Mechanicall Ventilation of the Lungs in the Treatment of Poliomyelitis

According to Slutzky, mechanical ventilation can be traced back as far as 500 years. The first practical negative-pressure ventilator, more commonly referred to as the “iron lung,” played a pivotal role in polio management during World War II (WWII). While other negative-pressure ventilators had been around for over a century at this time, the iron lung was the first negative-pressure ventilator that saw more practical/clinical use. The iron lung was created and developed in 1927 by Harvard medical researchers Phillip Drinker and Louis Agassiz Shaw.

Drinker and Shaw developed their prototype respirator by using an iron box along with two vacuum cleaners).

The iron lung works by stimulating a “push-pull” sensation in the chest; the patient’s lungs will continue to artificially inspire and expire. In WWII, one of the main issues with polio fatalities was simply an inability to breathe due to lung paralysis. The iron lung first saw consistent use in New York at Bellevue hospital. For polio patients suffering from chest paralysis, the ventilator was not only beneficial but absolutely essential for their survival.

While the iron lung did have its benefits, it certainly had its drawbacks. One of these drawbacks was requiring the patient to be fully submersed in the machine (except for the patient’s head). Although the patient could still read via a ledge, this required far more nursing interventions for simple tasks such as turning pages. In addition, because patients had to be fully submersed in the device, this resulted in a very large machine that took up much-needed space during the Polio outbreak in WWII. With the body being fully immersed, this also adds basic hygiene and care issues for nurses in charge of care. 

The iron lung played a crucial role in the healthcare system, but it was quickly outdated for more practical procedures. Slutsky states,
(t)His focus until this time was largely on providing ventilatory support (i.e., providing a replacement of the respiratory muscles). This changed over the ensuing few decades with a greater focus on oxygenation failure, catalyzed by easier approaches for measuring blood gases, the identification of acute respiratory distress syndrome (ARDS) , and the increased physiologic understanding of the impact of pressures in the lung on gas exchange.

Modern ventilation tends to rely more on the patient’s conscious effort to breathe rather than simply providing negative pressure. This is where the future of ventilation lies, by allowing patients the ability to breathe once again, from their own effort.  One of today’s most commonly used devices for mechanical ventilation is Non-invasive positive-pressure ventilation (NPPV). NPPV is the delivery of mechanical ventilatory support without an invasive nasotracheal or endotracheal tube. Nursing interventions for these generally include placing the client in a prone position, monitoring and administering medications, as well as providing adequate hydration and nutrition. In addition, meticulous attention must be paid to hygiene in order to reduce the chances of infection; this could even include airway suctioning to remove any signs of secretions. 

Ventilation procedures have come a long way. Despite the concept being well over five centuries old, we continue to make tremendous improvements. The iron lung is the ventilation device that popularized mechanical ventilation and is even still seen in use today. Without the iron lung and its widespread use, today’s medical floors would not have the modern, more effective/safe/practical methods seen today. Through the years, the necessary interventions may change, but nurses will always be there to ensure the safety of the patient, no matter the circumstance.

References

1. Choi, A. Y., Kim, M., Park, E., Son, M. H., Ryu, J.-A., & Cho, J. (2019). Outcomes of mechanical ventilation according to WIND classification in pediatric patients. Annals of Intensive Care, 9(1), NA. Retrieved from https://link-gale-com.worwic.idm.oclc.org/apps/doc/A591278380/HRCA?u=sali69408&sid=HRCA&xid= 8089659a
2. Hoffman, J. J., & Sullivan, N. J. (2017). Medical-surgical nursing: Making connections to practice.
3. Noidia, M. B. Ventilators: Iron lungs. (2013). Medical Buyer, Retrieved from https://search- proquest-com.worwic.idm.oclc.org/docview/1400164159?accountid=15136
4. Slutsky, A. S. (2015). History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury.ATS Journals. doi: https://doi.org/10.1164/rccm.201503-0421PP

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