Ventilator-Assisted Living©

Fall 1998, Vol. 12, No. 3

ISSN 1066-534X

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Read selected articles from this issue ...

Longterm Ventilation for Children in the United Kingdom
Dr. Robert Yates, MBBS, MSc, MRCP, FRCPCH, DA, Royal Manchester Children's Hospital, Manchester, United Kingdom

Speech for Tracheostomy Positive Pressure Ventilator Users
Jeannette D. Hoit, PhD, University of Arizona, Tucson, Arizona

Conversion: Iron Lung to Porta-Lung?
Carol Purington, Colrain, Massachusetts

Conversions: Pressure-Limited to Volume Ventilator
Gary Presley, Aurora, Missouri, and Dick Wieler, Columbia, Missouri

Bibliography, Calendar, etc.

Ventilator Obsolescence

Conversion: Iron Lung to Porta-Lung?

Carol Purington, Colrain, Massachusetts

After 42 years, Carol is trying to switch from night-time use of an iron lung to a Porta-Lung powered by the NEV-100. Carol contracted polio in 1955 at the age of 6. Since early May 1998, she has been experimenting with pressure settings and gradually increasing time in the Porta-Lung.

In April 1998, I had a momentous visit from the Boston district manager for Respironics, Michelle Schweiger, who told me that it is becoming increasingly difficult and expensive to keep parts and trained mechanics available for the iron lung.

We discussed the advantages of switching from the iron lung to the Porta-Lung, a smaller, lighter, fiberglass version of the iron lung that provides equally effective ventilation. Its power source, the NEV-100, would also run my chestpiece.

I decided to undergo a trial period (free) with the Porta-Lung in May. If I was going to attempt such a change, I definitely wanted to do it when healthy and rested, when convenient for my family, and when decisions could be made slowly. Obviously, there would be both physical and psychological adjustments.

One of my brothers made a stand for the Porta-Lung, which comes on very short legs, rather like a dachshund. The stand, made of plywood and two-by-fours, is on casters so it rolls easily. It brings the large model (140 lb.) Porta-Lung up to hospital bed height and takes up about as much floor space as the iron lung.

The mattress is comfortable, the headrest stable and level with the mattress, and the pillow a good firmness. The collar is identical to that of the iron lung, as is the mirror. The appearance of the front of the Porta-Lung is also familiar, except for the blue color, but the mirror view of its see-through door is startling. I felt like Sleeping Beauty in her glass case.

With the door closed, there is very little space between it and my left elbow. The Porta-Lung is several inches narrower than the iron lung (large size is 84" long and mattress width is 23"), and I was conscious of a confined sensation. Different positioning corrected that. The NEV-100 is computerized, with menu-driven settings. The whoosh-whoosh rhythm of the inspiration/expiration cycle is punctuated by a noise rather like the chirp of an electronic bird. It comes well-equipped with alarms, adjustable in pitch and volume.

The first session to work out approximate pressure settings was very fatiguing. I had to rely on the Porta-Lung to breathe for me, of course, because otherwise how could I tell if the settings were right? There is no other way, but it certainly was an exhausting process. There is psychological stress, as well, trying to ignore the lack of sufficient air while concentrating on what is wrong with the settings. By the end of the session, I was being fairly well ventilated by the Porta-Lung.

Becoming accustomed to the new rhythm went more slowly than I expected. The feeling of how it breathes for me was very different, somehow jerky – not uncomfortable and not exactly unpleasant, just different. I still felt tired after each practice. After I managed six hours at a stretch, I tried sleeping in the Porta-Lung.

The experience of the first night in the Porta-Lung was somewhere between great and dreadful. I woke up much too often to say I slept well, but I was never in enough distress to be counting the hours until morning.

My first double-header in the Porta-Lung went fairly well, the second night better than the first. But going back into the iron lung on the third night felt wonderfully familiar and refreshing. I started a chart on which I record various aspects of my nights – breathing comfort, restedness, quality and quantity of sleep, etc. The scores for the times in the Porta-Lung were 54% and 60%; the iron lung's score was 88%.

I decided to talk with Sunny Weingarten, fellow polio survivor and inventor and manufacturer of the Porta-Lung. He is friendly, sympathetic, and informative. I would have had an easier time with the pressure settings if I had called him sooner.

Several problems still need solving. One is how to position myself for postural drainage so that my left side is higher than my right. The iron lung has a good mechanism for tilting the bed-frame, and I have tried tipping the Porta-Lung mattress, which has a rounded bottom making it easy to tip. The angle seems to provide sufficient left-side elevation, but it places unacceptable pressure on the right side of my neck. That is another problem: how to avoid neck chafing. Also, my mother or other caregiver always works on my right side with the iron lung. My scoliosis means that caring for me from the left side is not the same as working from the right. The large Porta-Lung model I have only opens from the left. (The model with a right-side opening is only available custom-made, using the medium size as a base. It is almost as long as the large model, but the diameter is still the medium size – 20 inches – too small for my broad shoulders.)

By the end of July, I had used the Porta-Lung for 25 consecutive nights, and was sleeping and feeling well. One night I awarded the Porta-Lung a score of 94%. Soon I will have to decide whether to make a permanent change from old to new – a major choice for me and my caregivers, especially my mother. In addition to the central question of the adequacy of the Porta-Lung's ventilation, the attempted change has involved many subsidiary issues, which have all required thought and effort and research. I suspect each potential user will have different obstacles to overcome.

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