Historical review of pressure breathing. The authors trace the origins of pressure breathing and relate them to today's practice. Intermittent positive pressure breathing (IPPB) began with mouth-to-mouth insufflation (Elisha, 800 BC, and Tossach, 1847). Mechanical devices took over as the lung inflating methods of artificial ventilation at the end of the 19th century. Continuous positive pressure breathing (CPPB) was introduced in 1935; a continuous pressure of 2 to 10 cm H2O was maintained throughout the respiratory cycle. The expiratory pressure tended to prevent collapse of the bronchial airway and the inspiratory pressure provided a slight assistance to expansion of the lungs. Positive end expiratory pressure (PEEP) was developed to include a high inspiratory pressure as well as a positive end expiratory pressure. It has become widely used for the treatment of the adult respiratory distress syndromes. Recently, CPPB has been employed in children and in adults for the treatment of acute respiratory failure.
Get full access to this article
View all access options for this article.
References
1.
WienerPP: Values in a universe of chance. In Selected Writings of Charles S Pierce 1839-1914, New York, Doubleday & Co, 1958.
2.
TossachW: Man dead in appearance recovered by distending lungs with air. In CadwellT, BalfourJ: Medical Essays and Observations, 5th ed, London and Edinburgh, 1771, p 108.
3.
DavidRH: Deep diving and underwater rescue, II. J Roy Soc Arts82:1049, 1934.
4.
DemarchiibidVesaliusA: In DobkinAB, : Ventilators and Inhalators, 2nd ed, Boston, Little Brown & Co, 1972.
5.
HookeR: An experiment of preserving animals alive by blowing into their lungs with bellows. Roy Soc London Memoirs1:100, 1665. (cf also WolfeA: A History of Science, Technology and Philosophy in the 16th and 17th Centuries, New York, The Macmillan Co, 1939).
6.
MoreLT: The Life and Works of the Honourable Robert Boyle. London, Oxford University Press, 1944.
7.
SimpsonA: Compressed Air, as a Therapeutic Agent in the Treatment of Consumption, Asthma, Chronic Bronchitis and Other Diseases. Edinburgh, Sutherland and Knox, 1857.
8.
JacobsonJ: Hyperbaric oxygenation. Ann NY Acad Sci117:647, 1965.
9.
OertelMJ: Respiratory therapeutics. In VonZiems-sen: Handbook of Therapeutics, translated from the German by YeoJB, Baltimore, William Wood & Co, 1885, 3:547.
10.
NortonNR: Forced respiration in a case of carbolic acid poisoning. Med & Surg Rep. Presbyt Hosp NY1:127, 1896.
11.
EmersonH: Artificial respiration in the treatment of edema of the lungs. Arch Intern Med3:368, 1909.
12.
WelchWH: Zur Pathologie des Lungenodems. Virchow's Arch Pathol Anatlxxii:375, 1878.
13.
AuerJ, GatesFL: Experiments on the causation and amelioration of adrenalin pulmonary edema. J Exper Med26:201, 1917.
DrinkerP, McKhannCF: The use of a new apparatus for the prolonged administration of artificial respiration: I. A fatal case of poliomyelitis. JAMA92:1658, 1929.
16.
BarachAL: The use of helium in the treatment of asthma and obstructive lesions of larynx and trachea. Ann Intern Med9:739, 1935.
17.
BarachAL: The therapeutic use of helium. JAMA108:1273, 1936.
18.
BarachAL, MartinL, EckmanL: Positive pressure respiration and its application to the treatment of acute pulmonary edema and respiratory obstruction. Proc Am Soc Clin Invest16:664, 1937.
19.
BarachAL: Effects of inhalation of helium mixed with oxygen on the mechanics of respiration. J Clin Invest15:47, 1936.
20.
BarachAL, MartinS, EckmanM: Positive pressure respiration and its application to the treatment of acute pulmonary edema. Ann Intern Med12:754, 1938.
21.
BarachAL, SwensonP: Effect of breathing gases under positive pressure on lumens of small and medium-sized bronchi. Arch Intern Med63:946, 1939.
22.
KernanJD, BarachAL: Role of helium in cases of obstructive lesions in the trachea and larynx. Arch Otol26:419, 1937.
23.
PoultonEP: Left-sided heart failure with pulmonary edema treated with the pulmonary plus pressure machine. Lancet2:983, 1936.
24.
LaennecRTH: A Treatise on the Diseases of the Chest and on Mediate Auscultation. ForbesJohnDr, New York, Samuel Wood & Sons, 1830, p 211.
25.
SaengerM: Ueber asthma und seine Behandlung. Berlin, S Karger, 1910.
26.
HofbauerI: Pathologische physiologie der atmung. In BetheA, von BergmannG, EmbdenG, EllingerA: Handbuch der normalen und pathologischen.
27.
BarachAL, MolomutN: Oxygen mask metered for positive pressure. Ann Intern Med17:820, 1942.
28.
ThunebergT: The barospirator: a new machine for producing artificial respiration. Skand Arch Physiol48:80, 1926.
29.
WoodmanM: On the control of air pressure in the lungs after tracheotomy. J Laryngol Otol50:214, 1935.
30.
SegalMS, AisnerM: Management of certain aspects of gas poisoning with particular reference to shock and pulmonary complications. Ann Intern Med20:219, 1944.
31.
SegalMS: Inhalation therapy in the treatment of serious respiratory disease. N Engl J Med229:235, 1943.
32.
AnsbroFP: Positive pressure respiration in treatment of acute pulmonary edema. Am J Surg68:185, 1945.
33.
BickermanHA, BeckGJ: Pressure breathing with oxygen and helium-oxygen in pulmonary edema and obstructive dyspnea. Bull NY Acad Med26:410, 1950.
34.
HardyGC, BarachAL: Positive pressure respiration in treatment of irritant pulmonary edema due to chlorine gas poisoning. JAMA128:359, 1945.
35.
BarachAL: Recent advances in inhalational treatment of cardiac and respiratory disease; principles and methods. NY State J Med37:No. 12, 1937.
BarachAL, EckmanM, GinsbergE, RumseyCJr, KorrI, EckmanI, BessonG: Studies on positive respiration. I—General aspects and types of pressure breathing. II—Effects on respiration and circulation at sea level. J Aviation Med17:290, 1946. III—Effect of continuous pressure breathing on arterial blood gases at high altitude. J Aviation Med 18:139, 1949.
38.
FennWO, FerrisEB, SchmidtSF: The physiology of pressure breathing. A brief review of its status. J Aviation Med18:73, 1947.
39.
CarrDT, EssexHE: Certain effects of positive pressure respiration on the circulatory and respiratory systems. Am Heart J31:53, 1946.
40.
RahnH, OtisAB, ChadwickLE, FennWO: The pressure-volume diagram of the thorax and lung. Am J Physiol146:161, 1946.
41.
KetySS, SchmidtCF: The effects of active and passive hyperventilation on cerebral blood flow, cerebral oxygen consumption, cardiac output and blood pressure of normal young men. J Clin Invest25:107, 1946.
42.
EckmanM, BarachB, FoxC, RumseyCCJr, SomkinE, BarachAL: An appraisal of intermittent pressure breathing as a method of increasing altitude tolerance. J Aviation Med18:565, 1947.
43.
WerkoL: The influence of positive pressure breathing on the circulation in man. Acta Med Scand128, Suppl 193:1, 1947.
44.
FennWO, RahnH: Handbook of Circulation. Philadelphia, WB Saunders, 1959, p 80.
45.
CournandA, MotleyHL, WerkoL, RichardsDWJr: Physiological studies of effects of intermittent positive pressure breathing on cardiac output in man. Am J Physiol152:163, 1948.
46.
MotleyHL, LangLP, GordonB: Use of intermittent positive pressure breathing combined with nebulization in pulmonary disease. Am J Med5:853, 1948.
47.
TomashefskiJF: Treatment of chronic pulmonary disease with intermittent positive pressure breathing. Arch Ind Hygiene Occup Med5:1, 1952.
48.
GordonB, MotleyHL, TheodosPA, LangLP, TomashefskiJF: Consideration of the clinical and physiologic factors in the treatment of chronic pulmonary conditions. Dis Chest19:271, 1951.
49.
SheldonGP: Pressure breathing in chronic obstructive lung disease. Medicine42:197, 1963.
50.
MillerWF: A consideration of improved methods of nebulization therapy. N Engl J Med251:589, 1954.
51.
SheldonGP: Nebulized bronchodilators in obstructive lung disease, Part II. Ann Allerg30:69, 1972.
52.
GoldbergI, CherniackRM: The effects of nebulized bronchodilator delivered with and without IPPB on ventilatory function in obstructive emphysema. Am Rev Resp Dis91:13, 1965.
53.
ChesterEH, RaczI, BarlowPB, BaumGL: Bronchodilator therapy: comparison of acute response to three methods of administration. Chest62:394, 1972.
54.
PettyTL, GuthrieA: The effects of augmented breathing maneuvers on ventilation in severe chronic airway obstruction. Resp Care16:104, 1971.
55.
CurtisJK, RasmussenHK, CreeEM: IPPB therapy in chronic obstructive pulmonary disease (an evaluation of long-term home treatment). JAMA206:1037, 1968.
56.
KamatSR, DulfanoMJ, SegalMS: The effects of intermittent positive pressure breathing (IPPB-I) with compressed air in patients with severe chronic nonspecific obstructive pulmonary disease. Am Rev Resp Dis86:360, 1962.
57.
FowlerWS, HelmholtzH, MillerRD: Treatment of pulmonary emphysema with aerosolized bronchodilator drugs and intermittent positive pressure breathing. Proc Staff Mayo Clinic28:743, 1953.
58.
MillerRD, HepperGG: IPPB in managing diseases affecting ventilation. In Controversy in Internal Medicine, II, IngelfinderFJ, EbertRV, FinlandM, , Philadelphia, WB Saunders, 1974, p 263.
59.
TreverG, from TierstanS: Chronic disease and the family. Resp Ther4:35, 1974.
60.
MillerWF, SprouleBJ: Studies on role of intermittent inspiratory positive pressure oxygen breathing (IPPB-I-O2) in treatment of pulmonary edema. Dis Chest35:5, 1959.
61.
BarachAL: Continuous arrest of lung movement: The treatment of pulmonary tuberculosis in an equalizing pressure chamber. Am Rev Resp Dis43:56, 1941.
62.
BarachAL: Continuous immobilization of the lungs by residence in the equalizing pressure chamber in the treatment of pulmonary tuberculosis. Dis Chest12:3, 1946.
63.
BeckGJ, BickermanHA, SeanorHE: Physical methods simulating cough mechanisms: use in poliomyelitis, bronchial asthma, pulmonary emphysema, and bronchiectasis. JAMA150:1380, 1952.
64.
BeckGJ, BickermanHA, SeanorHE: Physical methods simulating mechanisms of the human cough. J Appl Physiol5:85, 1952.
65.
BeckGJ, SmithW: Mechanical production of expiratory flow rates surpassing the capacity of human coughing. Am J Med Sci226:241, 1953.
66.
CherniackR, GordonC, DrimmerD: Physiological effects of mechanical exsufflation on experimental obstructive breathing in human subjects. J Clin Invest12:1028, 1952.
67.
ColebatchHJH: Artificial coughing for patients with respiratory paralysis. Aust Ann Med10:201, 1961.
68.
MaloneyJB, ElamJO, HandfordSW, BallaGA, EastwoodDW, BrownES, Ten PasRH: Importance of negative pressure phase in mechanical respirators. JAMA152:212, 1953.
69.
ScottDB, StephenGW, DavieIT: Haemodynamic effects of a negative (subatmospheric) pressure expiratory phase during artificial ventilation. Br J Anaesth44:171, 1972.
70.
AuchinclossJH, GilbertR: An evaluation of the negative phase of a volume-limited ventilation. Am Rev Resp Dis95:66, 1967.
71.
Hedley-WhyteJ, LaverMB, BendixenHH: Effects of changes in tidal ventilation and physiological shunting. Am J Physiol206:891, 1964.
72.
HousleyE, LouzadoN, BecklakeMR: To sigh or not to sigh. Am Rev Resp Dis101:611, 1970.
73.
PettyTL, BigelowDB, BroughtonJD: A new volume-cycled ventilator. Resp Care17:481, 1972.
74.
AshbaughDG: The adult respiratory distress syndrome. Chest60:133, 1971.
75.
NettLM, AshbaughDG: Improvement in oxygenation in the adult respiratory distress syndrome by positive and expiratory pressure (PEEP). Resp Care16:173, 1971.
KumarA, FalkeKJ, GeffinB, : Continuous positive pressure ventilation in acute respiratory failure (effects on hemodynamics and lung functions). N Eng J Med183:1430, 1970.
78.
LutchJS, MurrayJF: Continuous positive pressure ventilation: effects on systemic oxygen transport and tissue oxygenation. Ann Intern Med76:193, 1972.
79.
PontoppidanH, GeffinB, LowensteinE: Acute respiratory failure in the adult. Part I. N Engl J Med287:690, 1972.
80.
GregoryGA, KittermanJA, PhibbsRH, TooleyWH, HamiltonWK: The treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure. N Engl J Med284:1333, 1971.
81.
BentleyD: A device to deliver continuous positive airway pressure (CPAP) to infants. Resp Care17:156, 1972.
82.
VidyasagarD, CherniackV: Continuous positive transpulmonary pressure in hyaline membrane disease: a simple device. Pediatrics48:296, 1971.
83.
MartinezA, LoughM, DoershukCF: A new negative-pressure device for treating infants with the respiratory distress syndrome. Resp Care17:565, 1972.
84.
DunnPM: Continuous positive airway pressure (CPAP) using the Gregory box. Proc Roy Soc Med64:8, 1974.
85.
PettyTL: Alphabet soup. Resp Care18:10, 1973. (cf also KittredgeP: The difference between PEEP, CPPB and CPAP. Resp Care 19:14, 1974).
86.
PontoppidanH, GeffinB, LowensteinE: Acute respiratory failure in the adult. Part III. N Engl J Med287:802, 1972.
87.
BarachAL, BickermanH, : Respiratory Physiology in Therapeutics. Baltimore, Williams and Wilkins, 1956, ch 2, 3, 4, 7, 8, 10.
88.
SeegalD: Nature as an adjunct to the clinical investigator. Pharos31:138, 1968.
89.
SchuetzK: Ueber Atmungstherapie und Koerperuebung (Treatment by respiratory therapy and physical exercise). Wien Klin Wschr48:392094, 1935.
90.
BarachAL, BickermanHA, BeckGJ: Advances in the treatment of nontuberculous pulmonary disease. Bull NY Acad Med28:353, 1952.
91.
BickermanHA, BeckGA, GordonC, BarachAL: Physical methods simulating mechanisms of the human cough; elimination of radiopaque material from the bronchi of dogs. J Appl Physiol5:No. 1:91, 1952.
92.
JonesRH, MacNamaraJ, GaenslerEA: The effects of IPPB in simulated pulmonary obstruction. Am Rev Resp Dis82:164, 1960.
93.
ThomanRL, StokerGL, RossJC: The efficacy of pursed lips breathing in patients with chronic obstructive pulmonary disease. Am Rev Resp Dis93:100, 1966.
94.
MuellerRE, PettyTL, FilleyGF: Ventilation and arterial blood gas changes induced by pursed lips breathing. J Appl Physiol28:783, 1970.
95.
IngramRHJr, SchilderDP: Effect of pursed lips expiration on the pulmonary pressure-flow relationship in obstructive lung disease. Am Rev Resp Dis96:381, 1967.
96.
CampbellEJM, HowardJBL: The sensation of breathlessness. Br Med Bull19:36, 1963.
97.
BarachAL: Physiologic advantages of grunting, groaning and pursed-lip breathing: adaptive symptoms related to the development of continuous positive pressure breathing. Bull NY Acad Med49:666, 1973.
98.
BarachAL, SmithW: New apparatus for continuous positive pressure breathing: preliminary report. Resp Care18:40, 1973.
99.
BickermanHA, RodgersJ: Continuous positive pressure breathing in chronic obstructive lung disease: effect on minute ventilation and blood gases. Ann AllergFeb1973.
