Critical Care physiology through history

Coda Change

Matt Morgan describes critical care physiology through history. Matt’s story begins in Copenhagen, 1952, when an 11-year-old girl in developed acute and severe polio. The last iron lung had been used. So, a young anaesthetist, Bjørn Ibsen, organised a tracheostomy and positive pressure ventilation (PPV) and changed the world. From that point we have discovered and understood the physiology of traumatic brain injury, mechanics of PPV, HFOV, APRV and echo to name a few. However, Matt contends that this story was not the beginning of our understanding of physiology. Matt will take you back through time to show how giraffes, dogs, fish and even frogs can teach us about physiology. Giraffes can tell us about the delivery of CPP. They utilise massive mean arterial pressures and a complex system of venous valves. The MAP is achieved through massive left ventricular hypertrophy – a completely normal finding in giraffes. High frequency oscillatory ventilation was first used in the 1970s… however, dogs have been doing this for 100s of 1000s of years ago. Airway pressure release ventilation was described in the late 1980s… again this is not new. Frogs and lizards have been using this method for millennia. Finally, Matt tells us about ice fish – who live 1.5 kilometres under the Antarctic Ocean surface. The ice fish CAN transcribe haemoglobin; however, it does not bother. All its oxygen is provided by dissolved oxygen in its harsh environment. Matt will pin his tale of historical physiology on the events around one of his patients – Nathan – who suffered a TBI. During delivering Nathan’s treatment, Matt relies on all these animal lessons. Matt wants you to remember these animals when thinking about physiology. In doing so, he hopes you will educate, innovate, and connect with other medical professionals.

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