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Denver, Colorado
Our initial experiences with the first 12 patients, which we described as Acute Respiratory Distress in Adults (Lancet 1967; 2[7511]:319–323), had many interesting origins. In 1964, after joining the faculty at the University of Colorado, I had just learned how to do arterial blood gases myself and had my own little laboratory, which we intended to use as support for our fledging Intensive Respiratory Care Unit (service). In equipping our humble little lab, which was adjacent to both the medical and surgical ICUs, we had scrounged around in storerooms for any useable respiratory equipment, such as mechanical ventilators that had been purchased some time ago, usually for research purposes. We had an unusual stroke of luck to find the 1954 model of the Engstrom volume-controlled respirator, designed for use in the last major polio epidemic that year, in the storeroom of the hospital. This equipment had the capability of providing adjustable end-expiratory pressure, which we later called positive end-expiratory pressure (PEEP).
One night in 1964, Dave Ashbaugh, the surgeon with our team, was trying to oxygenate a victim of a high-speed auto crash with a crushed chest. I was doing the blood gases. He could not get a PO2 higher than 44, until out of desperation, he applied end-expiratory pressure. This resulted in a great increase in PO2. I had a second patient with acute hemorrhagic pancreatitis, and tried PEEP, again out of desperation, using the Engstrom ventilator. It worked dramatically in improving arterial oxygenation. Both these patients died, but they had taught us great lessons about arterial oxygenation. Both patients had massive diffuse infiltrates occupying all lung fields. Inflation pressure requirements were high, but this requirement could be provided by the Engstrom. Other pressure-cycled ventilators that were coming into use in that era, the Puritan Bennett Series and Bird, could not deliver enough pressure, and they did not have the capability of PEEP. Soon after, industry began producing volume-cycled ventilators with PEEP controls to meet the demands of such patients in maintaining ventilation and arterial oxygenation.
Along with Dave and myself, two fellows, Boyd Bigelow and Bernie Levine, made up our team. Louise Nett was our nurse therapist. We encountered a total of 12 very similar patients within one year that fulfilled the criteria of refractory hypoxemia and low overall lung and chest wall compliance, following a variety of catastrophic injuries. The patients had varied responses to mechanical ventilation, depending on their illness; these included COPD, asthma, postoperative atelectasis, and other common problems resulting in acute respiratory failure. Five of 12 survived. All autopsied patients showed congested collapsed lungs with hyaline membranes and debris. In two patients for whom we could do the measurements, surfactant activity was reduced. ARDS was first considered as the theme of the Aspen Lung Conferences, previously known as emphysema conferences, with the 16th in 1972.
Thus ARDS was born! No brief introduction can cover all of the excitement that has focused on acute lung injury and repair. Also, nonacute lung injury and repair has an equally fascinating history, much of it introduced at these Aspen Lung Conferences, beginning with the 18th. Each of the 49 previous conferences has followed both specific and general themes, but acute and chronic lung injury has been among the most popular in recent years.
Fraternally, Tom Petty
May 29, 2007
FOOTNOTES
Conflict of Interest Statement: T.L.P. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.
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