1997 OPEN FORUM Abstracts
Phil Kittredge Memorial Lecture: Mechanical Ventilation: The Next 50 Years
Neil R. MacIntyre, MD, Monday, December 8, 1997.
Mechanical ventilation in 1997 is a life support technology that benefits millions of patients throughout the world. Despite its success, significant problems remain. Among the most important of these are iatrogenic lung injury from overdistension, oxygen toxicity and infection, patient discomfort from dys-synchronous support strategies and cumbersome hardware, and high costs. In the immediate future (i.e., over the next decade), a number of developments are likely to occur to address some of these issues. These include more responsive valving systems with feedback loops, non-convective flow technology (e.g., high frequency ventilation), pharmacologic adjuncts (e.g., nitric oxide, surfactant, antioxidants), and more cost-efficient equipment. Additionally, skilled physician extenders will be charged with operating these systems as the specialist physician pool shrinks. Predicting development beyond 10 years and out to 50 years is obviously more difficult. Nevertheless, one can speculate that basic science advances in a wide range of biomedical fields may impact life support system design. Examples might include extracorporeal support technologies, lung repair pharmacologic agents administered into the ventilator, combinations with other support technologies (e.g., cardiovascular dialysis) and computer technologies to control these processes. An additional development would be the incorporation nationwide of standardized (perhaps computer-controlled) management protocols. Such a national standardized network would allow for rapid assessment of new technologies under controlled circumstances. Professional experts in applying technology to human pathophysiology are going to be essential in developing these advances.
AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.