Vital Times 2020 - 108

out of the operating room. 2 In doing so, Dr. Ibsen
created the first intensive care unit (ICU).

Anesthesiologists'
Continued Innovation

Ibsen and the Story of Anesthesia

The polio epidemic and Dr. Ibsen's role in it changed
the face of anesthesiology and medicine forever.
Just as Dr. Ibsen drew upon the ingenuity of his
predecessors, many anesthesiologists also built
upon his work. Peter Safar, MD, inventor of modern
CPR, began to envision critical care as a continuum
from the prehospital setting, to the emergency
room, and to the ICU. He soon created the first
multidisciplinary ICU (1959) and the first critical care
fellowship in the U.S. (1961). Dr. Safar co-founded
the Society of Critical Care Medicine (SCCM) in 1971.

While Dr. Ibsen's work was groundbreaking, he
also built upon the work of prior anesthesiologists.
Throughout history, most new ideas have developed
from prior concepts. This human connection
spans generations, and the humility that arises
from this knowledge can facilitate learning,
minimize error, and encourage collaboration.
An anesthesiologist was able to rescue the Danish
polio crisis due to expertise that was unique to
the profession. The cuffed endotracheal tube
had been introduced by Arthur Guedel, MD, and
Ralph Waters, MD, in 1928. Dr. Waters' portable
" To and Fro " carbon dioxide absorber, invented
in 1919, had been a mainstay in operating
rooms. Dr. Ibsen applied a routine practice for
anesthesiologists during surgery-the application
of manual positive-pressure via a cuffed
endotracheal tube connected to a to-and-fro
canister 3-to the treatment of respiratory failure.
The concept of anesthesiologists as experts
in pulmonary gas exchange had long been
championed by Paluel Flagg, MD, who suggested
that we change our professional name to
" pneumatologists. " 4 In The Art of Anesthesia
(1919), an early American anesthesia textbook,
Dr. Flagg stated that " the physician was more
important than the specialty in which he practiced. "
Since anesthesiologists were skilled at delivering
inhalational agents, he hoped to expand our
scope to the bedside management of asphyxia.
Dr. Ibsen, by applying anesthetic techniques
to the ICU, was fulfilling Dr. Flagg's dream.

108 |

CSA Vital Times

The polio epidemic also revealed a gap between
advances made by respiratory physiologists
during World War II and their translation
into clinical practice. Sobered by the lack of
laboratory values available to guide ventilation,
scientists were galvanized to action. 2 Physiologist
Julius Comroe, Jr., MD's book The Lung (1955)
signified a sea change in the field. When Dr.
Comroe moved to UCSF in 1957 to direct a new
Cardiovascular Research Institute (CVRI), he
brought two anesthesiologists-Stuart Cullen, MD,
and John Severinghaus, MD-along with him.
Animated by the deficiencies revealed by polio,
Dr. Severinghaus, along with lab technician A.
Freeman Bradley, and leading scientists Richard
Stow, PhD, and Leland Clark, PhD, worked to
fine-tune electrodes for measuring pCO2 and
pO2. By 1958, all of their efforts culminated
in the first three-function blood gas analyzer.
Now, pH, pCO2, and pO2 could be derived from a
single blood sample, almost instantaneously.
In the late 1960s, two pediatric anesthesiologists-
John Inkster, MBBS, FRCA, of England, and George
Gregory, MD, of UCSF-reported similar findings,
adding to the growing field of respiratory physiology.



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