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The evolution of mechanical ventilation: How has medical technology changed breathing from ancient times to modern times?
Artificial ventilation or respiration refers to the process of helping the body to exchange gases through lung ventilation, external respiration and internal respiration. When an individual is unable to breathe on their own, a device called a ventilator manually moves air in and out of the lungs, preventing the buildup of carbon dioxide that could cause the lungs to collapse due to low pressure. The history of artificial ventilation dates back to the seventeenth century, during which time different methods have been developed to facilitate gas exchange, including manual methods, mechanical ventilation, and neural stimulation.
Manual Method
Lung ventilation can be achieved by manually inflating the lungs, either by the rescuer blowing directly into the patient's lungs (mouth-to-mouth breathing) or by using a mechanical device. Mouth-to-mouth breathing, as part of cardiopulmonary resuscitation (CPR), is an important skill in first aid. In some cases, mouth-to-mouth is also performed individually in cases of drowning or opioid overdose. Today, this direct inflation method is limited primarily to paramedics in most emergency procedures, with general rescuers being advised to perform full CPR if the patient is not breathing.
Mechanical ventilation
Mechanical ventilation is a method of mechanically assisting or replacing spontaneous breathing. This involves the use of a ventilator with bag-valve-mask compression by a registered nurse, physician, physician assistant, respiratory therapist, or other appropriate personnel. Mechanical ventilation is called "invasive" when it involves any equipment inserted through the mouth (such as an endotracheal tube) or skin (such as a tracheostomy tube).
In invasive mechanical ventilation, air is pushed into the trachea, whereas in non-invasive ventilation, air is breathed into the lungs.
Neural stimulation
Rhythmic stimulation of the diaphragm is performed with the help of electrical pulses. Diaphragm stimulation is a technique commonly used in people with spinal cord injuries to help them improve their breathing, speech and overall quality of life while on mechanical ventilation. As treatment techniques improve, diaphragm stimulation may help patients reduce their dependence on mechanical ventilation.
Historical BackgroundThe ancient Greek physician Galen may have been the first to describe artificial ventilation, noting that "if you blow air down the throat of a dead animal, you can inflate the bronchi and see the lungs expand to Maximum.” It wasn’t until 1773 that English physician William Hawes began to publicize the power of artificial ventilation and save lives after drowning. He rewards anyone who rescues others within a reasonable immersion time. Against this background, the Royal Humane Society was established and began research into more effective ventilation techniques.
Some of the methods and equipment used by the Royal Humane Society were similar to some of the methods used today, such as blowing air into the victim's nasal cavity with a wooden tube, or using a bellows and flexible tube to blow smoke into the intestines to compensate for the weak vitality.
Modern Challenges
In 2020, the supply of mechanical ventilators became a central concern for public health officials due to shortages caused by the 2019-20 coronavirus pandemic. During the epidemic, society's reliance on ventilators has highlighted the criticality and necessity of respiratory support technology.
With the advancement of technology and the accumulation of medical knowledge, today's ventilation technology provides safer and more effective respiratory support methods, thereby improving patients' survival rate and quality of life. However, future technological progress and the reconstruction of the medical system after the epidemic still face many challenges.
In the context of emergency and critical care, technological advances are not just about updating equipment, but also about re-evaluating occupational safety, personnel training and medical ethics. This got us thinking: How will future respiratory support technologies impact patients’ treatment options and the way they are cared for?
