Respirators and respiratory care.

The intellectual and technological roots of respirators and respiratory care may be traced back hundreds of years. The clinical evolution has taken the better part of a century, and it has been most closely linked to the development of open-chest surgery. Resuscitation and the treatment of poliomyelitis also have contributed ideas and technology to this evolution. If its successful performance had depended only on respirators, open-chest surgery would have become clinical routine 50-80 years ago. In fact, many factors had to be under control, many modes of treatment had to be available, before the breakthrough in open-chest surgery could occur. The most important factor may have been the effective control of sepsis and hemorrhage. Open-chest surgery forced the change from single-agent deep anesthesia with spontaneous ventilation to a balanced technique, using multiple drugs or agents, with controlled ventilation. Open-chest surgery also necessitated that physicians specialize in anesthesiology. Scandinavian scientists and physicians have contributed greatly to the field of respirators and respiratory care, as has the specialty of anesthesiology.