,air
wastransformedintopneumazotikon,orthevitalspirit,andwasdistributedthroughairfilledarteriestovariouspartsofthebody.Thepneumazotikoncarriedto
thebrainwassecondarilychangedtothepneumapsychikon(animalspirit).Thisanimalspiritwastransmittedtothemusclesbythehollownerves.Erasistratus
understoodthat...

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