The Reign of the Ventilator: Acute Respiratory Distress Syndrome, COVID-19, and Technological Imperatives in Intensive Care.

In the early phase of the COVID-19 pandemic, a dispute arose as to whether the disease caused a typical or atypical version of acute respiratory distress syndrome (ARDS). This essay recounts the emergence of ARDS and places it in the context of the technological transformation of modern hospital care-particularly the emergence of intensive care after the 1952 Copenhagen polio epidemic. The polio epidemic seemed to show the value of manual positive-pressure ventilation, leading to the proliferation of mechanical ventilators and the expansion of intensive care units in the 1960s. This created the conditions of possibility for ARDS to be described and institutionalized within modern intensive care. Yet the centrality of the ventilator to descriptions and definitions of ARDS quickly made it difficult to conceive of the disorder outside the framework of mechanical ventilation and blood gas levels, or to acknowledge the degree to which the ventilator was a source of iatrogenic injury and complications. Moreover, the imperative to understand and treat ARDS with mechanical ventilation set the stage for the early confusion about whether patients with COVID-19 should receive mechanical ventilation. This history offers many crucial lessons about how new technologies can lead to new and valuable therapies but can also subtly shape and constrain medical thinking. Moreover, ventilators not only changed how respiratory disorders were conceived; they also brought new forms of respiratory illness into existence.

Teaching medicine through film: Wiseman's medical trilogy revisited.

BACKGROUND: Between the late 1960s and early 1980s, Frederick Wiseman filmed hundreds of hours in an emergency department, intensive care unit and asylum. These films recorded events as they happened without rehearsal and narration. MAIN BODY: Cinema and Medicine meet each other in feature fiction film and in documentary format. Showing films in hospitals is revealing for both the unexpected audience but also the medical establishment. This paper revisits Wiseman's edited but explicit films and their revelation of the complexity of care in this era in the United States. Although they offer a narrow view of medical institutions and the issue of informed consent later became problematic, the films provide an intriguing glimpse of US healthcare and decision making. These films are largely unknown but would be an invaluable resource in a masterclass on medical ethics in urgent care and end-of-life decisions. CONCLUSIONS: Despite their flaws, Wisemans' medical films have a significant educational value. Each documentary can be used in a masterclass on medical ethics. The films provide ample opportunities to discuss core issues in healthcare, professional interactions, and decision making in critically ill patients.

Brain death revisited.

Until six decades ago, death was considered to be a specific point in time, referring to the moment at which life ends. With the availability of ventilators, even determining when death has occurred is becoming difficult, as cessation of life functions is often not simultaneous across organ systems. With increasing accessibility to intensive care units (ICUs) even in Tier II and Tier III cities, and the government making it mandatory to notify brain death to facilitate cadaveric organ transplants, it behooves the neurosurgeon and neurologist to totally understand the minutiae of brain death. The author reflects on his personal experience in certifying brain death, over two decades, in a quaternary care hospital. Knowing the pathophysiology of brain stem dysfunction will help the clinician better understand the rationale of the mandatory clinical tests prescribed. The necessity for an early diagnosis and the pitfalls in the clinical diagnosis of brain death, the limitations of the so-called confirmatory tests, and the concerns and ethical issues will be highlighted. Review of the world literature demonstrates that there is no international consensus even on what constitutes brain death. An individual could be considered legally dead in one country but not in another!

[Origin of commonly used eponyms in the Intensive Care Unit daily job]. / Origen de epónimos comúnmente empleados en la Unidad de Cuidados Intensivos.

Eponyms reflect the history of medicine, diseases, and doctors in their time. Their use is controversial, presenting supporters and detractors. However, the use of eponyms persist in the modern medical language in the Intensive Care Units and includes some frequently used ones such as Foley, Seldinger, Down, Macintosh, Magill, Ringer, Yankauer, Doppler, and French. The objective of this review is to promote biographical knowledge and the historical period in which its medical use took place, in order to deepen aspects of medicine history.

Intensive care medicine is 60 years old: the history and future of the intensive care unit.

Intensive care is celebrating its 60th anniversary this year. The concept arose from the devastating Copenhagen polio epidemic of 1952, which resulted in hundreds of victims experiencing respiratory and bulbar failure. Over 300 patients required artificial ventilation for several weeks. This was provided by 1,000 medical and dental students who were employed to hand ventilate the lungs of these patients via tracheostomies. By 1953, Bjorn Ibsen, the anaesthetist who had suggested that positive pressure ventilation should be the treatment of choice during the epidemic, had set up the first intensive care unit (ICU) in Europe, gathering together physicians and physiologists to manage sick patients - many would consider him to be the 'father' of intensive care. Here, we discuss the events surrounding the 1952 polio epidemic, the subsequent development of ICUs throughout the UK, the changes that have occurred in intensive care over the past 10 years and what the future holds for the specialty.

[40 years of neurological intensive care in Croatia]. / 40 godina neuroloskog intenzivnog lijecenja u Hrvatskoj.

On the 40 year anniversary of the foundation of the first Neurological intensive therapy unit (ICU) in Zagreb, Croatia and in the region, the author recalls circumstances which stipulated its realization. The process lasted several years, from the proposal in 1968, starting working in provisional conditions in 1971--acquiring experience, and normal functioning in the newly adapted rooms in 1974. Paying tribute to personalities who supported and participated in the advances of this process, the author informs that at the First Congress of Intensive Care (London, 1974) his report on Zagreb Neurological intensive therapy unit was the only one in neurology. The basic principles of therapy are nowadays the standard in the neurological departments, enabling better recovery from stroke, neurological ailment with high mortality. Positive development brought to the realization of the concept of comprehensive care for cerebrovascular patients, including prevention, early intensive therapy and neurological restoration measures after stroke.

From intensive care to critical care medicine: a historical perspective.

The evolution of Critical Care Medicine is traced in relationship to its predecessors, namely Intensive Care and Intensive Therapy. This commentary documents the initial physical care rendered by professional nurses in hospitals of the 19th century in locations close to the nursing stations. The development of incubators for newborns and life-support devices to support ventilation and renal function or to reverse fatal arrhythmias characterized Intensive Therapy of the early 20th century. In the most recent 50 years, Critical Care evolved for comprehensive, largely electronic monitoring and automated laboratory measurements to guide intensive therapy of multiorgan failures by critical care physicians and nurse specialists, pharmacists, and respiratory therapists using multiple life-support methodologies and devices.

Fifty years of infection control and healthcare design.

The examination of 1962 perspectives on healthcare provided by Ross Graham and Shannon Sibbald in their article "Looking Back 50 Years in Hospital Administration" provides an opportunity to see not only what happened 50 years ago, but how modern attitudes and concerns both match and differ from those of the past. Focusing on infection prevention and hospital design, this commentary explores the changes in procedure, policy and attitudes since 1962, and how they are affecting healthcare today.

The history of critical care in Kenya.

Critical care is a young specialty in Kenya. From its humble beginnings in the 1960s to present day Kenya, the bulk of this service has largely been provided by anaesthetists. We provide a detailed account of the growth and development of this specialty in our country, the attempts made by our people to grow this service within our borders and the vital role our international partners have played throughout this process. We also share a selection of our successes over the years, the challenges we have faced and our aspirations as we look to the future.

Evolution of management and investigations of cerebrovascular diseases in Croatia.

The author presents the history of management of cerebrovascular diseases (CVD) in Croatia since the beginning of medical health service in the country in the 19th and its evolution to the end of the 20th century. The foundation of the Zagreb School of Medicine in 1917 had paramount importance for the development of neurology, during the first period within the common specialty of neuropsychiatry. The interest for the CVD in Croatia became evident in the sixties of the past century, particularly when neurology has become a separate specialty in 1974. Fast progress in the field of CVD resulted from clinical applications of basic research and after discovery of risk factors in their occurrence. These advances and the appearance of a new medical specialty: intensive medicine, stimulated in Croatia the organization of the first Neurological Intensive Care Unit (ICU) in 1971. Clinical experience and investigations of the first neurological ICU stimulated this approach to CVD in other big hospitals in Croatia and in the surrounding countries. The results of new management were presented on national and international meetings, especially on 5 Zagreb Symposia on CVD. The concept of comprehensive care for CVD patients was promoted, as a continuum of prevention, early treatment--if necessary in the ICU followed by modern rehabilitation. The described efforts were stopped due to the wars in the former Yugoslavia in the last decade of the 20th century. The process has been reinstated with new enthusiasm and new teams at the beginning of the 21st century after the postwar consolidation in Croatia and in the region.

Critical Care Air Support Teams and deployed intensive care.

The evacuation of injured patients by air has been going on in one form or another for nearly 100 years. This paper presents some of the history behind Aeromedical Evacuation (AE), the current situation and looks to the future of this vital component in the chain of care from point of wounding to rehabilitation.