Historical perspectives in critical care medicine: blood transfusion, intravenous fluids, inotropes/vasopressors, and antibiotics.

Significant progress in critical care medicine has been the result of tireless observation, dedicated research, and well-timed serendipity. This article provides a historical perspective for four meaningful therapies in critical care medicine: blood transfusion, fluid resuscitation, vasopressor/inotropic support, and antibiotics. For each therapy, key discoveries and events that have shaped medical history and helped define current practice are discussed. Prominent medical and social pressures that have catalyzed research and innovation in each domain are also addressed, as well as current and future challenges.

The early development of intravenous apparatus.

Modern anaesthetists rely on the intravenous route for administration of drugs and fluids. This paper traces the development of intravenous equipment from the first, tentative experiments with the intravenous route through to the first intravenous cannulas.

History of vascular access.

Milestones in the history of the development of vascular access and the subsequent advances in practical clinical applications of the knowledge, techniques, technology, and experience to the beneficial management of a variety of patients are described. The original achievements are presented and briefly discussed primarily, but not exclusively, in relationship to the successful development of parenteral nutrition (PN). Beginning with the discovery of the circulation of blood, landmark events, resulting from astute observations, experimentation, and ingenious technological advances, are summarized or outlined chronologically over the past 4 centuries, with emphasis on the many recent accomplishments of basic and clinical scientists during the past 6 decades. Brief descriptions of several seminal contributions to safe and effective IV access, management, and therapy acknowledge and recognize the historical highlights that have allowed a complex and potentially hazardous therapeutic modality to evolve into a commonly applied useful adjunct to our current inpatient and outpatient armamentarium. A comprehensive list of references documents the highlights of the development of vascular access for the student of history.

[Infusion solutions]. / Les solutés de perfusion.

Infusion solutions or preparations for intravenous administration have been developed since 1830 after the work of Thomas Latta. This particular pharmaceutical form, which brings large accounts of liquid (100 to 3000 ml) and nourishes, equilibrates, hydrates, clears, serves as a vehicule for many drugs and allows organ storage, has had a considerable development owing to its successes in a number of severe diseases and because it has supported the emergence of critical care and intensive care medicine. This form has an unappreciated story. It was first used in hospitals but it is now manufactured by the pharmaceutical industry after a long series of technical improvements and galenic innovations bringing solutions to the problems successively encountered (microbial contamination, embolism, blood alteration, "saline fever", degradation and adsorption of drugs, allergic shock...) and answers to the new requirements resulting from progresses in physiology and biology (hydroeletrolytic support, plasma expansion, energy supply, acidobasic homeostasis, malnutrition...). This story is depicted with respect to the indications, the formulation, the infusion devices from the origin to nowadays.

[History of injections. Pictures from the history of otorhinolaryngology highlighted by exhibits of the German History of Medicine Museum in Ingolstadt]. / Die Geschichte der Injektionen. Bilder aus der Geschichte der Hals-Nasen-Ohren-Heilkunde, dargestellt an Instrumenten aus der Sammlung im Deutschen Medizinhistorischen Museum in Ingolstadt.

BACKGROUND: Injections are part of the arsenal of all medical disciplines. In addition to this common ground, each specialty has its own particular aspects; the historical development of these are presented here with respect to otorhinolaryngology. INTRAVENOUS INJECTIONS: The first experiments with intravenous injections were carried out in 1642 by a gentleman's hunting servant in eastern Germany. Similar experiments were done in 1656 by Christopher Wren, the astronomer, mathematician, and architect in Oxford, England, and a group of scientists around the physicist Robert Boyle. These experiments were prompted by new knowledge about blood circulation provided by William Harvey in 1628. The first books on the applications of intravenous infusions in humans were published in Germany by Major 1664 (Chirurgia Infusoria) and Elsholtz 1667 (Clysmatica Nova). Bladders of animals or enema syringes were used as instruments. Because of lethal accidents the infusions soon fell from favour. Köhler in Germany in 1776 eliminated a large bolus impacted in a patient's esophagus by an intravenous infusion of tartar emetic thus inducing violent vomiting. After this crucial experiment, foreign bodies in the esophagus were the most important indication for applying intravenous injections until Killian introduced extraction by esophagoscopy in 1990. CALIBRATED SYRINGES AFTER PRAVAZ: The French surgeon C. Pravaz in Lyon in 1853 invented a small syringe, the piston of which could be driven by a screw thus allowing exact dosage. A sharp needle with a pointed trocar could be introduced into the vessel making a dissection unnessessary. Pravaz used his syringe for obliteration of arterial aneurysms by injection of ferric sesquichlorate. Pravaz's syringe initiated the invention of a great number of various calibrated syringes made of glass or metal combined with glass. SUBCUTANEOUS INJECTION AND LOCAL ANAESTHESIA: The calibrated syringes were commonly used in the treatment of syphilis by mercurialization. In otorhinolaryngology, they had and still have their primary application in local anaesthesia, which was introduced by Carl Ludwig Schleich in Berlin in 1892. PARAFFIN-INJECTIONS: Around 1900 the injection of liquid paraffin for closing defects in subcutaneous tissues came into use (Gersuny in Vienna, Delangre in Tournai). This technique was immediately applied to rhinological indications such as a saddle nose (Stein 1901). This gave rise to the invention of special syringes and modifications of paraffin with different hardness and melting points. Around the middle of this century, paraffin was abandoned for this application because of serious complications, and new substances were introduced such like teflon, silicone and collagen. The historical development of these techniques of injections is described in details with many literature citations and figures.

The history of intravenous therapy.

Modern IV therapy is less than a century old. Yet, it was known that medications could be injected into a vein as early as the 1600s. Because of a lack of scientific methods, original attempts to deliver IV fluids and drugs met with little success. Two world wars brought in the era of modern IV therapy. However, the greatest advance in drugs, equipment, and procedures has occurred in the past 25 years.

History and current application of intravenous therapy in children.

More than 36,000,000 individuals in the United States were hospitalized in 1985, and, on the average, 25% of hospitalized patients have insertion of an intravenous catheter (IVC). Considering those 9,000,000 IVC placements in 1985, it may be surprising to learn that "modern" intravenous (IV) therapy has a lifetime that is barely 40 years old. For the pediatrician, IV access holds particular importance, since its acquisition is often the rate-limiting step in initiation of a therapeutic plan, particularly in the setting of cardiopulmonary resuscitation. This article is a review of the nearly 500-year history of IV therapy and an overview of the IV techniques and products currently available for use in pediatric patients.