Use of the rocking bed to augment ventilation in patients with poliomyelitis.

As the first step in an attempt to clarify criteria for use of the rocking bed rather than the respirator as an aid to breathing for patients with weakness of respiratory muscle function caused by poliomyelitis, ventilation studies were done on seven patients with pronounced weakness or paralysis of the respiratory muscles. Average tidal air volume was considerably less when the patient was on the rocking bed than when he was in the respirator. Since the tidal air volume with the patient on the rocking bed represents the maximum that can be produced with the apparatus, whereas the volume in the respirator represents the patient's usual tidal air and the respirator is capable of a greater volume if necessary, it is apparent that in cases of complete paralysis of the respiratory muscles the respirator has a large margin of safety, the rocking bed none. From clinical observations made on 51 patients who were put upon the rocking bed-23 of them early in the course of the disease and 28 after they had been ill three months or more-it was concluded that the rocking bed is contraindicated for patients who are febrile and in whom the disease is progressing rapidly, and for those with atelectasis or urinary or pulmonary infection. It must be used with extreme care in the case of patients early in the course of the disease who are not tracheotomized, because of a tendency toward increased accumulation of mucus and the danger of atelectasis. General guides were developed with regard to use of the rocking bed for patients with post-acute poliomyelitis, and somewhat different rules were drawn for use of the apparatus in cases in which there is a chronic respiratory problem.The rocking bed will give artificial respiration in cases of respiratory weakness, but will not provide enough tidal air for the patient with paralysis of the muscles of respiration.