Treatment of polio led to the evolution of the modern ICU

Dr. Andrew Pitkin, a UF clinical assistant professor of anesthesiology and medicine, lectures on 1952 Copenhagen polio epidemic. Photo by Maria Belen Farias

Until the early 1950s, polio was a feared disease that killed and paralyzed thousands of children in the U.S. and abroad. 

Since the polio vaccine was made available in 1955, cases of the viral disease, which can affect nerves, have nearly vanished. But innovations that grew out of treating polio – like the hospital intensive care unit – remain. 

Dr. Andrew Pitkin, MBBS, a UF clinical assistant professor of anesthesiology and medicine, presented the lecture, “Poliomyelitis and the birth of modern intensive care,” on Dec. 8, as part of the monthly History of Medicine lecture series. 

“(The ICU) really is an integral part of medicine today, but it’s hard to remember that wasn’t always the case,” said Pitkin, who trained in internal medicine, anesthesia and critical care in the United Kingdom. 

The evolution of the modern ICU grew out of the reaction of a few doctors to a major polio outbreak in Copenhagen, Denmark in 1952, Pitkin said. There were not nearly enough negative pressure respirators, or ‘iron lungs’, available for the flood of polio patients. 

So Bjorn Ibsen, a Danish anesthesiologist, suggested using positive-pressure ventilation by tracheostomy as a way to save patients whose breathing was affected by polio. 

At Blegdamshospital in Copenhagen, about 250 local medical students were used to manually ventilate polio patients with an anesthesia bag in 8-hour shifts, Pitkin said. That took courage on the medical students’ part, he said, since polio was a contagious disease. Families were typically quarantined from a child with polio. 

“Many patients made lasting friendships with their students,” Pitkin said. 

The first intensive care unit was later established at Kommunehospitalet in Copenhagen in December 1953 and the use of prolonged manual positive pressure ventilation eventually led to mechanical positive pressure ventilation. 

“It was the beginning really of a revolution of medicine,” Pitkin said.