Noninvasive Ventilation Mukesh Kumar Agarwal
Chapter Notes

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To have an idea, how the journey from primitive noninvasive ventilation to modern day noninvasive ventilation took place.
1838–In the very beginning, noninvasive body ventilators were used. They were so named because negative pressure around body assisted ventilation. They were manually powered. Scottish physician, John Dalziel described a negative pressure machine. It consisted of an airtight box in which patient had to sit with head protruding outside.
1928–Philip Drinker, a Boston engineer developed iron lung. It was first electrically powered ventilator.
1931–J.H. Emerson of Cambridge developed modified version of iron lung. It had the option of manual operation in event of electricity failure.
1949–Chest shells, Fairchild Huxley chest respirator and Monaghan portable respirator were developed.
Early 1960s–NIV was used successfully to treat patient with neuromuscular diseases.
1960s–Better results and better airway protection led to transition to invasive ventilation from noninvasive ventilation.
After 1960s–There was re-emergence of noninvasive ventilation.
Early 1980s–CPAP was used to treat sleep apnea.
1987–Nocturnal CPAP with nasal mask was used to treat chronic respiratory insufficiency.3
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Figure 1.1: Evolution of noninvasive ventilation
1990 onwards NIV gained widespread acceptance and NIV devices became quite popular.
An outline of evolution of noninvasive ventilation is depicted in Figure 1.1.
Clinical Pearl
Noninvasive ventilation gained much popularity due to complications associated with endotracheal intubation and invasive mechanical ventilation.
In a Nutshell
The various points are clear from the historical aspect.
  1. The need of ventilatory support in addition to medical treatment was felt much earlier.
  2. Negative pressure ventilators were developed first.
  3. Limitations of noninvasive ventilation led to shift of interest from noninvasive to invasive ventilation.
  1. Drinker P, Shaw LA. An apparatus for prolonged administration of artificial respiration. Designs for adults and children. J Clin Invest 1929;7:229-47.
  1. Mehta Sangeeta, Hill Nicholas S. Noninvasive Ventilation. American J. Respir Crit Care Med 2001;163:540-77.
  1. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnea by continuous positive pressure applied through the nares. Lancet 1981;1:862-65.
  1. Wiers PW, Le Coultre R, Dallinga OT, Van Dijl W, Meinesz AF, Sluiter HJ. Cuirass respirator treatment of chronic respiratory failure in scoliotic patients. Thorax 1977;32:(2)221-28.