ABSTRACT
Different clinical problems and technological advances have shaped the development of ventilator support into what we have today. The first commercially available iron lung became available in the 1930s; it was cumbersome in size and expensive. Despite this, it was still extensively used for the management of chronic respiratory failure (CRF) until the 1970s. The Copenhagen Polio epidemic in 1952 brought about another step forward; a relative dearth of iron lung ventilators compared to the United States prompted the use of tracheostomy and bag mask ventilation by nurses and medical students to provide ventilator support, with a dramatic reduction in mortality. These positive results, combined with the drawbacks of the iron lung such as the worsening of upper airway obstruction, and cumbersome machine size, drove the gradual transition from negative pressure ventilation to positive pressure ventilation. The Salk and Sabin polio vaccines brought about the end of the polio epidemics, but the lessons learned are still utilized today. The next step in the development of NIV was the use of continuous positive airway pressure (CPAP) via facemask to treat OSA. This led to a series of new user interfaces that improved comfort and tolerance. Today, we have a range of ventilators from small portable devices to more advanced units that have greater monitoring features, combined with a variety of comfortable mask interfaces that have allowed NIV to be employed in a wide range of conditions causing acute and chronic respiratory failure.
