ventilator

1 Ventilatorens historie

Ventilatorens historie

The Use of a New Apparatus for the Prolonged Administration of Artificial Respiration

Folkehelse 1929: The iron lung was invented in 1929 by Philip Drinker (1893-1977), a professor at the School of Public Health at Harvard University.

Enlisting the help of his brother, Cecil, and Louis Shaw (1886-1940) Drinker, built a prototype, tested it on cats, and designed a device large enough for humans. The first iron lung used in the treatment of polio victims was invented by Philip Drinker, Louis Agassiz Shaw, and James Wilson at Harvard, and tested October 12, 1928 at Children’s Hospital, Boston. The original Drinker iron lung was powered by an electric motor attached to two vacuum cleaners, and worked by changing the pressure inside the machine

Drinker startet opp med støvsuger-motorer (ikke vaskemaskin!)


POLIO-UTBRUDDET I KØBENHAVN 1952

In the Copenhagen epidemic of 1952, large numbers of patients were ventilated by

hand ("bagged") by medical students and anyone else on hand, because of the large

number of bulbar polio patients and the small number of ventilators available

Fra august til desember 1952 ble 2241 pasienter med akutt polio innlagt ved Blege-

dam-hospitalet i København. I den uken epidemien var på sitt mest intense, ble 320

pasienter med akutt polio innlagt. Av de 2241 pasientene hadde 345 puste- og/eller

svelgeproblemer. De var uforberedt: de hadde EN jernlunge (Emerson) og six `cui-

rass respirators' til rådighet. Under epidemien kom det 50 nye pasienter per dag.

Anestesilegen Bjørn Ibsen måtte argumentere for at sluttstadiet av polio ikke var utslukking av hjernefunksjoner, men at disse pasientene var underventilert for åndedrettslammelse og kunne reddes ved god ventilasjon! Løsningen var ekstrem: jernlungene kunne de klare seg foruten: Poliopasientene skulle ha trakeostomi, og bli ventilert for hand så de ble sikret til-strekkelig oksygen til lungene. Lassen was unconvinced, but he gave Ibsen the benefit of the doubt. There followed one of the most dramatic and in its consequences, profoundly influential, moments in the history of medicine. Lassen picked a twelve-year-old girl, Vicki. She ws in a very bad condition with paralysis of all four limbs. She was gasping for breath. Her temperature was a hundred and two degrees Fahrenheit. She was cyanotic [blue] and dying. Ibsen asked the ENT surgeon to perform a tracheostomy, through which he introduced a cuffed tube attached to a ventilator bag. In-itially he found it very difficult to ventilate her lungs, as the airways were in spasm. Within minutes she was dying. Discreetly the hospital physicians who had gathered to observe the new treatment realised they had duties elsewhere and started to drift away. The girl too was, not surprisingly, becoming very agitated, so Ibsen gave her a slug of barbi-turate Pentothal, at which point her own weak respiratory' efforts ceased. And as she stopped breathing, her bronchi relaxed and Ibsen was finally able to ventilate her. When the other physicians returned ... the girl's skin colour had returned to normal. Both body temperature and blood pressure were restored to normal too. This twelve-year-old girl was the first pa-tient during the epidemic who survived as a result of this medical intervention.'

Slik begynte intensivmedisin slik det idag praktiseres ved modern anestesiavdelinger

De hadde fortsatt ikke maskiner, lungene ble ventilert for hånd, på dugnad. På slut-

ten av epidemien hadde 1500 medisinstudenter deltatt i manuell bagging!


TIMELINE

Tidligst: The earliest one called the ‘iron lung’, was originally developed by Dalziel. In 1832, Dr. John Dalziel of Scotland developed a box to ventilate a "drowned sea-man." Dr. E.J. Woillez designed an artificial respirator in 1876 that was said to have looked and operated much like the Drinker or Emerson iron lung. The great American inventor Alexander Graham Bell even built a test version "va-cuum jacket" in the 1880s with hand-operated bellows much like those on the iron lung. In 1889, Dr. O.W. Doe reported to the Obstetrical Society of Boston on the devel-opment of an infant resuscitator box by Dr. Egon Braun in Vienna. This early form of artificial respirator obtained a pressure seal by having the child's mouth pressed against a rubber diaphragm opening, while the rest of the body was entirely enclosed within the wooden box.

The operator blew into the pipe to force the chest to compress, causing air to ex-haust out of the pipe creating a suction that would expand the chest. This provided life-saving artificial respiration. According to the report, the operator would repeat the process twenty to thirty times in a minute. Doe reports that Braun had used the artificial respirator device in fifty cases and was completely successful. In comparison to modern respiration devices, this early model only lacked a system of regulation and automation. In 1918, the South African Dr. W. Steuart came closest to developing a machine most like the ones that later made Drinker and Emerson famous. Steuart's machine was a sealed wooden box made specifically for treating poliomyelitis that operated by variable-speed, motor-driven bellows. Although his machine was supposedly a great success, the work was never formally reported and therefore became largely forgotten.


1919 Only a year later, Tulane University physiologists Felix P. Chillingsworth and Ralph Hopkins developed and tested a dog plethysmograph which produced ventila-tion by means of an electric pump that produced rhythmic variations in pressure. This device could have operated as a respirator had it been fully pressurized with a neck seal. 1920 During the 1920s people who could not breathe on their own were aided by a pulmonator. This was a machine similar to fireplace bellows. It inflated and deflated the lungs by forcing air in and then sucking it back out again. Previous artificial resuscitators, such as the pulmonator, were also poor solutions as their air supplies were too forceful and damaged other organs. 1929 Drinker and McKhanns studies found that manual methods of artificial re-suscitation had been ineffective in providing the necessary oxygen interchange and could not be used for extended periods of time. They outlined several main objec-tives in their respirator design: long and steady function, adaptability to many ages and sizes, the ability to regulate the rate and depth of respiration, and the ability to provide proper artificial respiration without harming the patient. In 1931, inveterate tinkerer John Haven "Jack" Emerson unveiled a less expensive iron lung. Drinker and Harvard promptly sued Emerson for patent violations, which proved unwise. In the subsequent legal battles Emerson demonstrated that every aspect of Drinker's patents had been patented by others at earlier times. Emerson won the case, and Drinker's patents were declared invalid. In 1977, the National Health Interview Survey reported that there were 254,000 persons living in the United States who had been paralyzed by polio.


SELVHJELP - NØDVENTILATOR

1929 Drinker and Roy employed common household and conveniently available hardware store materials in their emergency respirator The materials included a car inner tube for a rubber collar, bilslange a common vacuum pump to provide pressure, støvsuger a six-inch square piece of double-thick glass, a piece of sole leather to serve as the valve, (skosåle lær) a glass U-tube with colored water to show pressure, and several pieces of spruce wood. furuplanker

Image of an emergency respirator, from the article by Drinker and Roy.


IMPROVISASJON

Ideene ble tatt i bruk. Her er fra en BMJ artikkel i 1958. SIR, On a recent trip to New Zealand a passenger contracted poliomyelitis of a rapid-ly ascending type.

De var altså til sjøs, uten noen andre til å hjelpe seg og klarte å bygge et apparat så han kunne puste, og holdt liv i ham en stund med denne kassa: Se litt på denne arbeidstegningen:


CASE: LT WESSELHOEFT:

Fisher var en prest som hadde arbeidet i Kina i 16 år, I 1943 hjalp han noen amerikanere fra ATCs India-China division. I en annen artikkel i samme bladet (forsiden) er Glenn Miller meldt savnet…. Her sitter piloten alene i flyet, flyr med den ene hånden og pumper luft i pasienten med den andre: Among Fisher's American guests was a non-flier, Lt. Robert Wessel-hoeft, Jr., stricken with infantile paralysis, while on a photo-mapping expedition. Unable to breathe, Wesselhoeft was kept alive 14 days at the Fisher mission by artificial respiration, and then flown out in an L-5

whose pilot, Maj. Welch, worked the lever of a primitive lung-compressing apparatus with one hand and flew the little plane with the other for three hours. Wesselhoeth was later taken by ATC to Calcutta in a hospital plane and after more than two months in a hospital, was flown to Wash-ington in an improvised iron lung, stopping at the Azores to pick up Lt. Mary E. Hoadley, a flight nurse who had once attended Fred Snite, Jr., in his iron lung in Miami. Lt. Wesselhoeft arrived in Washington sufficiently recovered from his ordeal to joke with reporters.


IMPROVISASJON 2

Disse kom fra et hangarskip til et militærhospital med en jernlunge og to pasienter.. så da måtte de bygge en: it was suggested that H.M.S. Hermione should attempt the manufacture of an iron lung, as the only available one was in use. from the experience of these two cases it is obvious that a unit, sufficient for the immediate purpose and at little expense, can be put together in a very short time; secondly, that the unit can be made from materials readily available in H.M. ships,

Oljetønne med motor fra en vaskemaskin ….


REDNINGSAKSJON

Her forteller de om to pasienter I jernlunge som blir reddet fra sykehuset under flommen i Winnipeg i 1950

Flere redningsoperasjoner:

I boken: God's Mountain by James G. Ashwin the battle to save Jim's life at Ludhiana; the hasty improvisation to repair the iron lung on which his life depended, with automobile innertubes and a coupling from a railroad car


ARBEIDSTEGNINGER

Her er koblingen til støvugeren

Inntil støvsugeren kunne kobles på, matte medhjelpere gjøre manuell brystkompre-sjon:


Problemet var at…. The vacuum cleaner was taking part of the air out of the cylinder, but it wasn’t forcing any back. Its blower was just ventilating positive air pressure into the room.

There was the problem: to make some sort of a compound ,valve with ports that could use, in correct sequence, both the negative and posi-tive pressure, already available. Moreover, it had to deliver a choice in operating speed. Human beings of different ages breathe at different rates. Figuren viser hvordan det ble lost. I dag er polio vaksinen effektiv, og moderne anes-tesi utøver god kontroll på ventilasjon:

ventilator

Health & Medicine

philip drinker

var uforberedt

treatment of polio victims

original drinker iron

til desember

lsningen var ekstrem

yearold girl

nye pasienter