ABSTRACT
This Arts and Medicine feature reviews The Autumn Ghost, an historical retelling of the 1952 polio epidemic in Copenhagen, Denmark, which catalyzed developments in anesthesia and respiratory support procedures that are still in use today.
Subject(s)
Critical Care , Poliomyelitis , Humans , Critical Care/history , Denmark/epidemiology , Epidemics/history , Poliomyelitis/epidemiology , Poliomyelitis/history , Poliomyelitis/prevention & control , History, 20th CenturyABSTRACT
Trends in nutritional science are rapidly shifting as information regarding the value of eating unprocessed foods and its salutary effect on the human microbiome emerge. Unravelling the evolution and ecology by which humans have harboured a microbiome that participates in every facet of health and disease is daunting. Most strikingly, the host habitat has sought out naturally occurring foodstuff that can fulfil its own metabolic needs and also the needs of its microbiota, each of which remain inexorably connected to one another. With the introduction of modern medicine and complexities of critical care, came the assumption that the best way to feed a critically ill patient is by delivering fibre-free chemically defined sterile liquid foods (that is, total enteral nutrition). In this Perspective, we uncover the potential flaws in this assumption and discuss how emerging technology in microbiome sciences might inform the best method of feeding malnourished and critically ill patients.
Subject(s)
Critical Care/history , Diet/history , Food, Formulated/history , Gastrointestinal Microbiome , Nutritional Support/history , Perioperative Care/history , Critical Care/methods , Critical Illness/therapy , Diet/adverse effects , Diet/methods , Dietary Fiber/microbiology , Dietary Fiber/therapeutic use , Food, Formulated/adverse effects , History, 20th Century , Humans , Malnutrition/diet therapy , Malnutrition/history , Malnutrition/microbiology , Nutritional Support/methods , Parenteral Nutrition, Total/adverse effects , Parenteral Nutrition, Total/history , Parenteral Nutrition, Total/methods , Perioperative Care/adverse effects , Perioperative Care/methods , United StatesABSTRACT
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.
Subject(s)
COVID-19/therapy , Intensive Care Units/history , Respiration, Artificial/history , Respiratory Distress Syndrome/history , Ventilators, Mechanical/history , Critical Care/history , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Pandemics , Poliomyelitis/history , Poliomyelitis/therapy , Positive-Pressure Respiration/history , Respiratory Distress Syndrome/therapy , SARS-CoV-2ABSTRACT
Actualmente, la nutrición enteral forma parte de las medidas de tratamiento que se aplican a los pacientes críticos. Es una técnica que, procedente del antiguo Egipto, solo tuvo un rápido desarrollo desde principios del siglo XX hasta nuestros días. Los diferentes avances en este campo, relacionados con las indicaciones, la metodología de aplicación, la selección de las dietas, el manejo de las complicaciones, el seguimiento de la eficacia y el diseño y aplicación de los protocolos asistenciales, han permitido que la nutrición enteral pueda aplicarse con seguridad y eficacia a los pacientes críticos. A pesar de ello, quedan aún muchos aspectos por desarrollar con el fin de conseguir que los pacientes se beneficien de manera óptima del tratamiento con nutrición enteral
Enteral nutrition is part of the treatment plan designed for a great number of critically ill patients. After a first description in ancient Egypt, enteral nutrition was only rapidly developed during the last century. Advances in indications, tube feeding methods, enteral formula selection, diagnosis and treatment of gastrointestinal-related complications, efficacy monitorization, and use of protocols for enteral nutrition administration in clinical practice make this nutritional technique more feasible and secure for critically ill patients. Nevertheless, several issues in this field need more investigation to increase enteral nutrition development, efficacy, and safety in these patients
