History of Technology in the Intensive Care Unit
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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