Carl Gunnar Engström
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Carl Gunnar David Engström (1 September 1912 – 9 January 1987) was a Swedish physician and innovator. He is the inventor of the first intermittent positive pressure mechanical ventilator that could deliver breaths of controllable volume and frequency and also deliver inhalation anesthetics. The Engström150 Respirator (EngströmUniversal Respirator) began series production in 1954. The basic principle of the mechanical ventilator is still the same today, but a technological leap was made with the Siemens-Elema servo fan in the 1970s.


Life

Engström was born on 1 September 1912 in Oskarshamn to Carl Johan Engström and Judith Ringberg. He obtained is degree in medicine in 1941. He worked from 1941 at Stockholm Hospital for Infectious Diseases and started to work in the Swedish Air Force in 1956. He got his PhD in medicine at the
Uppsala University Uppsala University ( sv, Uppsala universitet) is a public university, public research university in Uppsala, Sweden. Founded in 1477, it is the List of universities in Sweden, oldest university in Sweden and the Nordic countries still in opera ...
in 1963 with a thesis entitled ''The clinical application of prolonged controlled ventilation: with special reference to a method developed by the author''. Before the invention of Engström, the only available respirator was the iron lung. It is negative pressure ventilator, a
mechanical respirator A ventilator is a piece of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators ...
which encloses most of a person's body, and varies the air pressure in the enclosed space, to stimulate breathing.Jackson, Christopher D., MD, Dept. of Internal Medicine, and Muthiah P Muthiah, MD, FCCP, D-ABSM, Assoc. Prof. of Medicine, Div. of Pulmonary / Critical Care / Sleep Medicine, Univ. of Tennessee College of Medicine-Memphis, et.al.
"What is the background of the iron lung form of mechanical ventilation?,"
April 11, 2019, Medscape, retrieved April 12, 2020 (short summary of iron history and technology, with photo)
Grum, Cyril M., MD, and Melvin L. Morganroth, MD
"Initiating Mechanical Ventilation,"
in '' Intensive Care Medicine'' 1988;3:6-20, retrieved April 12, 2020
It assists
breathing Breathing (or ventilation) is the process of moving air into and from the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen. All aerobic creatures need oxygen for cellular ...
when
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
control is lost, or the work of breathing exceeds the person's ability suffering from
polio Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe s ...
and botulism and certain poisons (for example,
barbiturates Barbiturates are a class of depressant drugs that are chemically derived from barbituric acid. They are effective when used medically as anxiolytics, hypnotics, and anticonvulsants, but have physical and psychological addiction potential as ...
,
tubocurarine Tubocurarine (also known as ''d''-tubocurarine or DTC) is a toxic alkaloid historically known for its use as an arrow poison. In the mid-1900s, it was used in conjunction with an anesthetic to provide skeletal muscle relaxation during surgery or ...
). Rows of iron lungs filled hospital wards at the height of the polio outbreaks of the 1940s and 1950s helping children, and some adults, with bulbar polio and bulbospinal polio. A polio patient with a paralyzed diaphragm would typically spend two weeks inside an iron lung while recovering. This machine kept the patient breathing, with the help of underpressure and overpressure. The whole body, except the head, was placed in a pressure chamber, where it was not possible to regulate how much air the patient received. Engstrom found that the iron lungs did not adequately ventilate patients with severe poliomyelitis. This problem solved Engström with his respirator, by blowing air into the patient's lungs via a simple
tube Tube or tubes may refer to: * ''Tube'' (2003 film), a 2003 Korean film * ''The Tube'' (TV series), a music related TV series by Channel 4 in the United Kingdom * "Tubes" (Peter Dale), performer on the Soccer AM television show * Tube (band), a ...
through the trachea. The respirator had a cylinder to determine the amount of air, and a pump. A tube was inserted into the patient's trachea, a small balloon was inflated as a seal around the tube, and then the respirator pumped air into the lungs. The amount of air and the amount per unit of time was set with a knob. Engström patented the respirator in 1950. Engstrom's respirators were used for the first time in Blegdams Hospital,
Copenhagen Copenhagen ( or .; da, København ) is the capital and most populous city of Denmark, with a proper population of around 815.000 in the last quarter of 2022; and some 1.370,000 in the urban area; and the wider Copenhagen metropolitan ar ...
, Denmark, during a polio outbreak in 1952. Engström respirators were also tested in the 1953 Swedish polio epidemic. The Engstrom 150 Respirator (Engstrom Universal Respirator) began series production in 1954. Mivab, the company that first manufactured Engström's respirator, is today a part of the Datex / Ohmeda division of
General Electric General Electric Company (GE) is an American multinational conglomerate founded in 1892, and incorporated in New York state and headquartered in Boston. The company operated in sectors including healthcare, aviation, power, renewable energ ...
Health Care.
Positive pressure ventilation Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional pref ...
systems are now more common than negative pressure systems like the iron lungs. It proved to be lifesaving in other conditions including respiratory insufficiency and soon superseded the iron lung throughout Europe.


References


External links


Image of the 1954 Engstrom 150 respirator at www.woodlibrarymuseum.org

Picture of Carl-Gunnar Engström, page 12
{{DEFAULTSORT:Engstrom, Carl Gunnar 1987 deaths 1912 births 20th-century Swedish physicians 20th-century Swedish inventors Scientific instrument makers