Iron lung
Iron lung | |
---|---|
Specialty | Pulmonology |
ICD-9-CM | 93.99 |
MeSH | D015919 |
An iron lung is a type of
The use of iron lungs is largely obsolete in modern medicine as more modern breathing therapies have been developed
The iron lung is a large horizontal cylinder designed to stimulate breathing in patients who have lost control of their respiratory muscles. The patient's head is exposed outside the cylinder, while the body is sealed inside. Air pressure inside the cylinder is cycled to facilitate inhalation and exhalation. Devices like the Drinker, Emerson, and Both respirators are examples of iron lungs, which can be manually or mechanically powered. Smaller versions, like the cuirass ventilator and jacket ventilator, enclose only the patient's torso. Breathing in humans occurs through negative pressure, where the rib cage expands and the diaphragm contracts, causing air to flow in and out of the lungs.
The concept of external negative pressure ventilation was introduced by John Mayow in 1670. The first widely used device was the iron lung, developed by Philip Drinker and Louis Shaw in 1928. Initially used for coal gas poisoning treatment, the iron lung gained fame for treating respiratory failure caused by polio in the mid-20th century. John Haven Emerson introduced an improved and more affordable version in 1931. The Both respirator, a cheaper and lighter alternative to the Drinker model, was invented in Australia in 1937. British philanthropist William Morris financed the production of the Both–Nuffield respirators, donating them to hospitals throughout Britain and the British Empire. During the polio outbreaks of the 1940s and 1950s, iron lungs filled hospital wards, assisting patients with paralyzed diaphragms in their recovery.
Design and function
The iron lung is typically a large horizontal cylinder in which a person is laid, with their head protruding from a hole in the end of the cylinder, so that their full head (down to their voice box) is outside the cylinder, exposed to ambient air, and the rest of their body sealed inside the cylinder, where air pressure is continuously cycled up and down to stimulate breathing.[1][2][3][11][12]
To cause the patient to inhale, air is pumped out of the cylinder, causing a slight vacuum, which causes the patient's chest and abdomen to expand (drawing air from outside the cylinder, through the patient's exposed nose or mouth, into their lungs). Then, for the patient to exhale, the air inside the cylinder is compressed slightly (or allowed to equalize to ambient room pressure), causing the patient's chest and abdomen to partially collapse, forcing air out of the lungs, as the patient exhales the breath through their exposed mouth and nose, outside the cylinder.[1][2][3][11][12]
Examples of the device include the Drinker respirator, the Emerson respirator, and the Both respirator. Iron lungs can be either manually or mechanically powered, but are normally powered by an electric motor linked to a flexible pumping diaphragm (commonly opposite the end of the cylinder from the patient's head).
Smaller, single-patient versions of the iron lung include the so-called cuirass ventilator (named for the cuirass, a torso-covering body armor). The cuirass ventilator encloses only the patient's torso, or chest and abdomen, but otherwise operates essentially the same as the original, full-sized iron lung. A lightweight variation on the cuirass ventilator is the jacket ventilator or poncho or raincoat ventilator, which uses a flexible, impermeable material (such as plastic or rubber) stretched over a metal or plastic frame over the patient's torso.[1][7][13][14]
Method and use
Humans, like most mammals, breathe by negative pressure breathing:
Invention and early use
Initial development
In 1670, English scientist John Mayow came up with the idea of external negative pressure ventilation. Mayow built a model consisting of bellows and a bladder to pull in and expel air.[16] The first negative pressure ventilator was described by British physician John Dalziel in 1832. Successful use of similar devices was described a few years later. Early prototypes included a hand-operated bellows-driven "Spirophore" designed by Dr Woillez of Paris (1876),[17] and an airtight wooden box designed specifically for the treatment of polio by Dr Stueart of South Africa (1918). Stueart's box was sealed at the waist and shoulders with clay and powered by motor-driven bellows.[18]
Drinker and Shaw tank
The first of these devices to be widely used however was developed in 1928 by Phillip Drinker and Louis Shaw of the United States.
Variations
Boston manufacturer Warren E. Collins began production of the iron lung that year.[26][27] Although it was initially developed for the treatment of victims of coal gas poisoning, it was most famously used in the mid-20th century for the treatment of respiratory failure caused by polio.[20]
Danish physiologist August Krogh, upon returning to Copenhagen in 1931 from a visit to New York where he saw the Drinker machine in use, constructed the first Danish respirator designed for clinical purposes. Krogh's device differed from Drinker's in that its motor was powered by water from the city pipelines. Krogh also made an infant respirator version.[28]
In 1931, John Haven Emerson (1906–1997) introduced an improved and less expensive iron lung.
The United Kingdom's first iron lung was designed in 1934 by Robert Henderson, an Aberdeen doctor. Henderson had seen a demonstration of the Drinker respirator in the early 1930s and built a device of his own upon his return to Scotland. Four weeks after its construction, the Henderson respirator was used to save the life of a 10-year-old boy from New Deer, Aberdeenshire who had poliomyelitis. Despite this success, Henderson was reprimanded for secretly using hospital facilities to build the machine.[31][32]
Both respirator
The Both respirator, a negative pressure ventilator, was invented in 1937 when Australia's epidemic of poliomyelitis created an immediate need for more ventilating machines to compensate for respiratory paralysis. Although the Drinker model was effective and saved lives, its widespread use was hindered by the fact that the machines were very large, heavy (about 750 lbs or 340 kg), bulky, and expensive. In the US, an adult machine cost about $2,000 in 1930, and £2,000 delivered to Melbourne in 1936. The cost in Europe in the mid-1950s was around £1,500. Consequently, there were few of the Drinker devices in Australia and Europe.[33]
The South Australia Health Department asked Adelaide brothers Edward and Don Both to create an inexpensive "iron lung".[34] Biomedical engineer Edward Both designed and developed a cabinet respirator made of plywood that worked similarly to the Drinker device, with the addition of a bi-valved design which allowed temporary access to the patient's body.[33] Far cheaper to make (only £100) than the Drinker machine, the Both Respirator also weighed less and could be constructed and transported more quickly.[33][35] Such was the demand for the machines that they were often used by patients within an hour of production.[36]
Visiting London in 1938 during another polio epidemic, Both produced additional respirators there which attracted the attention of William Morris (Lord Nuffield), a British motor manufacturer and philanthropist. Nuffield, intrigued by the design, financed the production of approximately 1700 machines at his car factory in Cowley and donated them to hospitals throughout all parts of Britain and the British Empire.[36] Soon, the Both–Nuffield respirators were able to be produced by the thousand at about one-thirteenth the cost of the American design.[34] By the early 1950s, there were over 700 Both-Nuffield iron lungs in the United Kingdom, but only 50 Drinker devices.[37]
Polio epidemic
Rows of iron lungs filled hospital wards at the height of the polio outbreaks of the 1940s and 1950s, helping children, and some adults, with bulbar polio and bulbospinal polio. A polio patient with a paralyzed diaphragm would typically spend two weeks inside an iron lung while recovering.[38][39]
Modern development and usage
Polio vaccination programs have virtually
Replacement
The positive pressure ventilator has the asset that the patient's airways can be cleared and the patient can be seated on semi-seated position in the acute phase of polio. The fatality rate on using iron lungs on respiratory paralysis patients could be as high as 80% to 90%, most patients either drowning in their own saliva as their swallowing muscles had been paralyzed, or from organ shutdown due to acidosis due to accumulated carbon dioxide in bloodstream due to clogged airways. By using the positive pressure ventilators instead of iron lungs, the Copenhagen hospital team was able to decrease the fatality rate eventually down to 11%.[44] The first patient treated this way was a 12-year-old girl named Vivi Ebert, who had bulbar polio.
The iron lung now has a marginal place in modern
Continued use
Despite the advantages of positive ventilation systems, negative pressure ventilation is a truer approximation of normal physiological breathing and results in a more normal distribution of air in the lungs. It may also be preferable in certain rare conditions,
At least a few patients today still use the older machines, often in their homes, despite the occasional difficulty of finding replacement parts.[46]
Joan Headley of
On October 30, 2009,
In 2013, the
In 2021, the
On March 11, 2024, Paul Alexander of Dallas, Texas, United States, died at the age of 78. He had been confined to an iron lung for 72 years from the age of six, longer than anyone, and was the last man living in an iron lung. With his death, Martha Lillard is the only person in the U.S. known to use an iron lung.[57]
COVID-19 pandemic
In early 2020, reacting to the COVID-19 pandemic, to address the urgent global shortage of modern ventilators (needed for patients with advanced, severe COVID-19), some enterprises developed prototypes of new, readily-producible versions of the iron lung. These developments included:
- a compact, torso-sized "exovent" developed by a team in the United Kingdom, which included the Marshall Aerospace and Defence Group, the Imperial College Healthcare NHS Trust, along with teams of medical clinicians, academics, manufacturers, engineers and citizen scientists;[7][58]
- a full-size iron lung developed in the United States by a team led by Hess Services, Inc., of Hays, Kansas.[9][10]
See also
References
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- ^ a b c d e Rockoff, Mark, M.D., "The Iron Lung and Polio," Archived April 9, 2023, at the Wayback Machine, video (8 minutes), January 11, 2016, OPENPediatrics and Boston Children's Hospital on YouTube, retrieved April 11, 2020 (historical background and images, explanatory diagrams, and live demonstrations)
- ^ a b c Jackson, Christopher D., MD, Dept. of Internal Medicine, and Muthiah P Muthiah, MD, FCCP, D-ABSM, Assoc. Prof. of Medicine, Div. of Pulmonary / Critical Care / Sleep Medicine, Univ. of Tennessee College of Medicine-Memphis, et.al., "What is the background of the iron lung form of mechanical ventilation?," Archived July 2, 2022, at the Wayback Machine April 11, 2019, Medscape, retrieved April 12, 2020 (short summary of iron history and technology, with photo)
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- ^ Buncombe, Andrew (November 22, 2017). "America's last iron lung users on their lives spent inside obsolete ventilators". The Independent. Archived from the original on May 25, 2022. Retrieved April 16, 2019.
- ^ a b c "Modern iron lung designed to address ventilator shortage," Archived March 22, 2023, at the Wayback Machine, April 6, 2020, New Atlas, retrieved April 11, 2020
- Calgary, Alberta, Canada, retrieved April 23, 2020
- ^ KSNW-TV, retrieved April 11, 2020
- ^ a b Allen, Margaret, "Hess offers iron lung for COVID-19," Archived February 25, 2021, at the Wayback Machine April 9, 2020, Hays Daily News, retrieved April 11, 2020
- ^ London, England, (illustrated description of the device and its history), retrieved April 11, 2020
- ^ a b "How Does Iron Lung Work?: Polio Survivor, 82, Among Last to Use Breathing Equipment," Archived April 11, 2020, at the Wayback Machine August 21, 2018, Newsweek retrieved April 11, 2020
- ^ "The 'iron lung' and the modern 'ventilation'," Archived April 11, 2020, at the Wayback Machine Oxy.gen, retrieved April 11, 2020
- Bologna, Italy(picture of jacket ventilator ["poncho"], and other information.), retrieved April 12, 2020
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- ^ Emerson, John H (July 1998). "Some Reflections on Iron Lungs and Other Inventions" (PDF). Respiratory Care. 43 (7): 577. Archived from the original on March 24, 2006. Retrieved October 12, 2016.
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- ^ a b c Kenneth E. Behring Center (2011). "The iron lung and other equipment". Whatever happened to polio?. Washington, DC: National Museum of American History. Archived from the original on June 4, 2011. Retrieved July 2, 2011.
- ^ "Today in History: Iron Lung Used for the First Time (1928)". Tebyan.net. Archived from the original on August 15, 2011. Retrieved November 14, 2013.
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- ^ "Artificial Lung on Wheels Prove Life Saver" Popular Mechanics, December 1930 Archived August 15, 2020, at the Wayback Machine photo of earliest production units from Boston
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- ^ Naomi Wu [@reaksexycyborg] (November 23, 2017). "Via @NireBryce – we've got a nice old lady running out of collars for her iron lung. Lot of 💩 going on in the world we can't do anything about – but this seems 100% doable. @hackaday, @make, textile tech folks – any ideas? From https://gizmodo.com/the-last-of-the-iron-lungs-1819079169 …" (Tweet) – via Twitter.
- ^ Kobie, Nicole (November 28, 2017). "A woman on an iron lung is running out of the spare parts she needs to live. Cue the maker community..." Wired. Archived from the original on October 26, 2021. Retrieved October 26, 2021.
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Further reading
- Emerson, JH; Loynes, JA (1978). The evolution of iron lungs: respirators of the body-encasing type (PDF). Cambridge, Massachusetts: J.H. Emerson Company. [ISBN unspecified]
- ISBN 9781608191192
- ISBN 9780099499527
- Respiration Without Breathing – about the Thunberg "barospirator" built by John Emerson.
- "A medical triumph: The iron lung", January–February 1979 Respir Ther., 9(1):71–73, on PubMed, NCBI, National Institutes of Health
External links
- "Iron Lung." Claude Moore Health Sciences Library, University of Virginia
- Both respirator at the Powerhouse Museum