British engineers are developing a modern version of the negative-pressure ventilator, according to foreign media reports. But we're all more familiar with the "iron lung," as it's commonly known. As a relief measure for the shortage of ventilators caused by the COVID-19 epidemic, this simple, inexpensive alternative could provide much-needed support for critically ill patients.
Rendering of the exovent
In response to the current epidemic and predicted demand, health authorities need to strike a difficult balance between safeguarding the quantity and safety of medical devices.
Even when the equipment is available, it needs to be monitored by trained professionals. In addition, the dangers to patients and healthcare workers during intubation cannot be ignored.
It's important to note that the iron lung works in reverse to the intermittent positive pressure ventilator. The latter pumps air or oxygen directly into the lungs to help the patient breathe.
A concept introduced in the 17th century, its classic shape involves creating an airtight cylindrical chamber large enough to accommodate a pleasant person, allowing the patient's head to protrude through a special collar.
Inside the chamber was a diaphragm hooked up to an electric motor, which was driven by a crank that caused the diaphragm to expand and contract. As the volume inside the chamber changes, the resulting air pressure rises and falls.
The negative-pressure ventilator allows the patient's chest to expand and contract even when the patient is completely paralyzed. At the height of polio in the 20th century, these iron lungs were common in hospitals and even in homes.
Although it has since been replaced by more advanced machines, the crisis caused by the COVID-19 pandemic has led many to turn their attention to it once again.
The University of Warwick, the Marshall Aerospace and Defense Group, the Imperial NHS Trust, the Royal Ear, Nose and Throat Hospital, and a team of citizen scientists, clinicians, academics, manufacturers, and engineers have developed a new NPV device they call the "exovent".
The device is currently in the prototype stage and will be tested in two intensive care clinics in the UK. Unlike a ventilator, the exovent requires no intubation and is simpler to design and operate.
The designers say patients are able to stay awake, take medication, eat and drink, and talk to someone over the phone. The machine also improves cardiac efficiency by 25 percent compared with traditional ventilators, so watch out for adverse effects on heart function.
The developers say they expect to manufacture 5,000 units of the exovent in the United Kingdom within a week once it is approved. In addition, the device can be used in routine wards, freeing up valuable ICU resources for critically ill patients.
Because the machine encloses only the chest cavity to compress air and oxygen, the few moving parts involved are readily available and can be individually adapted to the patient.
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