Iron lung: Difference between revisions

Browse history interactively

← Previous edit Next edit →

Content deleted Content added

VisualWikitext

Inline

Revision as of 10:35, 18 April 2012

nananananananananananananananana NALLAN!!!!!

@@ Line 1: / Line 1: @@
+nananananananananananananananana NALLAN!!!!!
-{{about|the medical device|the band|Iron Lung (band)}}
-{{lead too short|date=August 2011}}
-{{Interventions infobox |
-  Name        = Negative pressure ventilator |
-  Image       = Iron lung CDC.jpg |
-  Caption     = An Emerson iron lung. The patient lies within the chamber, which when sealed provides an effectively oscillating atmospheric pressure. This particular machine was donated to the [[Centers for Disease Control and Prevention]] Museum by the family of [[poliomyelitis]] patient Barton Hebert of Covington, Louisiana, who had used the device from the late 1950s until his death in 2003. |
-  ICD10       = |
-  ICD9        = {{ICD9proc|93.99}} |
-  MeshID      = D015919 |
-  OPS301      = |
-  OtherCodes  = |
-  HCPCSlevel2 =
-}}
-A '''negative pressure ventilator''' (often referred to colloquially as an '''[[iron lung]]''') is a form of [[medical ventilator]] that enables a person to [[breathing|breathe]] when normal [[Muscles of respiration|muscle]] control has been lost or the work of breathing exceeds the person's ability.
-==Method and use==
-Humans, like most other animals, breathe by ''negative pressure'' breathing:<ref name=stemnet>{{cite web|author=|title=Gas Exchange in Humans|url=http://www.stemnet.nf.ca/~dpower/resp/exchange.htm|accessdate=2011-07-01}}</ref> the rib cage expands and the [[Thoracic diaphragm|diaphragm]] contracts, expanding the [[chest cavity]]. This causes the pressure in the chest cavity to decrease, and the [[lung]]s expand to fill the space. This, in turn, causes the pressure of the air inside the lungs to decrease (it becomes negative, relative to the atmosphere), and air flows into the lungs from the atmosphere: [[inhalation]]. When the diaphragm relaxes, the reverse happens and the person [[exhalation|exhales]]. If a person loses part or all of the ability to control the muscles involved, breathing becomes difficult or impossible.
-[[Image:Iron Lung ward-Rancho Los Amigos Hospital.gif|thumb|Iron lung ward filled with polio patients, [[Rancho Los Amigos Hospital]], California (1953)]]
-The person using the iron lung is placed into the central chamber, a cylindrical steel drum. A door allowing the head and neck to remain free is then closed, forming a sealed, air-tight compartment enclosing the rest of the person's body. Pumps that control airflow periodically decrease and increase the [[air pressure]] within the chamber, and particularly, on the chest. When the pressure is below that within the lungs, the lungs expand and atmospheric pressure pushes air from outside the chamber in via the person's nose and airways to keep the lungs filled; when the pressure goes above that within the lungs, the reverse occurs, and air is expelled. In this manner, the iron lung mimics the physiological action of breathing: by periodically altering intrathoracic pressure, it causes air to flow in and out of the lungs. The iron lung is a form of [[non-invasive (medical)|non-invasive]] therapy.
-==Invention and early use==
-[[Image:Poumon artificiel.jpg|thumb|Staff in a [[Rhode Island]] hospital are examining a patient in an iron lung tank respirator during the [[History of poliomyelitis|1960 polio epidemic]]. The iron lung encased the [[thoracic cavity]] in an air-tight chamber. The chamber was used to create a negative pressure around the thoracic cavity, thereby causing air to enter the lungs to equalize [[Breathing#Mechanics|intrapulmonary pressure]].]]
-[[File:Museum-gt-eiserne-lunge.jpg|thumb|Iron lung from the 1950s in the [[Stadtmuseum Gütersloh|Gütersloh Town Museum]]. In Germany, nowadays less than a dozen of these breathing machines are presented to the public.]]
-The first negative pressure ventilator was described by Scottish physician [[John Dalziel]] in 1832. Successful use of similar devices was described a few years later.
-The first of these devices to be widely used however was developed by Drinker and Shaw in 1928.<ref name=Gilgoff2002>{{cite book|editor-last=Gilgoff|editor-first=Irene S.|last=Laurie|first=Gini|title=Breath of Life: The Role of the Ventilator in Managing Life-Threatening Illnesses|chapter=Ventilator users, home care, and independent living: a historical perspective|pages=161–201|publisher=Scarecrow Press, Inc.|location=Lanham, Maryland|year=2002|isbn=0-8108-3488-X|url=http://books.google.com/books?id=ngA1izcCrFQC&pg=PA161&lpg=PA161&dq=%22Ventilator+users,+home+care,+and+independent+living:+a+historical+perspective%22&source=bl&ots=mpAz4WBI8A&sig=BCn90LxY7ISgXP6LegX9eQU91FA&hl=en&ei=-nEWTsCNPI2osAKqirEv&sa=X&oi=book_result&ct=result&resnum=2&ved=0CB4Q6AEwAQ#v=onepage&q=%22Ventilator%20users%2C%20home%20care%2C%20and%20independent%20living%3A%20a%20historical%20perspective%22&f=false}}</ref> The iron lung, often referred to in the early days as the "Drinker respirator", was invented by [[Phillip Drinker]] (1894{{spaced ndash}}1972) and [[Louis Agassiz Shaw Junior]], [[professor]]s of [[Occupational hygiene|industrial hygiene]] at the [[Harvard School of Public Health]].<ref name=Sherwood1973>{{cite journal|last1=Sherwood|first1=RJ|title=Obituaries: Philip Drinker 1894–1972|journal=The Annals of Occupational Hygiene|volume=16|issue=1|pages=93–4|year=1973|doi=10.1093/annhyg/16.1.93|url=http://annhyg.oxfordjournals.org/content/16/1/93.extract|accessdate=2011-07-01}}</ref><ref name=Gorham1979>{{cite journal|last1=Gorham|first1=J|title=A medical triumph: the iron lung|journal=Respiratory Therapy|volume=9|issue=1|pages=71–3|year=1979|pmc=|pmid=10297356|doi=|url=|accessdate=2011-07-01}}</ref><ref name=OSHHarvard>{{cite web|author=The Harvard Education and Research Center for Occupational Safety and Health
-|title=2010-2011 Student Handbook|publisher=The Harvard Education and Research Center for Occupational Safety and Health|location=Cambridge, Massachusetts|year=2010|url=http://www.hsph.harvard.edu/research/erc/files/no_whoswho_editsept10updates.pdf|accessdate=2011-07-02}}</ref><ref name=Lehigh>{{cite web|author=P.C. Rossin College of Engineering and Applied Science|title=Philip Drinker '17|work=Distinguished Alumni: Great Talents & Bright Minds|publisher=Lehigh University|location=Bethlehem, Pennsylvania|year=2011|url=http://www3.lehigh.edu/engineering/about/drinker.asp|accessdate=2011-07-01}}</ref> The machine was powered by an electric motor with air pumps from two vacuum cleaners. The air pumps changed the pressure inside a rectangular, airtight metal box, pulling air in and out of the lungs.<ref name=NMAH2011>{{cite web|author=Kenneth E. Behring Center|title=The iron lung and other equipment|work=Whatever happened to polio?|publisher=National Museum of American History|location=Washington, DC|year=2011|url=http://americanhistory.si.edu/polio/howpolio/ironlung.htm|accessdate=2011-07-02}}</ref>
-The first clinical use of the Drinker respirator on a human was on October 12, 1928 at the [[Children's Hospital Boston|Children's Hospital]] in [[Boston]].<ref name=Gorham1979/><ref>[http://www.tebyan.net/Events_History/World_Events/2010/10/12/140096.html Today in History: Iron Lung Used for the First Time (1928)]</ref> The subject was an eight-year-old girl who was nearly dead as a result of [[respiratory failure]] due to [[poliomyelitis]] (often called polio or infantile paralysis).<ref name=Lehigh/> Her dramatic recovery, within less than a minute of being placed in the chamber, helped popularize the new device.<ref name=OSHHarvard/>
-Boston manufacturer Warren E. Collins began production of the iron lung that year.<ref name=Silver2007>{{cite book|author1=Julie K. Silver|author2=Daniel J. Wilson|title=Polio Voices|location=Santa Barbara|publisher=Praeger Publishers|year=2007|page=141|accessdate=2011-07-01}}</ref><ref> [http://books.google.com/books?id=qOIDAAAAMBAJ&pg=PA975&dq=Popular+Science+1930+plane+%22Popular+Mechanics%22&hl=en&ei=_7BlTsWeBYTWgQf9mIiLCg&sa=X&oi=book_result&ct=result&resnum=10&sqi=2&ved=0CE8Q6AEwCQ#v=onepage&q&f=true "Artificial Lung on Wheels Prove Life Saver" ''Popular Mechanics'', December 1930] photo of earliest production units from Boston</ref> 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 poliomyelitis.<ref name=Sherwood1973/>
-In 1931, [[John Haven Emerson]] (February 5, 1906{{spaced ndash}}February 4, 1997) introduced an improved and less expensive iron lung.<ref name=Geddes2007>{{cite journal|last=Geddes|first=LA|title=The history of artificial respiration|journal=IEEE Engineering in Medicine and Biology Magazine: the Quarterly Magazine of the Engineering in Medicine & Biology Society|volume=26|issue=6|pages=38–41|year=2007|pmid=18189086|doi=10.1109/EMB.2007.907081}}</ref><ref name=NMAH>{{cite web|author=|title=Iron Lung|publisher=National Museum of American History|url=http://americanhistory.si.edu/collections/object.cfm?key=35&objkey=114|accessdate=2011-07-01}}</ref> The Emerson iron lung had a bed that could slide in and out of the cylinder as needed, and the tank had portal windows which allowed attendants to reach in and adjust limbs, sheets, or hot packs.<ref name=NMAH2011/> Drinker and Harvard University sued Emerson, claiming he had infringed on patent rights. Emerson defended himself by making the case that such lifesaving devices should be freely available to all.<ref name=NMAH2011/> Emerson also 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.
-==Modern usage==
-Rows of irons lungs filled hospital wards at the height of the polio outbreaks of the 1940s and 1950s. [[Polio vaccine|Polio vaccination]] programs have virtually [[Poliomyelitis eradication|eradicated]] new cases of poliomyelitis in the United States. Because of this, and also the development of modern [[Medical ventilator|ventilators]] and widespread use of [[tracheal intubation]] and [[tracheotomy]], the iron lung has virtually disappeared from modern medicine. For example, in 1959, there were 1,200 people using tank respirators in the United States, but by 2004 there were only 39.<ref name=NMAH2011/>
-[[Positive pressure ventilation]] systems are now more common than negative pressure systems. Positive pressure ventilators work by blowing air into the patient's lungs via [[intubation]] through the airway; they were used for the first time in [[Blegdams Hospital]], [[Copenhagen]], Denmark during a polio outbreak in 1952.<ref name=Reisner2009>{{cite web|author=Louise Reisner-Sénélar|title=The Danish anaesthesiologist Björn Ibsen a pioneer of long-term ventilation on the upper airways|year=2009|url=https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B7CdB217pf6yN2QxOGI5NTUtZWIzYS00N2NhLWFhODQtOGZjMjdhZTlkZGE5&hl=de|accessdate=2011-07-01}}</ref><ref name=Wackers1994>{{cite book|last=Wackers|first=Ger|title=|chapter=Chapter 4: Theaters of truth and competence. Intermittent positive pressure respiration during the 1952 polio-epidemic in Copenhagen|year=1994|url=http://www.fdcw.unimaas.nl/personal/WebSitesMWT/Wackers/proefschrift.html#h4|accessdate=2011-07-01}}</ref> It proved a success and soon superseded the iron lung throughout Europe.
-The iron lung now has a marginal place in modern [[respiratory therapy]]. Most patients with paralysis of the breathing muscles use modern [[mechanical ventilation|mechanical ventilators]] that push air into the airway with positive pressure. These are generally efficacious and have the advantage of not restricting patients' movements or caregivers' ability to examine the patients as significantly as an iron lung does. However, [[Pressure#Negative pressures|negative pressure]] ventilation is a truer approximation of normal physiological breathing and results in more normal distribution of air in the lungs. It may also be preferable in certain rare conditions, such as [[Ondine's curse]], in which failure of the medullary respiratory centers at the base of the brain result in patients having no [[Autonomic nervous system|autonomic]] control of breathing. At least one reported polio patient, [[Dianne Odell]], had a spinal deformity that caused the use of mechanical ventilators to be [[contraindicated]].<ref name=Sydney2008>{{cite news|author=|title=Power failure kills iron lung lady|work=The Sydney Morning Herald|date=2008-05-29|url=http://www.smh.com.au/news/world/power-failure-kills-iron-lung-lady/2008/05/29/1211654160059.html|accessdate=2011-07-01}}</ref> There are patients who today still use the older machines, often in their homes, despite the occasional difficulty of finding the various replacement parts. Joan Headley of Post-Polio Health International stated to CNN that there are approximately 30 patients in the USA still using an iron lung.<ref name=CNN2008>{{cite news|author=|title=Woman dies after life spent in iron lung|date=May 28, 2008|url=http://www.cnn.com/2008/US/05/28/iron.lung.death.ap/index.html|accessdate=2011-07-01}} {{Dead link|date=September 2011|bot=RjwilmsiBot}}</ref> That figure may be inaccurately low; [[Houston, Texas|Houston]] alone had 19 iron lung patients living at home in 2008.<ref name=Neergaard2009>{{cite news|author=Lauran Neergaard|title=Emergency officials struggle to find those on life-support during power outages|date=2009-01-13|url=http://www.ems1.com/ems-products/consulting-management/articles/447100-Emergency-officials-struggle-to-find-those-on-life-support-during-power-outages|accessdate=2011-07-01}}</ref> [[Martha Mason (writer)|Martha Mason]] of [[Lattimore, North Carolina]] died on May 4, 2009, after spending 60 of her 72 years in an iron lung.<ref name=Fox2009>{{cite news|last=Fox|first=Margalit|title=Martha Mason, Who Wrote Book About Her Decades in an Iron Lung, Dies at 71|work=The New York Times|date=2009-05-10|url=http://www.nytimes.com/2009/05/10/us/10mason.html?_r=1&scp=1&sq=iron%20lung&st=cse|accessdate=2011-07-01}}</ref>
-On the 30th of October 2009, [[June Middleton]] of [[Melbourne, Australia]], who had been entered in the [[Guinness Book of Records]] as the person who spent the longest time in an iron lung, died aged 83, having spent more than 60 years in her iron lung.<ref name=Sydney2009>{{cite news|author=|title=Dead after 60 years in iron lung|work=The Sydney Morning Herald|date=2009-11-01|url=http://www.smh.com.au/national/dead-after-60-years-in-iron-lung-20091101-hqyy.html?autostart=1|accessdate=2011-07-01}}</ref>
-[[Biphasic Cuirass Ventilation]] is a modern development of the iron lung, consisting of a wearable rigid upper-body shell (a [[cuirass]]) which functions as a negative pressure ventilator.
-==See also==
-* [[Both Respirator]]
-* [[Biphasic Cuirass Ventilation]]
-==References==
-{{reflist|2}}
-==Further reading==
-* {{cite book|last1=Emerson|first1=JH|authorlink1=John Haven Emerson|last2=Loynes|first2=JA|title=The evolution of iron lungs: respirators of the body-encasing type|publisher=J.H. Emerson Company|location=Cambridge, Massachusetts|year=1978}}
-* [[Martha Mason (writer)|Martha Mason]], a polio survivor, penned a best-selling memoir, ''Breath'', about her life inside an iron lung.
-* [[Margaret Atwood]] mentions an iron lung in her book ''Cat's Eye''
-* [[Peg Kehret]] mentions the use of an iron lung in her autobiographical book, ''[[Small Steps: The Year I Got Polio]]''
-* [[Elizabeth Berg (author)|Elizabeth Berg]] shares a fictionalization of the true story of Pat Raming, the first woman to give birth to baby while in an iron lung, in her book, We are all Welcome Here. 2006.
-==External links==
-{{commons category|Iron lungs}}
-{{Respiratory system procedures}}
-{{DEFAULTSORT:Iron Lung}}
-[[Category:Medical pumps]]
-[[Category:Poliomyelitis]]
-[[Category:Respiratory therapy]]
-[[Category:1928 introductions]]
-[[Category:Mechanical ventilation]]
-[[da:Jernlunge]]
-[[de:Eiserne Lunge]]
-[[es:Pulmón de acero]]
-[[fr:Poumon d'acier]]
-[[it:Polmone d'acciaio]]
-[[he:ריאת ברזל]]
-[[nl:IJzeren long]]
-[[ja:鉄の肺]]
-[[no:Jernlunge]]
-[[pl:Żelazne płuco]]
-[[fi:Rautakeuhko]]
-[[sv:Järnlunga]]
-[[zh:鐵肺]]