19 - Long-term ventilatory support

Summary

Historical introduction

The polio outbreaks that affected the developed world in the early and mid-twentieth century are of particular historical importance. They acted as an impetus to the development of intensive care as a place where ‘life support’ could be provided while awaiting recovery from critical illness. Second, as survival in those who developed respiratory failure occurred, particularly following the introduction of positive pressure ventilation, significant numbers then required long-term respiratory support.

Depending upon the severity of an outbreak, there was the need to provide artificial ventilation to relatively large numbers of polio patients. Most at risk were children and young adults, who had not acquired ‘herd’ immunity. Providing such emergency care was to present major logistic problems for the hospitals at that time. Few ventilators were available before 1940, and even in the 1950s hospitals could easily be overwhelmed. In the healthcare service of today, it is easy to forget the devastating impact of the polio epidemics. Throughout the 1950s, over 3000 died in the US each year and, in the 1952–3 Copenhagen outbreak, one hospital was required to provide mechanical ventilation for 31 patients over the course of 3 weeks. Today, nearly 60 years after effective vaccination brought the epidemics under control, over 100,000 long-term survivors remain alive in the US and up to 30,000 in the UK.