What is the background of the iron lung form of mechanical ventilation?

Updated: Apr 11, 2019
  • Author: Christopher D Jackson, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

The Roman physician Galen first used mechanical breathing in the second century by blowing air into the larynx of a dead animal using a reed. Author George Poe used a mechanical respirator to revive an asphyxiated dog. [1] The Drinker and Shaw tank-type ventilator of 1929 was one of the first negative-pressure machines widely used for mechanical ventilation. Better known as the iron lung, this metal cylinder completely engulfed the patient up to the neck. A vacuum pump created negative pressure in the chamber, which resulted in expansion of the patient's chest. This change in chest geometry reduced the intrapulmonary pressure and allowed ambient air to flow into the patient's lungs. When the vacuum was terminated, the negative pressure applied to the chest dropped to zero, and the elastic recoil of the chest and lungs permitted passive exhalation (see image below). 

An example of the Drinker and Shaw negative-pressu An example of the Drinker and Shaw negative-pressure ventilator (iron lung).

Ventilation of the patient was accomplished without the placement of a tracheostomy or an endotracheal tube. Nevertheless, this mode of ventilation was cumbersome and led to patient discomfort. In addition, it limited access to the patient by health care providers. Because the negative pressure created in the chamber was exerted on the abdomen as well as the chest, the cardiac output tended to decrease from pooling of venous blood in the lower torso.

Today, negative-pressure ventilation is used in only a few situations. The cuirass, or shell unit, allows negative pressure to be applied only to the patient's chest by using a combination of a form-fitted shell and a soft bladder. It provides a suitable and attractive option for patients with neuromuscular disorders, especially those with residual muscular function, because it does not require a tracheostomy with its inherent problems.


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