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The birth of intensive care

Intensive care. How many times we heard about this hospital unit in the last weeks? One bed in ICU draws a line between life and death. If the ICU is full, people that cannot access it might die. 

Are you waiting for another article about Covid-19? Not this time. I will talk instead about a 70-years-old epidemic: the polio outbreak in Denmark. Why? Because thanks to it, ICUs were invented.

The Danish polio outbreak

August 1952. At the Blegdam Hospital in Copenhagen, 50 people were hospitalized every day. 12-24% of patients developed respiratory failure, and the only cure available was the iron lung. The city had one available, and dozens of people died because they couldn’t access it. Half of them were children. The situation was dramatic, until when Bjørn Ibsen had an idea that revolutionized modern medicine. 

The iron lung

Before explaining Ibsen’s idea, let’s see how the iron lung works. It creates negative pressure around the body, forcing ribs (and therefore lungs), to expand. Air would then flow inside the lungs to fill the empty space. Unfortunately, weak patients were not able to swallow, therefore saliva and stomach content could also be sucked in the lungs, causing suffocation. 

Ibsen’s idea

Ibsen proposed an opposite approach. His idea was to actively blow air in the lungs through tracheostomy: after making an incision in the neck, a tube was inserted into the windpipe to deliver oxygen to the lungs. In this way, they would expand as consequence of the air coming in, and then the body would relax during exhalation. The first patient to be treated in this way was Vivi Ebert, a 12-years-old girl with respiratory failure. Ibsen inserted a tube in her windpipe, then blew air to her lungs by constantly squeezing a bag attached to it. She survived, demonstrating that the technique was successful. There was only one problem: suitable ventilators weren’t available at that time. So what happened? In six-hours shifts, medical and dental students from the University of Copenhagen ventilated patients by hand. This heroic effort continued for several weeks. Mortality dropped from 87% to 31%, and approximately 120 lives were saved thanks to this strategy. Intensive care units were born.

Remember the 26th of August

Some anesthetists and doctors mark on their calendars the 26th of August as ‘Bjørn Ibsen day’. Maybe it would be a good idea to put it in our calendar as well, to honor a low profile innovator who changed healthcare forever and contributed to save thousands of lives.

Bjørn_Aage_Ibsen

A portrait of Ibsen, taken from Wikipedia.

Source

https://www.nature.com/articles/d41586-020-01019-y

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