A NEW RESPIRATOR

Journal/Book: Reprinted from THE LANCET April 11. 1953 p. 723. 1953;

Abstract: ASSISTANT PHYSICAN COUNTY HOSPITAL SKIVE DENMARK IN the autumn of 1952 we had in Denmark a poliomyelitis epidemic of the utmost severity as regards both the type of illness and the numbers affected. There was a high proportion of cases with bulbar involvement and the treatment of patients with respiratory paralysis proved a difficult problem. At Blegdam Hospital Copenhagen where treatment was largely centralised it soon became necessary to supplement the ordinary methods of applying artificial respiration to these patients. In coöperation with the anæsthetists good results were obtained by positive-pressure ventilation (Lassen 1953). The method is briefly as follows: A high tracheotomy is performed and a rubber tube with an inflatable cuff is fitted closely into the patient's trachea. The lungs are then insufflated by manual compression of a rubber bag filled with oxygen or o mixture of oxygen and nitrogen. The gas circulates in a closed system ; exhaled gas passen through an absorber which removes the carbon dioxide and back to the rubber bag. The oxygen consumed is replaced from an oxygen cylinder. Manual ventilation was performed by medical students of Copenhagen University. They worked 8-hour shifts so the treatment of each patient needed three students every 24 hours. This method was adopted elsewhere in Denmark including the medical department of the County Hospital Skive. Its use here however was more difficult since no students are available and manual respiration had therefore to be carried out by the nurses. Replacement of human labour by some automatic method was thus highly desirable. A respirator constructed here has proved an effective alternative (fig. 1). It is simple to make and compared with other respirators it is very cheap. The essence of its function is that it depends on variation in pressure in the patient's respiratory system with which the apparatus has an airtight connection. The highest pressure in the lungs at the close of the inspiratory phase sets off expiration. Not till the pressure in the lungs equals atmospheric pressure can the next inspiration start. There is thus a constant action and reaction between patient and respirator. ... ___MH

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