Historical Perspective

Dr Tom Hilliard

Consultant in Paediatric Respiratory & Sleep Medicine

Dr Philip Drinker

Developed ‘iron lung’ ventilator, 1928

1948 US polio epidemic

to supply helium-oxygen mixtures during inspiration. to provide respiration when the tank respirator was opened for nursing procedures. to provide adequate ventilation in emergencies or transfer. to inflate or re-expand lung that was collapsed or.was congested by pulmonary oedema.

Bower and colleagues (Los Angeles) reported success with IPPV applied to the airway. They had two Bennett positive pressure valves which they used to supplement tank respirators:

1952 Copenhagen polio epidemic

• Begdam Hospital, Aug-Dec 1952

• 3000 cases admitted

• 2241 confirmed poliomyelitis

• 1250 had paralysis

• 345 needed treatment for respiratory insufficiency

Dr. Bjørn Ibsen, 1952

• tracheotomy just below the larynx

• inflatable rubber cuff tube in trachea

• frequent suction

• repeated bronchoscopy

• postural drainage

• manual positive pressure ventilation using oxygen and nitrogen.

Re-emergence of non-invasive ventilation

1947 Motley et al. Am J Med ….use of IPPB via mouthpiece for acute care…….

1960s Goldwater Rehabilitation Center, NY ….nocturnal and daytime IPPB for NM disease…….

1981 Sullivan …introduction of face mask for treatment of OSA……

1983 Rideau …..application in DMD………

Survival in hypercapnic patients with DMD

Health-related QoL

Survival by cohort

LTV children in the UK 1999

• Questionnaire survey• Children 0-16 years• 141 children identified

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10

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80

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

New patients

Current patients

Long-term ventilation case load 1996 – 2008