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Lung Injury Caused by Mechanical Ventilation*

Arthur S. Slutsky, MD, FCCP
Author and Funding Information

*From the Samuel Lunenfeld Research Institute, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. Supported in part by Medical Research Council (Canada).

Correspondence to: Arthur S. Slutsky, MD, FCCP, Mount Sinai Hospital, 600 University Ave, Suite 656A, Toronto, Ontario M5G 1X5; e-mail: arthur.slutsky@utoronto.ca



Chest. 1999;116(suppl_1):9S-15S. doi:10.1378/chest.116.suppl_1.9S-a
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Extract

Over 250 years ago, John Fothergill presented an interesting case report, addressing for the first time the issue of lung injury that could be induced by artificial respiration.1 The case involved a surgeon, William Tossack, who observed an apneic, pulseless individual who had collapsed due to noxious fumes from a coal pit. As described by Fothergill, “Mr. Tossack applied his mouth close to the patients, and by blowing strongly, pulling the nostrils at the same time, raised his chest fully by his breath. The Surgeon immediately felt six or seven very quick beats of the heart; the Thorax continued to play and the pulse was soon felt in the arteries. In one hour, the patient began to come to himself; within four hours he walked home; and in as many days, returned to his work.” Fothergill went on to expand on the case report and suggested that mouth-to-mouth resuscitation may be better than using a mechanical method of insufflating the lungs with air using a pair of bellows because “the lungs of one man may bear, without injury, as great a force as those of another man can exert; which by the bellows cannot always be determin’d.” Thus, Fothergill clearly understood and proposed the concept of lung injury that could be produced by artificial respiration.


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