Bjorn Ibsen

Bjørn Aage Ibsen (born August 30, 1915 in Frederiksberg ; † August 7, 2007 in Copenhagen ) was a Danish anesthetist and a co-founder of intensive care medicine .

education

As a medical student in a provincial hospital in Jutland , Ibsen gained his first anesthetic experience with ether masks and tongue holders as early as 1939 . After successfully completing his medical studies in 1940 at the University of Copenhagen ( Københavns Universitet ), Ibsen initially aimed for a career as a surgeon . It was not until 1949 that he changed his career when he received an offer from the Massachusetts General Hospital to be trained as an anesthetist under the direction of the famous doctor Henry K. Beecher .

The development of the intensive care unit

Ibsen's key experience: his first long-term ventilation in 1952

In March 1952, the doctor Mogens Bjørneboe treated a newborn child with congenital tetanus . The child had severe cramps , and Bjorneboe wondered if it was possible to treat these cramps with curare . However, he did not know of any trained anesthetist who was able to perform this treatment. He remembers that two years earlier, on a boat trip back from the USA, he met Ibsen's wife, who told him about her husband's work. Bjørneboe decided to offer Ibsen a collaboration.

Ibsen curated and ventilated the child manually with a resuscitator . The child initially recovers quickly. Ibsen hesitated, however, and finally interrupted the treatment because Henry K. Beecher taught him a negative attitude towards long-term curarization of patients in Boston . The child quickly began to tense up again and died shortly afterwards.

For Ibsen, this was a key experience to question some of the methods and theories that had been learned from the USA so far .

The great poliomyelitis epidemic of 1952

In the breakout year of the great polio - epidemic in Denmark (1952) were registered over 5,722 poliomyelitis cases, including more than 2,450 with respiratory paralysis . The for Copenhagen competent Blegdam - hospital , took in the first six weeks after the outbreak of the epidemic daily between 30 and 50 polio patients, but only one for the iron lung and six Cuirass respirators were available. In view of the exceeded admission capacities, the medical team under the direction of Henry Lassen looked for alternative treatment methods. Mogens recommended Bjørneboe to invite the anesthetist Bjørn Ibsen for an interview. Two years earlier, Ibsen had come across an article written by AG Bower together with others, in which the successes of mechanical positive pressure ventilation as a supplement to negative pressure monitoring in the treatment of polio patients were described.

Ibsen had the intuition that patients with bulbar and / or respiratory poliomyelitis do not die from an overabundance of viruses in the blood or in the brain , as has been suggested by many colleagues, but rather from an increase in the CO ₂ content in the blood due to hypoventilation . He autopsied four deceased poliomyelitis patients who were ventilated through the iron lung and found excessive carbon dioxide levels, although the lungs were functional. Henry Lassen then asked Ibsen to work out a treatment method within a weekend in order to then try it out on a patient selected by Lassen.

Ibsen's first IPPV ventilation treatment during the poliomyelitis epidemic

On August 26, 1952, a seriously ill 12-year-old girl was admitted who suffered from severe poliomyelitis . Her legs, arms and breathing muscles were already partially paralyzed. The girl's lungs were almost completely closed and threatened to choke on her own saliva for a short time . The following day Ibsen undertook the treatment of the patient under the eyes of the medical team of the Blegdam Hospital. As first the ENT - physician Dr. Falbe-Hansen using local anesthesia a tracheostomy performed, the child fell into respiratory distress and panic and could not initially Ibsen intubated be. Ibsen decided to put the child into an artificial coma to suppress the bronchospasm . Ibsen's colleagues then assumed that the treatment had failed and left the room. Ibsen first sucked off the lung mucus and then ventilated the patient manually using an oxygen- filled bellows . The colleagues who returned found that Ibsen was able to ventilate the patient and that the lungs were almost free of mucus.

Using the experiment , Ibsen demonstrated that the previous standard treatment with negative pressure ventilation resulted in high CO ₂ values ​​in the exhaled air, even if the oxygen saturation in the blood was satisfactory. In addition, the symptoms of an increase in CO _{2 were} made recognizable: high blood pressure and wet, cold and sweaty skin . Although the symptoms were already known, the connection with the level of CO ₂ in the blood was not recognized.

After Ibsen's demonstration, Henry Lassen ordered all polio patients with breathing difficulties to ventilate manually within 3 days. This presented an enormous logistical challenge: monitoring stations were set up for treatment, at the height of the epidemic 250 medical students and 260 nurses were employed to ensure continuous positive pressure ventilation of the patients, the mortality rate of patients with respiratory problems at Bledgdamshospital then fell from 87% 25%.

The confirmation of long-term ventilation as therapy and the establishment of the first intensive care unit

In June 1953, a child with tetanus was admitted to Blegdam Hospital. This time Ibsen decided to carry out the treatment he had already described from 1952 without premature termination. For Ibsen, the symptoms of a tetanus patient who cannot breathe due to convulsions and a polio patient who can no longer breathe due to muscle weakness were very close. He curated the tetanus patient to put him into a polio-like state, then he manually ventilated the child with a resuscitator . The treatment lasted for 17 days (with alternating teams) until the little patient woke up again.

As an external employee of the Blegdam Hospital, Ibsen billed the administration for 17 days. Startled by the high costs, the city of Copenhagen decided to hire Ibsen internally as a doctor and give him the task of setting up an anesthesia department.

In 1954 Ibsen headed an independent anesthesia department in the municipal hospital in Copenhagen and set up an all-day recovery room , which enabled intensive treatment of patients independent of diagnosis and illness and trained specialist staff exclusively for intensive care, thus establishing the world's first intensive care unit .

Honors

• Ibsen was the commander of the Dannebrogden
• August 26th (1952, the first IPPV treatment) is commemorated as "Björn Ibsen Day"

Web links

• S. Pincock Bjørn Ibsen: The Lancet 2007.
• L. Reisner-Sénélar; The Danish anesthetist Bjørn Ibsen - a pioneer of long-term ventilation via the upper airways, dissertation to obtain the doctoral degree in medicine from the human medicine department of the Johann Wolfgang Goethe University in Frankfurt am Main

Individual evidence

1. ↑ ^{a b} Stephen Pincock: Bjørn Aage Ibsen. In The Lancet . Vol. 370, H. 9598, November 3, 2007, p. 1538, doi: 10.1016 / S0140-6736 (07) 61650-X .
2. ^ [Mogensen, JV, Bjørn Ibsen in Memoriam. DASINFO (Journal of the Danish Society for Anesthesia and Intensive Care Medicine) Oct. 2007. p. 47.]
3. ↑ [Ibsen, B., From anesthesia to anesthesiology. Personal experiences in Copenhagen during the past 25 years. Acta Anaesthesiologica Scandinavica. Supplementum 1975; 61: p. 9]
4. ↑ [Ibsen, B., From anesthesia to anesthesiology. Personal experiences in Copenhagen during the past 25 Years. Acta Anaesthesiologica Scandinavica. Supplementum 1975; 61: 1-69, P. 21.]
5. ↑ ^{a b c} [L. Reisner-Sénélar; The Danish anesthetist Bjørn Ibsen - a pioneer of long-term ventilation via the upper airways, dissertation to obtain a doctorate in medicine from the human medicine department of the Johann Wolfgang Goethe University in Frankfurt am Main]
6. ^ ^{A b} L. Reisner-Sénélar, The birth of intensive care medicine: Bjørn Ibsen's records. Intensive Care Medicine, May 2011 ( Memento of the original from March 4, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
7. ^ [Bower, AG, Bennett, VR, Investigation on the Care and Treatment of Poliomyelitis Patients. Part I and II. Annals of Western Medicine and Surgery 1950; 10: pp. 561-582 and 11: pp. 686-716.]
8. ↑ [Ibsen, B., From anesthesia to anesthesiology. Personal experiences in Copenhagen during the past 25 Years. Acta Anaesthesiologica Scandinavica. Supplementum 1975; 61: 1-69, P. 31.]
9. ^ [Ibsen, B., Organization of an intensive therapy department in Copenhagen. Retrospect and Prospect. The anesthetist 1986; 17: P. 272-7.]
10. ↑ [Ibsen, B., From anesthesia to anesthesiology. Personal experiences in Copenhagen during the past 25 years. Acta Anaesthesiologica Scandinavica. Supplementum 1975; 61: 1-69, p. 29.]
11. ↑ RV Trubuhovich: August 26th 1952 at Copenhagen: 'Bjørn Ibsen's Day'; a significant event for anesthesia. In: Acta anaesthesiologica Scandinavica. Volume 48, Number 3, March 2004, pp. 272-277, doi : 10.1111 / j.0001-5172.2004.0328.x , PMID 14982558 .
12. ↑ [Klinikum im Friedrichshain, Symposion Bjørn Ibsen - Remembrance Day: Intensive care medicine began in Europe 65 years ago] [1]