BjÃ¸rn Aage Ibsen
Back in 1939, won Ibsen as a medical student in a provincial hospital in Jutland first anesthesia experience with Ethermasken and tongue holders. After successfully completing his medical studies in 1940 at the University of Copenhagen ( Københavns Universitet ) sought Ibsen initially but a career as a surgeon at. It was not until 1949 he changed his career when he received an offer from the Massachusetts General Hospital to be trained under the guidance of the famous physician Henry K. Beecher to the anesthesiologist.
Developing the ICU
Ibsen's key experience: his first long-term ventilation 1952
In March 1952, the doctor Mogens Bjørneboe treated a newborn child with congenital tetanus. The child had severe cramps, and Björneboe wondered if it was possible to treat these cramps with curare. However, he did not know a trained anesthesiologist who was able to perform this treatment. He remembers that he had two years previously met on a boat trip from the U.S., Ibsen's wife, who told him about the work of her husband. Bjørneboe Ibsen decided to offer a collaboration.
Ibsen curarisierte and the child ventilated manually with a resuscitator. The child recovers quickly at first. Ibsen hesitated, and finally stopped the treatment because He was taught by Henry K. Beecher, a negative attitude for long-term curarization of patients in Boston. The child began quickly to cramp and died shortly thereafter.
For Ibsen, this was a key experience to provide the previously learned from the U.S. methods and theories partly in question.
The great polio epidemic in 1952
In the breakout year of the great polio epidemic in Denmark ( 1952) 5,722 cases of poliomyelitis were registered, including more than 2,450 with respiratory paralysis. The body responsible for Copenhagen Blegdam Hospital, took in the first six weeks after the outbreak of the epidemic day between 30 to 50 polio patients, but for which only an iron lung and six Cuirass respirators were available. Given the exceeded absorption capacities searched the medical team under the direction of Henry Let for alternative treatment methods. It recommended Mogens Bjørneboe to invite the anesthesiologist Bjørn Ibsen for an interview. Ibsen was two years ago on one of A. G. Bower joined together with other authored article in which the success of a mechanical positive pressure ventilation have been described as a supplement to the vacuum beam stays in the treatment of polio patients.
Ibsen had the intuition that patients do not die with bulbar and / or respiratory poliomyelitis at a superset of virus in the blood or in the brain, as has been held by many colleagues, but due to hypoventilation related increase of CO2 concentration in the blood. He obduzierte four late poliomyelitis patients were ventilated by the iron lung and found excessive levels of carbon dioxide, although the lungs were functional. Let Henry Ibsen called on then, over one weekend work out a treatment method for in order then to test in a patient selected from Lassen.
Ibsen's first IPPV treatment during the poliomyelitis epidemic
On August 26, 1952 a seriously ill 12 - year-old girl was admitted, which suffered from severe poliomyelitis. Your legs, arms and breathing muscles were already partially paralyzed. The girl had an almost completely zugeschleimte lungs and threatened to choke on your own saliva in the short term. The following day, Ibsen undertook under the eyes of the medical team of the Blegdam Hospital, the treatment of the patient. As the first otolaryngologist Dr. Falbe -Hansen performed a tracheotomy using local anesthesia, the child fell into respiratory distress and panic and could not of Ibsen initially be intubated. Ibsen decided to place the child in an induced coma in order to suppress the bronchospasm. Ibsen 's colleagues then took on that treatment had failed and left the hall. Ibsen initially drawn from the lung mucus and then undertook manual ventilation of the patient by means of an oxygen-filled bellows. The returned colleagues found that Ibsen could ventilate the patient and the lungs were almost mucus- free.
Based on the experiment demonstrated Ibsen, that the current standard treatment with negative pressure ventilation resulted in high CO2 levels in the exhaled air, even if the oxygen saturation in the blood was satisfactory. In addition, the symptoms of a CO2 increase were made visible: high blood pressure and a cold, wet and sweaty skin. Although the symptoms were already aware of the context of the CO2 content in the blood was not recognized.
After the demonstration Ibsen, Henry Let prompted within 3 days all polio patients with respiratory problems manually ventilate. This was a huge logistical challenge: monitoring stations were used to treat established at the peak of the epidemic 250 medical students and 260 nurses were employed to ensure a continuous positive pressure ventilation of patients, the mortality rate of patients with respiratory complaint on Bledgdamshospital dropped then from 87% to 25 % ..
The confirmation of the long-term ventilation as therapy and the establishment of the first intensive care unit
A child with tetanus was admitted to Blegdam Hospital in June 1953. Ibsen decided this time to carry out his already described treatment from 1952 without premature termination. For Ibsen, the symptoms of tetanus patients who can not breathe because of convulsions, and a polio patient who can not breathe due to muscle weakness were very close. He curarisierte the tetanus patients to put him in a polio -like condition, then he ventilated the child with a manual resuscitator. The treatment gave 17 days to ( with alternating team) to the small patient woke up.
As an external employee of Blegdam Hospital, presented the Ibsen administration 17 days into account. Alarmed by the high cost, the City of Copenhagen Ibsen decided to adjust internally as a doctor and to delegate the task to establish an anesthesia department.
1954 led Ibsen on the commune hospital in Copenhagen an independent anesthesia department and set up a full-day recovery room, which allowed a diagnosis and disease- independent intensive treatment of patients as well as qualified personnel trained exclusively for the intensive treatment, thus the world's first intensive care unit was established.