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In 1965, at the beginning of his third year of medical school, Georges Boussignac left
his native Bosnia.
A free spirit, he could not bear the authoritarianism of a regime that interfered in the
personal and professional life of the population.
3
By chance, he is hitchhiked to the Italian border by Italians on their way to Reims,
eastern France.
He has no precise goal, and stays with them.
The natural sympathy that emerges from the young refugee makes them take him in
friendship and offer him a train ticket to Paris.
He does not have a penny in his pocket and does not speak a word of French when he
disembarks at Gare de l’Est (Eastern Railways Station) in Paris.
He spends several nights on a bench, until he meets a fellow countryman who tells
him where to sleep, eat, wash, and take steps to stay on French territory.
4
5
As a political refugee in France, he survives on small jobs.
One day, he was offered a job as a plumber.
The company’s boss tell him that he will be hired permanently if he manages to install
and put in working order, alone and in one weekend, the plumbing of the science
rooms of a high school.
Of this trade, he knows only what he has observed, the previous days, in the other
workers.
With no help other than his intuitive fluid mechanics genius, his installation works.
Here is how he became a plumber!
6
At the same time that he was working as a plumber for a living, he attended the
Alliance Française to improve my French and to be able to register as a free candidate
for medical school.
His deep vocation remained medicine and care of the sick. He was accepted as a
second year equivalent.
7
From a plumber to a leaning man hired in a hospital as a waiver.
He gave up plumbing and in parallel to his studies, worked as an orderly, in fact a
sweeper, during the day at the Saint Antoine hospital in Paris.
Close to the treatment rooms, one day he heard a misdiagnosis from a resident.
Leaning on his broom, he took the liberty of pointing out the mistake.
He was astonished by the resident, who admitted the correctness of the reasoning
and did not hold it against him.
On the contrary, he went to tell the chief resident that it seemed to him that this
waiter was not in his place.
The head of the department, Professor Caroli, summoned him to his office to
understand his situation, which Georges Boussignac explained with his accent
still very pronounced at that time.
In order to allow him to have hours of sleep more compatible with his studies,
he offered him a position as night supervisor in a psychiatric hospital for which
the tasks were relatively rare (mastering from time to time a few agitated
subjects!) ; the rest of the time, he could therefore sleep.
That's when he met Sylvette, the love of his life.
8
He is allowed to take some exams orally, unlike other students, because the examiner
understood that the written word could be a barrier to success when his knowledge
was obvious.
Having acquired French nationality, and due to an administrative incompatibility, his
university medical degree is no longer valid.
In only six months, he resumed all the courses, and retook a state diploma which
gave him the right to practice.
He continued his medical studies, which he completed with a specialty in anesthesia
and critical care at the Henri Mondor Créteil hospital near Paris.
9
Attracted by the young specialty of anesthesia, he enrolled in Créteil in the
department of Professor Pierre Huguenard.
Professor Huguenard was one of the so-called "big bosses" of the time. At the origin
of many advances in anesthesia, he reigned as absolute master in his department,
not accepting contradiction.
He immediately perceived the qualities of Georges Boussignac, and the exceptional
doctor he was, only asking to be able to express himself.
As an anesthesiologist and Critical care Physician, he has been working for twenty
years in Professor Pierre Huguenard’s unit.
His experience in the operating room, as well as in intensive care unit, make it
recognized and appreciated.
Moreover, he shows that many of the devices used are poorly adapted, mainly with
regard to airway management and mechanical ventilation.
Professor Huguenard offers him an academic positionthat Georges refuses, arguing
that he wanted to keep total freedom.
Huguenard, somewhat flabbergasted, contrary to what one might have feared, did
not take it badly, and agreed to keep him as an attaché and independent researcher.
10
Medical Engineering, he divides his time between the clinic with the patients and the
faculty laboratory.
What he designs, he can then test it.
He thus develops many probes, and especially his first one, the "Boussignac Bougie"
which guides the progress of an intubation catheter while oxygenating the patient.
11
A dramatic event will lead him to conceive an innovative device.
In the nearby Orly airport, a Boeing of Varig Airlines crashed.
The 3 survivors, the pilot and his co-pilots, are intoxicated by the chlorinated
emanations.
All three patients were polypneic and obviously hypoxic, as indicated by the
blood gases performed.
High-flow Oxygen did not help. The military doctors consulted believe that his
patients with lungs burned by the hot gases from the fire are beyond any
therapeutic recourse. Georges refuses to give up. And this is where his
medical genius confronts reality and finds a solution.
If the oxygen administered does not cross the alveolar-capillary barrier, it is
because the alveolar-capillary barrier is effectively damaged by the fire.
It would be possible to place these patients under artificial respiration, but that
would be to condemn them in the short term.
He has this idea of leaving them on spontaneous ventilation but to make them
breathe oxygen put under positive pressure thanks to a waterproof transparent
plastic enclosure that he "tinkers" with the department's equipment.
The pressure of the chamber is regulated by a tube dipped in a bottle of
physiological saline and allowing the oxygen admitted to the chamber to
"bubble".
The first spontaneous ventilation under positive pressure is born.
All three patients survive after a few days of this treatment.
14
He has this idea of leaving them on spontaneous ventilation but to make them
breathe oxygen put under positive pressure he needs a device.
Within a couple of minutes, he develops the first Continuous Positive Airway
Pressure device ever.
With plastic bags, a child's bicycle inner tube and plaster, Georges Boussignac
tinkers with a kind of diving suit: large airtight bags filled with oxygen are tightly
attached to the head.
The pressure of the chamber is regulated by a tube dipped in a bottle of
physiological saline and allowing the oxygen admitted to the chamber to
"bubble".
The first spontaneous ventilation under positive pressure is born.
All three patients survive after a few days of this treatment.
15
From the idea to the functionnal device, he will develop and improve its system
for 10 years.
It is on this principle that Georges will create the famous CPAP of Boussignac.
This continuous positive pressure device operating in "open" mode, with a
virtual valve created by a high velocity gas flow, is recognized worldwide as a
device for the management of pulmonary edema and many other respiratory
distresses.
16
• In detail
• The oxygen molecules are accelerated to the speed of sound due to four
capillaries.
• The oxygen arrives under pressure at the level of an annular room.
• The percussion of oxygen molecules generates a zone of "turbulence"
transforming speed into pressure.
• Excess gas escapes freely and continuously: it’s an open system.
• Continuous adaptation to the specific needs for every single patient
17
Then, he filed his first patents and joined forces with the Vygon company in order to
continue his work and develop his inventions on an industrial scale.
18
Rapidly, Boussignac CPAP was established in the management of cardiogenic
pulmonary edema and the number of intubated patients was drastically reduced.
19
Since, he’s developped many useful devices for Anesthesia, Critical Care, Emergency,
Newborn care and so one, always supported by Vygon R&D department.
20
21
The recent news with the COVID-19, which sometimes evolves towards serious forms
of respiratory insufficiency, and ARDS, has found with the CPAP of Boussignac a
solution allowing in many cases to avoid the use of artificial respirators.
The alveolo-capillary membrane, damaged by the virus, no longer allows oxygen to
diffuse.
The Boussignac CPAP makes it possible to physiologically force this passage, without
damaging the alveoli.
In April, 3 weeks before his death, he was tirelessly testing different types of viral
filters on his CPAP to ensure that there was no dispersion of viral particles to protect
caregivers.
22
As a tireless explorer of respiratory physiopathology, he has shown the way and
swung opinions, even opposition, to the use of his solutions, which are so simple to
implement. "The inherent differences between doctors who believe and doctors who
think are common sense and simplicity," once he told me.
We've learned to appreciate them through the use of his simple solutions, and they
remain a cause for celebration every time I use his CPAP.
George's other legacy is the discretion with which he has been to us, his friends, a
leader with quiet strength.
Thus, seemingly determined to replace with his erudition and knowledge, the poorly
acquired biases and certainties that we all had, he was someone who erased many of
our faults and replaced them with the progress he helped us make.
23
Today we are confronted with his absence and he leaves us a great void.
For having accompanied his projects during his last months, his lucidity and common
sense were a barrier to a serious crisis of legitimacy that the medical world and
science in general is going through.
It is thanks to men like him, good and determined, that we caregivers can hope to
respond in the best possible way and act as a firewall to critical situations such as
those we are going through. For this, and for what he stands for, we will not forget
him.
24

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Georges boussignac legacy with commentaries

  • 1. 1
  • 2. 2
  • 3. In 1965, at the beginning of his third year of medical school, Georges Boussignac left his native Bosnia. A free spirit, he could not bear the authoritarianism of a regime that interfered in the personal and professional life of the population. 3
  • 4. By chance, he is hitchhiked to the Italian border by Italians on their way to Reims, eastern France. He has no precise goal, and stays with them. The natural sympathy that emerges from the young refugee makes them take him in friendship and offer him a train ticket to Paris. He does not have a penny in his pocket and does not speak a word of French when he disembarks at Gare de l’Est (Eastern Railways Station) in Paris. He spends several nights on a bench, until he meets a fellow countryman who tells him where to sleep, eat, wash, and take steps to stay on French territory. 4
  • 5. 5
  • 6. As a political refugee in France, he survives on small jobs. One day, he was offered a job as a plumber. The company’s boss tell him that he will be hired permanently if he manages to install and put in working order, alone and in one weekend, the plumbing of the science rooms of a high school. Of this trade, he knows only what he has observed, the previous days, in the other workers. With no help other than his intuitive fluid mechanics genius, his installation works. Here is how he became a plumber! 6
  • 7. At the same time that he was working as a plumber for a living, he attended the Alliance Française to improve my French and to be able to register as a free candidate for medical school. His deep vocation remained medicine and care of the sick. He was accepted as a second year equivalent. 7
  • 8. From a plumber to a leaning man hired in a hospital as a waiver. He gave up plumbing and in parallel to his studies, worked as an orderly, in fact a sweeper, during the day at the Saint Antoine hospital in Paris. Close to the treatment rooms, one day he heard a misdiagnosis from a resident. Leaning on his broom, he took the liberty of pointing out the mistake. He was astonished by the resident, who admitted the correctness of the reasoning and did not hold it against him. On the contrary, he went to tell the chief resident that it seemed to him that this waiter was not in his place. The head of the department, Professor Caroli, summoned him to his office to understand his situation, which Georges Boussignac explained with his accent still very pronounced at that time. In order to allow him to have hours of sleep more compatible with his studies, he offered him a position as night supervisor in a psychiatric hospital for which the tasks were relatively rare (mastering from time to time a few agitated subjects!) ; the rest of the time, he could therefore sleep. That's when he met Sylvette, the love of his life. 8
  • 9. He is allowed to take some exams orally, unlike other students, because the examiner understood that the written word could be a barrier to success when his knowledge was obvious. Having acquired French nationality, and due to an administrative incompatibility, his university medical degree is no longer valid. In only six months, he resumed all the courses, and retook a state diploma which gave him the right to practice. He continued his medical studies, which he completed with a specialty in anesthesia and critical care at the Henri Mondor Créteil hospital near Paris. 9
  • 10. Attracted by the young specialty of anesthesia, he enrolled in Créteil in the department of Professor Pierre Huguenard. Professor Huguenard was one of the so-called "big bosses" of the time. At the origin of many advances in anesthesia, he reigned as absolute master in his department, not accepting contradiction. He immediately perceived the qualities of Georges Boussignac, and the exceptional doctor he was, only asking to be able to express himself. As an anesthesiologist and Critical care Physician, he has been working for twenty years in Professor Pierre Huguenard’s unit. His experience in the operating room, as well as in intensive care unit, make it recognized and appreciated. Moreover, he shows that many of the devices used are poorly adapted, mainly with regard to airway management and mechanical ventilation. Professor Huguenard offers him an academic positionthat Georges refuses, arguing that he wanted to keep total freedom. Huguenard, somewhat flabbergasted, contrary to what one might have feared, did not take it badly, and agreed to keep him as an attaché and independent researcher. 10
  • 11. Medical Engineering, he divides his time between the clinic with the patients and the faculty laboratory. What he designs, he can then test it. He thus develops many probes, and especially his first one, the "Boussignac Bougie" which guides the progress of an intubation catheter while oxygenating the patient. 11
  • 12. A dramatic event will lead him to conceive an innovative device. In the nearby Orly airport, a Boeing of Varig Airlines crashed.
  • 13. The 3 survivors, the pilot and his co-pilots, are intoxicated by the chlorinated emanations. All three patients were polypneic and obviously hypoxic, as indicated by the blood gases performed. High-flow Oxygen did not help. The military doctors consulted believe that his patients with lungs burned by the hot gases from the fire are beyond any therapeutic recourse. Georges refuses to give up. And this is where his medical genius confronts reality and finds a solution.
  • 14. If the oxygen administered does not cross the alveolar-capillary barrier, it is because the alveolar-capillary barrier is effectively damaged by the fire. It would be possible to place these patients under artificial respiration, but that would be to condemn them in the short term. He has this idea of leaving them on spontaneous ventilation but to make them breathe oxygen put under positive pressure thanks to a waterproof transparent plastic enclosure that he "tinkers" with the department's equipment. The pressure of the chamber is regulated by a tube dipped in a bottle of physiological saline and allowing the oxygen admitted to the chamber to "bubble". The first spontaneous ventilation under positive pressure is born. All three patients survive after a few days of this treatment. 14
  • 15. He has this idea of leaving them on spontaneous ventilation but to make them breathe oxygen put under positive pressure he needs a device. Within a couple of minutes, he develops the first Continuous Positive Airway Pressure device ever. With plastic bags, a child's bicycle inner tube and plaster, Georges Boussignac tinkers with a kind of diving suit: large airtight bags filled with oxygen are tightly attached to the head. The pressure of the chamber is regulated by a tube dipped in a bottle of physiological saline and allowing the oxygen admitted to the chamber to "bubble". The first spontaneous ventilation under positive pressure is born. All three patients survive after a few days of this treatment. 15
  • 16. From the idea to the functionnal device, he will develop and improve its system for 10 years. It is on this principle that Georges will create the famous CPAP of Boussignac. This continuous positive pressure device operating in "open" mode, with a virtual valve created by a high velocity gas flow, is recognized worldwide as a device for the management of pulmonary edema and many other respiratory distresses. 16
  • 17. • In detail • The oxygen molecules are accelerated to the speed of sound due to four capillaries. • The oxygen arrives under pressure at the level of an annular room. • The percussion of oxygen molecules generates a zone of "turbulence" transforming speed into pressure. • Excess gas escapes freely and continuously: it’s an open system. • Continuous adaptation to the specific needs for every single patient 17
  • 18. Then, he filed his first patents and joined forces with the Vygon company in order to continue his work and develop his inventions on an industrial scale. 18
  • 19. Rapidly, Boussignac CPAP was established in the management of cardiogenic pulmonary edema and the number of intubated patients was drastically reduced. 19
  • 20. Since, he’s developped many useful devices for Anesthesia, Critical Care, Emergency, Newborn care and so one, always supported by Vygon R&D department. 20
  • 21. 21
  • 22. The recent news with the COVID-19, which sometimes evolves towards serious forms of respiratory insufficiency, and ARDS, has found with the CPAP of Boussignac a solution allowing in many cases to avoid the use of artificial respirators. The alveolo-capillary membrane, damaged by the virus, no longer allows oxygen to diffuse. The Boussignac CPAP makes it possible to physiologically force this passage, without damaging the alveoli. In April, 3 weeks before his death, he was tirelessly testing different types of viral filters on his CPAP to ensure that there was no dispersion of viral particles to protect caregivers. 22
  • 23. As a tireless explorer of respiratory physiopathology, he has shown the way and swung opinions, even opposition, to the use of his solutions, which are so simple to implement. "The inherent differences between doctors who believe and doctors who think are common sense and simplicity," once he told me. We've learned to appreciate them through the use of his simple solutions, and they remain a cause for celebration every time I use his CPAP. George's other legacy is the discretion with which he has been to us, his friends, a leader with quiet strength. Thus, seemingly determined to replace with his erudition and knowledge, the poorly acquired biases and certainties that we all had, he was someone who erased many of our faults and replaced them with the progress he helped us make. 23
  • 24. Today we are confronted with his absence and he leaves us a great void. For having accompanied his projects during his last months, his lucidity and common sense were a barrier to a serious crisis of legitimacy that the medical world and science in general is going through. It is thanks to men like him, good and determined, that we caregivers can hope to respond in the best possible way and act as a firewall to critical situations such as those we are going through. For this, and for what he stands for, we will not forget him. 24