the current23:17How the polio epidemic led to the creation of the modern ICU
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In 1949, polio was raging across America.
By 1952, the epidemic had spread all over the world, and Copenhagen, Denmark was suffering as autumn began. More than 3,000 people were hospitalized, with patients wheezing and having trouble breathing. Some were paralyzed.
The doctors and nurses there could do little.
“In an unlucky few (usually less than about 5 percent of people with the disease) paralysis develops. The virus actually reaches nerves in the spinal cord and causes weakness in the limbs.” Dr. Hannah said. Wensh said. the current Hosted by Matt Galloway.
“If you’re really unlucky, [you had] Weakness of the respiratory muscles and, if you’re really unlucky, the muscles that control things like swallowing, this was called bulbar polio. ”
Wansch is a critical care physician and researcher at the Sunnybrook Health Science Center in Toronto. her book, Ghosts of Autumn: How the fight against the polio epidemic revolutionized modern medicine, Explore how polio in Denmark forced health professionals to rethink critical care.
“There was this epidemic in Copenhagen, and it was at that very moment that we figured out how to provide polio patients with so-called ‘positive pressure ventilation,’ which is modern ventilation,” Wansch said.
“This was really the catalyst for the development of modern intensive care. So as an intensive care physician, I was very interested in this, because this is exactly where my specialty started. .”
patient care
In his book, Wansch traces how the devastating effects of the polio epidemic created the impetus for modern ventilation systems. Ventilators, which allow patients with respiratory illnesses to breathe, were an important medical device during the height of the COVID-19 pandemic.
They were hitting a wall because the mortality rate was about 90 percent.– Dr. Hannah
“Intensive care units, ventilators, all kinds of equipment, and what we can do for people, we take these things for granted,” she says. “There was a time before that, too. That’s what makes this epidemic so special, because it was a turning point.”
Until the polio vaccine was developed in 1955, treatment of severe polio cases was possible only with the use of iron lungs. The iron lung is a large ventilator that surrounds most of the patient’s body and helps stimulate breathing during paralysis. At the peak of the crisis, Copenhagen had only one iron lung.
But even if there were iron lungs all over the world, the machine would be useless.
“At the end of August, we were receiving about 50 patients a day, many of them with bulbous polio, which had already caused dozens of deaths,” Wansch said. “They also knew that even if they had an iron lung, bulbous polio would not do much in an iron lung. I did.”
find a solution
In this moment of crisis, anesthesiologists Dr. Bjorn Arge Ibsen had an idea.
“He was an incredibly smart guy and insightful,” Wansch said. ”[He] He was the one who actually proposed the breakthrough in this treatment, which was to force air into the lungs in the way we used to do with patients in the operating room, instead of trying to open them by suctioning them. The idea was to send a ”
“He was very experienced in keeping people alive in the operating room because he gave them general anesthesia, paralyzed them, and then had to breathe for them,” Wansch said. said.
“The main problem for these polio patients is [was] They simply couldn’t breathe enough, and if he could both “Protecting your airway” means keeping secretions from the back of your throat out of your lungs and allowing you to breathe as well… which might solve your problem. ”
Bibi Ebert, a 12-year-old girl with bulbous polio, will be the first patient to receive the procedure.
“He took over her care, and after a rocky start, he was able to keep her alive by blowing air and hand-like ventilation, just as he had done for the people in the operating room. This was pretty kind because it demonstrated what it could do.” A miraculous thing. said Wansch.
However, without the benefits of ventilators at the time, it would have been impossible for doctors to keep patients ventilated 24 hours a day. Ibsen asked medical students at the University of Copenhagen to perform manual ventilation day and night.
“They had six eight-hour shifts, 10-minute cigarette breaks every hour, and it really didn’t seem to end. for weeks and months.
“It’s an exciting story in terms of people flocking to cities.”