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Artificial ventilation

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Artificial ventilation or respirationis when amachine assists ina metabolic process to exchange gases in the body by pulmonary ventilation, external respiration, and internal respiration.[1]A machine called a ventilator provides the person air manually by moving air in and out of the lungs when an individual is unable to breathe on their own. The ventilator prevents the accumulation of carbon dioxide so that the lungs don't collapse due to the low pressure.[2][3]The use of artificial ventilation can be traced back to the seventeenth century. There are three ways of exchanging gases in the body: manual methods, mechanical ventilation, and neurostimulation.[4]

Artificial ventilation
Respiratory therapist examining a mechanically ventilated patient on anIntensive Care Unit.
Other namesartificial respiration
SpecialtyPulmonary

Here are some key words used throughout the article. The process of forcing air into and out of the lungs is known as ventilation. The process by which oxygen is taken in by the bloodstream is called oxygenation. Lung compliance is the capacity of the lungs to contract and expand. The obstruction of airflow via the respiratory tract is known as airway resistance. The amount of ventilated air that is not involved in gas exchange is known as dead-space ventilation.[5][tone]

Types

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Manual methods

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Further information:Mouth-to-mouth resuscitation

Pulmonary ventilation is done by manual insufflation of the lungs either by the rescuer blowing into the patient's lungs (mouth-to-mouth resuscitation), or by using a mechanical device. Mouth-to-mouth resuscitation is also part ofcardiopulmonary resuscitation(CPR) making it an essential skill forfirst aid.In some situations, mouth to mouth is also performed separately, for instance in near-drowningandopiateoverdoses.[6]The performance of mouth to mouth on its own is now limited in most protocols tohealth professionals,whereas lay first aiders are advised to undertake full CPR in any case where the patient is not breathing. This method of insufflation has been proved more effective than methods which involve mechanical manipulation of the patient's chest or arms, such as theSilvester method.[7]

Mechanical ventilation

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Main article:Mechanical ventilation

Mechanical ventilation is a method to mechanically assist or replace spontaneousbreathing.[8]This involves the use ofventilatorassisted by aregistered nurse,physician,physician assistant,respiratory therapist,paramedic,or other suitable person compressing abag valve mask.Mechanical ventilation is termed "invasive" if it involves any instrument penetrating through the mouth (such as an endotracheal tube) or the skin (such as atracheostomytube).[9]There are two mainmodes of mechanical ventilationwithin the two divisions: positive pressure ventilation, where air (or another gas mix) is pushed into thetrachea,and negative pressure ventilation, where air is, in essence, sucked into the lungs.[10]

Tracheal intubationis often used for short-termmechanical ventilation.It's when a tube is inserted through the nose (nasotracheal intubation) or mouth (orotracheal intubation) and advanced into thetrachea.In most cases tubes with inflatable cuffs are used for protection against leakage and aspiration. Intubation with a cuffed tube is thought to provide the best protection against aspiration. Downside of tracheal tubes is the pain and coughing that follows. Therefore, unless a patient is unconscious or anesthetized,sedativedrugs are usually given to provide tolerance of the tube. Other disadvantages of tracheal intubation include damage to the mucosal lining of thenasopharynxororopharynxand subglottic stenosis.

In an emergency acricothyrotomycan be used by health care professionals, where an airway is inserted through a surgical opening in thecricothyroid membrane.This is similar to atracheostomybut acricothyrotomyis reserved for emergency access. This is usually only used when there is a complete blockage of thepharynxor there is massive maxillofacial injury, preventing other adjuncts being used.[11]

Neurostimulation

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Main article:Diaphragm pacing

A rhythmic pacing of the diaphragm is caused with the helpof electrical impulses.[12][13]Diaphragm pacing is a technique used by persons with spinal cord injuries who are on a mechanical ventilator to aid with breathing, speaking, and overall quality of life. It may be possible to reduce reliance on a mechanical ventilator with diaphragm pacing.[14]Historically, this has been accomplished through the electrical stimulation of aphrenic nerveby an implanted receiver/electrode,[15]though today an alternative option of attachingpercutaneouswires to the diaphragm exists.[16]

History

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The Greek physicianGalenmay 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]Vesaliustoo describes ventilation by inserting a reed or cane into thetracheaof animals.[18]

It wasn't until 1773, when an English physicianWilliam 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 Coganwho was another English physician had become interested in the same subject during a stay atAmsterdam.

In the summer of 1774, Hawes and Cogan each brought fifteen friends to a meeting at the Chapter Coffee-house inSt Paul'sChurchyard, where they founded theRoyal 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 physiologistMarshall Hallin 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 byHenry 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 SirEdward 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 includedDr. George Edward Fell's "Fell method" or "Fell Motor."[23]It consisted of a bellows and a breathing valve to pass air through atracheotomy.He collaboratied with Dr.Joseph O'Dwyerto invent the Fell-O'Dwyer apparatus, which is a bellows instrument for the insertion and extraction of a tube down the patientstrachea.[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.

See also

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References

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  1. ^Stocker R, Biro P (February 2005)."Airway management and artificial ventilation in intensive care".Current Opinion in Anesthesiology.18(1): 35–45.doi:10.1097/00001503-200502000-00007.ISSN0952-7907.PMID16534315.
  2. ^Tortora GJ, Derrickson, Bryan (2006).Principles of Anatomy and Physiology.John Wiley & Sons Inc.
  3. ^"medilexicon.com, Definition: 'Artificial Ventilation'".Archived fromthe originalon 2016-04-09.Retrieved2016-03-30.
  4. ^Shiao SY, Ruppert SD, Tolentino-Delosreyes AF (2007)."Evidence-Based Practice: Use of the Ventilator Bundle to Prevent Ventilator-Associated Pneumonia".American Journal of Critical Care.16(1): 20–27.doi:10.4037/ajcc2007.16.1.20.PMID17192523.Retrieved2024-03-08.
  5. ^Brouillette RT, Marzocchi M (2009-09-30)."Diaphragm Pacing: Clinical and Experimental Results".Biology of the Neonate.65(3–4): 265–271.doi:10.1159/000244063.ISSN0006-3126.PMID8038293.
  6. ^Newell C, Grier S, Soar J (2018-08-15)."Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation".Critical Care.22(1): 190.doi:10.1186/s13054-018-2121-y.ISSN1364-8535.PMC6092791.PMID30111343.
  7. ^"Artificial Respiration".Microsoft Encarta Online Encyclopedia 2007. Archived fromthe originalon 2009-10-30.Retrieved2007-06-15.
  8. ^"What Is a Ventilator? - NHLBI, NIH".www.nhlbi.nih.gov.Retrieved2016-03-27.
  9. ^GN-13: Guidance on the Risk Classification of General Medical DevicesArchivedMay 29, 2014, at theWayback Machine,Revision 1.1. FromHealth Sciences Authority.May 2014
  10. ^Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, González M, Elizalde J, Nightingale P, Abroug F, Pelosi P (2008-01-15)."Evolution of Mechanical Ventilation in Response to Clinical Research".American Journal of Respiratory and Critical Care Medicine.177(2): 170–177.doi:10.1164/rccm.200706-893OC.ISSN1073-449X.PMID17962636.
  11. ^Carley SD, Gwinnutt C, Butler J, Sammy I, Driscoll P (March 2002)."Rapid sequence induction in the emergency department: a strategy for failure".Emergency Medicine Journal.19(2): 109–113.doi:10.1136/emj.19.2.109.PMC1725832.PMID11904254.Retrieved2007-05-19.
  12. ^Bhimji, S. (16 December 2015). Mosenifar, Z. (ed.)."Overview - Indications and Contraindications".Medscape - Diaphragm Pacing.WebMD LLC.Retrieved19 February2016.
  13. ^Khanna, V.K. (2015)."Chapter 19: Diaphragmatic/Phrenic Nerve Stimulation".Implantable Medical Electronics: Prosthetics, Drug Delivery, and Health Monitoring.Springer International Publishing AG Switzerland. p. 453.ISBN978-3-319-25448-7.Retrieved19 February2016.
  14. ^Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM (April 2016)."Diaphragm pacing: the state of the art".Journal of Thoracic Disease.8(Suppl 4): S376–S386.doi:10.21037/jtd.2016.03.97.ISSN2072-1439.PMC4856845.PMID27195135.
  15. ^Chen, M.L., Tablizo, M.A., Kun, S., Keens, T.G. (2005)."Diaphragm pacers as a treatment for congenital central hypoventilation syndrome".Expert Review of Medical Devices.2(5): 577–585.doi:10.1586/17434440.2.5.577.PMID16293069.S2CID12142444.
  16. ^"Use and Care of the NeuRx Diaphragm Pacing System"(PDF).Synapse Biomedical, Inc. Archived fromthe original(PDF)on 19 February 2016.Retrieved19 February2016.
  17. ^Colice GL (2006). "Historical Perspective on the Development of Mechanical Ventilation". In Martin J Tobin (ed.).Principles & Practice of Mechanical Ventilation(2 ed.). New York: McGraw-Hill.ISBN978-0-07-144767-6.
  18. ^Chamberlain D (2003)."Never quite there: a tale of resuscitation medicine".Clin Med.3(6): 573–7.doi:10.7861/clinmedicine.3-6-573.PMC4952587.PMID14703040.
  19. ^"A Watery Grave- Discovering Resuscitation, exhibits.hsl.virginia.edu".exhibits.hsl.virginia.edu.Archived fromthe originalon 2017-01-06.Retrieved2016-03-30.
  20. ^"Sir Edward Albert Sharpey-Schafer".Encyclopaedia Britannica.Retrieved8 August2018.
  21. ^American National Red Cross (1933).American Red Cross First Aid Text-Book (Revised).Philadelphia: The Blakiston Company. p. 108.
  22. ^Nolte H (March 1968). "A New Evaluation of Emergency Methods for Artificial Ventilation".Acta Anaesthesiologica Scandinavica.12(s29): 111–25.doi:10.1111/j.1399-6576.1968.tb00729.x.PMID5674564.S2CID2547073.
  23. ^Angela Keppel, Discovering Buffalo, One Street at a Time, Death by Electrocution on Fell Alley?, buffalostreets.com
  24. ^STEVEN J. SOMERSON, MICHAEL R. SICILIA, Historical perspectives on the development and use of mechanical ventilation, AANA Journal February 1992/Vol.60/No.1, page 85
  25. ^19th century pioneers of intensive therapy in North America. Part 1: George Edward Fell, Crit Care Resusc. 2007 Dec;9(4):377-93abstract
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