Elsevier

Critical Care Clinics

Volume 25, Issue 1, January 2009, Pages 185-200
Critical Care Clinics

History of Technology in the Intensive Care Unit

https://doi.org/10.1016/j.ccc.2008.12.002Get rights and content

Critical care medicine is a young specialty and since its inception has been heavily reliant upon technology. Invasive monitoring has its humble beginnings in the continuous monitoring of heart rate and rhythm. From the development of right heart catheterization to the adaption of the echocardiogram for use in shock, intensivists have used technology to monitor hemodynamics. The care of the critically ill has been buoyed by investigators who sought to offer renal replacement therapy to unstable patients and worked to improve the monitoring of oxygen saturation. The evolution of mechanical ventilation for the critically ill embodies innumerable technological advances. More recently, critical care has insisted upon rigorous testing and cost-benefit analysis of technological advances.

Section snippets

Early Invasive Monitoring

Invasive monitoring in the intensive care unit owes a great deal to many forward-thinking pioneers in this field. In 1929, the German resident Forssmann, in an attempt to deliver drugs more effectively for cardiac resuscitation, inserted a nonflow directed (no balloon) catheter into his own arm and advanced it to what was calculated to be his right heart (Fig. 1). He walked to the radiology department to verify its placement by radiography.1 Forssmann's successful experiment was considered a

The Early Years

The origins of clinical echocardiography date back to the 1950s under the leadership of Edler and Hertz. Echocardiography was initially performed in the motion-mode, which provided a one-dimensional axial view of the heart displayed as monochromic dots.21 The technology progressed in the early 1970s with primitive two-dimensional (2D) imaging obtained by recording the various levels of brightness from ultrasonic reflections of the heart. Clinicians were able to visualize cardiac structures and

Brief History of Dialysis

Since the eighteenth century, physicians have been aware that the peritoneum could be used as a conduit to remove excess and potentially “toxic” fluid from the peritoneal space. Peritoneal dialysis first clinical application was in Germany in 1923 by George Ganter.38 He was concerned about the attempts of others to use extracorporeal membranes to dialyze patients that required the use of hirudin, an extract from leeches to provide anticoagulation. He instilled a sterile solution into the

The Early Years

Historically, the clinical lack of sensitivity to detect hypoxemia is well documented.61 This problem perplexed investigators for over forty years. Pulse oximeters saw limited use in a few pulmonary research laboratories. The oximeters used were bulky, required recalibration after each use and were capable of causing second degree skin-burns. In 1972, the Japanese engineer Ayogi accidentally discovered the basis for modern pulse oximetry while experimenting with dye techniques to measure

The Modern Origins

The nineteenth century saw the development of negative pressure ventilation with little clinical utility until Drinker-Shaw invented the iron lung in 1929. This machine was first effectively used to manage the respiratory paralysis caused by polio. The iron lung was a cylindric tank in which patients would be enclosed with only their head protruding. This machine created negative pressure around the patient's body to create inhalation and exhalation occurred passively.76 The Cuirass ventilator,

Summary

The history of technology in the ICU spans five decades of pioneering work by dedicated investigators from medical, bioengineering and other fields. Technology has played a significant role in the advancement of the practice of critical care medicine. The understanding of hemodynamics, first by the PAC and subsequently by echocardiogram, has enhanced our understanding of the physiology of critical illness. The development of CRRT has allowed practitioners to dialyze ICU patients; the monitoring

Acknowledgments

We would like to thank Denise McGinly for her help in preparing this article. We are also grateful to Karen Mitchell, Rosemary Schwedel and Betty Jean Swartz at Cooper University Hospital, New Jersey.

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