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From Iron Lungs to Modern Ventilators - A Look at our History

Clinical healthcare terminology and words like ventilator, respirator, N95, PPE seem to be at the tip of the tongue of … just about everyone these days. At Barlow Respiratory Hospital the terminology and the commitment to care they represent, is nothing new.

We were founded in Los Angeles in 1902 as a tuberculosis sanatorium at a time when there were limited medical interventions available. Beyond our history of providing care for patients with respiratory illness, for decades, we have specialized in serving patients on mechanical ventilators. We developed the Therapist-Implemented Patient-Specific “TIPS©” Weaning Protocol, published in the medical journal CHEST in 2001, now considered a best practice and utilized in weaning patients from mechanical ventilation nationwide.

Barlow Respiratory Hospital is a long-term acute care hospital (LTCH / LTACH) in Los Angeles that provides post-ICU care and ventilator weaning for patients who are chronically critically ill and medically complex. We are the only not-for-profit respiratory hospital in California.

While we do not yet know what our role will be in this current COVID-19 crisis, we continue to monitor the situation and remain at the ready with years of experience on the front lines as historic diseases – tuberculosis, influenza and polio – have been tamed. Tuberculosis patients were once treated with lung-collapse procedures at Barlow Respiratory hospital before early cures were developed in the last century. Polio patients were treated at Barlow using an iron lung through the 1950s. Methods of care were transformed when mechanical ventilation evolved as standard practice for the treatment of patients with acute respiratory failure in the first ICUs in the 1960s. Patients now come to Barlow Respiratory Hospital after an extended stay in the ICU and many are on mechanical ventilators.

THE IRON LUNG
Polio, or Poliomyelitis, was a crippling communicable disease caused by a virus. There was no cure. Beginning in 1916, polio epidemics appeared each summer in at least one part of the country, with the most serious occurring in the 1940s and 1950s. In 1952, the worst epidemic year, three thousand people died from polio.

The iron lung, a negative pressure ventilator, was invented in 1927 to enable patients with polio to breathe on their own. Most patients spent a few weeks or months in the iron lung to reverse the paralysis of chest muscles associated with polio.

At the height of the polio outbreaks, rows of iron lungs filled hospital wards to help patients with paralyzed lungs breathe. An iron lung like this one (left: Man using an Emerson tank respirator equipped with a mirror, 1950s. Courtesy of Post-Polio Health International) was used to treat patients with polio at Barlow Respiratory Hospital.

Polio vaccination programs have now virtually eradicated new cases of the disease in the United States. Widespread vaccinations began in 1955 and by 1979 the virus had been completely eliminated in the United States. Because of this, and the development of modern ventilators, and widespread use of tracheal intubation and tracheotomy, the iron lung has mostly disappeared from modern medicine. Barlow Respiratory Hospital keeps one iron lung on display as a reminder of those days.

Now, modern mechanical ventilators , positive pressure ventilation systems, are the standard of care and work by blowing air

into a patient's airways and lungs using a breathing tube. Types of breathing tubes include endotracheal, or ET tubes, that are placed into the mouth or nose and down into the windpipe, and tracheostomy tubes that are placed in an opening through the neck into the windpipe (trachea).

Most of the patients who come to Barlow Respiratory Hospital on a ventilator have a tracheostomy tube. Barlow has expertise in ventilator weaning to liberate those patients from mechanical ventilation using the “TIPS©”weaning protocol.


AWARD-WINNING RESPIRATORY CARE
Barlow Respiratory Hospital has served chronically critically ill and medically complex patients with specialized respiratory care for more than a century. The hospital has a legacy of serving patients who cannot be cared for in any other setting including those who suffer the stigma of a frightening, communicable disease. Now in a second century of service, Barlow Respiratory Hospital is among a handful of hospitals nationwide that has earned the Gold Seal of Approval® for Disease Specific Certification for Respiratory Failure by the Joint Commission, the only one in California. Barlow is also the only West Coast Passy-Muir Center of Excellence, recognized for treating patients with tracheostomies, on and off the ventilator.

EDUCATIONAL PARTNERSHIPS AND AFFILIATED MEDICAL PROFESSIONAL TRAINING PROGRAMS
By the early 1960s, the number of tubercular patients had decreased dramatically along with important training opportunities for nursing students. The Sisters of St. Joseph of Carondelet Mt. St. Mary’s School of Nursing contracted with Barlow Sanatorium Association in Los Angeles in April 1961 to permit students four weeks of clinical experience in the care of patients with long term or chronic respiratory diseases, especially tuberculosis.

Barlow has historically served as an affiliated teaching facility to train generations of physicians, nurses, respiratory therapists, physical, occupational and speech therapists, pharmacists, and clinical nutrition allied health professionals. Our tradition of educating medical professionals of the future to care for the chronically critically ill is a vital role Barlow plays in our community, and one in which we take great pride.

RECENT HISTORY, 21ST CENTURY AND BEYOND
In 1984 Barlow Respiratory Hospital was certified as a Long Term Acute Care Hospital (LTCH/LTACH), to serve patients with specialized post-ICU respiratory care.

Barlow leads LTACHs in outcomes reporting with over 90 publications –most notably the Therapist-Implemented Patient-Specific “TIPS©” weaning protocol in 2001, and the 23 hospital Ventilation Outcomes Study published in 2007. Beginning in 2017, we have published an annual Outcomes Book, reporting on data specific to our weaning and patient care outcomes.



Barlow Respiratory Hospital is an established national leader in Ventilator Weaning and serves patients referred by nearly 100 regional hospitals in California.

Since 1988 we have treated nearly 22,000 patients including close to 7,000 patients in our ventilator weaning program.


Our clinical staff is trained, experienced and ready for whatever this current crisis may bring.