The Annals of Thoracic Surgery, Vol 31, 386-393, Copyright © 1981 by The Society of Thoracic Surgeons
A historical account of the "wet lung of trauma" and the introduction of intermittent positive-pressure oxygen therapy in world war II
LA Brewer 3d
During World War II, my associates and I observed for the first time in
medical history that casualties with severe brain, thoracic, abdominal, and
extremity trauma, who had persistent "wet" respiration (wet lung of
trauma), were most difficult to resuscitate, withstood operation poorly,
and had the highest mortality. The etiology appeared to be ineffectual
cough and persistent bronchopulmonary fluid from hemorrhage, pulmonary
transudates resulting from anoxia, airway obstruction, and unknown causes
secondary to trauma, some of which have been discovered since then. Our
treatment consisted of assisting cough, transnasal tracheobronchial
aspiration and oxygenation, bronchoscopy, and tracheostomy. To treat the
advanced form, pulmonary edema, I devised an effectual hand-operated
intermittent positive-pressure oxygen machine, which has been supplanted by
elegant automatic volume- and pressure-regulated devices. Through the use
of the intermittent positive-pressure breathing machines, most hospitals
have developed thriving departments of respiratory therapy. Better
physiological monitoring and use of intermittent mandatory ventilation and
positive end-expiratory pressure have improved the care, but our basic
principles of treatment are still the standards of respiratory therapy.
