Rhonchi

I never took care of anyone who was in an iron lung, but I did see one in action on a patient at UVa many years ago. The main thing I remember was that the huge piston which provided the actual pressure gradient to cause ventilation. As I recall, the vent sheets were different because an iron lung is so different from a mechanical ventilator.

The family of a Tennessee woman who spent more than 50 years in an iron lung says she has died after a power failure shut down the machine that kept her breathing.

Dianne Odell said she died early Wednesday. The 61-year-old had been confined to the 3.5-metre-long machine since she was stricken by polio at 3 years old.

Brother-in-law Will Beyer said family members were unable to get an emergency generator working for the iron lung after a power failure knocked out electricity to the Odell family’s residence near Jackson.

Ms. Odell spent her life in the iron lung, cared for by her parents and other family members. Though confined inside the apparatus, Ms. Odell managed to get a high school diploma, take college courses and write a children’s book.

Any of our readers ever manage an iron lung?

Background on iron lungs, which includes some interesting links to other iron lung information.

CurEvents.com – A Global Current Events Discussion Forum – Avian influenza (H5N1): implications for intensive care.
Abstract
Background As influenza A/H5N1 spreads around the globe the risk of an epidemic increases.
Discussion Review of the cases of influenza A/H5N1 reported to date demonstrates that it causes a severe illness, with a high proportion of patients (63%) requiring advanced organ support. Of these approx. 68% develop multiorgan failure, at least 54% develop acute respiratory distress syndrome, and 90% die. Disease progression is rapid, with a median time from presentation to hospital to requirement for advanced organ support of only 2 days.
Conclusion
The infectious nature, severity and clinical manifestations of the disease and its potential for pandemic spread have considerable implications for intensive care in terms of infection control, patient management, staff morale and intensive care expansion.

AARC Webcast Central:

Looks like a good service from the AARC. Live and archived webcasts for AARC members. The upcoming one about the issue of Mechanical Ventilation in Mass Casualty settings looks like an important one.

It’s not often one sees news in the media about the difficulty in managing the ventilation of a patient. I love the line about ventilating a brick.

VOA News – Bad Bugs Need New Drugs
An aggressive staph infection called MRSA had eaten a hole in his lungs. Scott Smith says over the next two months the child had six blood transfusions. “His lungs were so bad they couldn’t supply the oxygen his body needed.” Surgeons had to insert five chest tubes in his body due to the hole that was in his lungs. “A respiratory therapist told us his lungs were so hard and infected that it was like trying to pump air into a brick,” says Scott Smith.

This is all the talk of the AARC disaster preparedness mailing lists. Even I, so many years out of practice in the RT game feel like I could provide help with mechanical ventilation if bird flu hits in earnest. This is assuming of course, I myself am not put down by the flu!

Hospitals Short on Ventilators if Bird Flu Hits – New York Times
No one knows whether an avian flu virus that is racing around the world might mutate into a strain that could cause a human pandemic, or whether such a pandemic would cause widespread illness in the United States. But if it did, public health experts and officials agree on one thing: the nation’s hospitals would not have enough ventilators, the machines that pump oxygen into sick patients’ lungs.

Right now, there are 105,000 ventilators, and even during a regular flu season, about 100,000 are in use. In a worst-case human pandemic, according to the national preparedness plan issued by President Bush in November, the country would need as many as 742,500.

To some experts, the ventilator shortage is the most glaring example of the country’s lack of readiness for a pandemic.

What happens if you have mass casualties who all need mechanical ventilation? Sounds like a mess to me, but folks are thinking hard about the allocation of ventilation technologies in such an event. Let’s hope we don’t need to implement it.
Concept of Operations for Triage of Mechanical Ventilation in an Epidemic — Hick and O’Laughlin, 10.1197/j.aem.2005.07.037 — Academic Emergency Medicine

The recent outbreak of severe acute respiratory syndrome and the growing potential of an influenza pandemic force us to consider the fact that despite great advances in critical care medicine, we lack the capacity to provide intensive care to the large number of patients that may be generated in an epidemic or multisite bioterrorism event. Because many epidemic and bioterrorist agent illnesses involve respiratory failure, mechanical ventilation is a frequently required intervention but one that is in limited supply. In advance of such an event, we must develop triage criteria that depend on clinical indicators of survivability and resource utilization to allocate scarce health care resources to those who are most likely to benefit. These criteria must be tiered, flexible, and implemented regionally, rather than institutionally, with the backing of public health agencies and relief of liability. This report provides a sample concept of operations for triage of mechanical ventilation in epidemic situations and discusses some of the ethical principles and pitfalls of such systems.

Read the whole thing.