Global InformationIron lung information
| Iron lung | |
|---|---|
 An Emerson iron lung | |
| Specialty | Pulmonology |
| ICD-9-CM | 93.99 |
| MeSH | D015919 |
An iron lung is a type of negative pressure ventilator (NPV), a mechanical respirator which encloses most of a person's body and varies the air pressure in the enclosed space to stimulate breathing.[1][2][3][4] It assists breathing when muscle control is lost, or the work of breathing exceeds the person's ability.[1] Need for this treatment may result from diseases including polio and botulism and certain poisons (for example, barbiturates, tubocurarine).
The use of iron lungs is largely obsolete in modern medicine as more modern breathing therapies have been developed[5] and due to the eradication of polio in most of the world.[6] However, in 2020, the COVID-19 pandemic revived some interest in the device as a cheap, readily-producible substitute for positive-pressure ventilators, which were feared to be outnumbered by patients potentially needing temporary artificially assisted respiration.[7][8][9][10]
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.
Polio vaccination programs and the development of modern ventilators have nearly eradicated the use of iron lungs in the developed world. Positive pressure ventilation systems, which blow air into the patient's lungs via intubation, have become more common than negative pressure systems like iron lungs. However, negative pressure ventilation is more similar to normal physiological breathing and may be preferable in rare conditions. As of 2024[update], after the death of Paul Alexander, only one patient in the U.S., Martha Lillard is still using iron lungs. In response to the COVID-19 pandemic and the shortage of modern ventilators, some enterprises developed prototypes of new, easily producible versions of the iron lung.
- ^ a b Shneerson, Dr. John M., Newmarket General Hospital, (Newmarket, Suffolk, U.K.), "Non-invasive and domiciliary ventilation: negative pressure techniques," Archived March 16, 2023, at the Wayback Machine #5 of series "Assisted ventilation" in Thorax, 1991;46:131–35, retrieved April 12, 2020
- ^ 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)
- ^ 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)
- ^ Grum, Cyril M., MD, and Melvin L. Morganroth, MD, "Initiating Mechanical Ventilation," Archived June 22, 2022, at the Wayback Machine in Intensive Care Medicine 1988;3:6–20, retrieved April 12, 2020
- ^ Corrado, A.; Ginanni, R.; Villella, G.; Gorini, M.; Augustynen, A.; Tozzi, D.; Peris, A.; Grifoni, S.; Messori, A.; Nozzoli, C.; Berni, G. (March 2004). "Iron lung versus conventional mechanical ventilation in acute exacerbation of COPD". The European Respiratory Journal. 23 (3): 419–24. doi:10.1183/09031936.04.00029304. ISSN 0903-1936. PMID 15065832.
- ^ 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.
- ^ "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
- ^ Laderas, Crystal, reporter: "Alberta team building modern 'iron lung' for COVID-19 in dire environments," Archived October 13, 2022, at the Wayback Machine, (video & text), March 25, 2020, as updated March 26, 2020, City News / Citytv, Edmonton, Alberta, Canada – also broadcast as "Bioengineers build modern 'iron lung' for COVID-19 in dire environments: Scientists build a prototype 'iron lung' for COVID-19 patients in crisis environments. The machine is a last resort for patients when hospital ventilators are not available," Archived June 20, 2021, at the Wayback Machine (video only), March 25, 2020, 660 News / CityNews / Citytv, Calgary, Alberta, Canada, retrieved April 23, 2020
- ^ "One Kansas company is switching gears to make iron lung ventilators," Archived October 15, 2022, at the Wayback Machine (video & text), April 10, 2020, KSNW-TV, retrieved April 11, 2020
- ^ 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