The rocking bed and pneumobelt are noninvasive ventilators that were developed and saw their greatest use during the latter years of the polio epidemics but are used rarely today. They both rely on the effect of gravity to assist diaphragmatic motion and are particularly well suited to patients with severe diaphragmatic weakness or paralysis. Neither one should be used in the management of acute respiratory failure, and both have limited present-day applicability. Despite the similarities, there are also important differences, such as portability and suitability for nocturnal versus daytime use. This chapter reviews the historical development, mechanisms of action, and present-day uses of the rocking bed and pneumobelt. Glossopharyngeal breathing, another noninvasive approach to ventilator assistance, is discussed briefly at the end of the chapter.
The conceptual groundwork for development of the rocking bed was laid during the early 1930s by Eve,1 who described the use of manual rocking to assist ventilation in two patients with acute respiratory paralysis. The technique consisted of placing the patient supine on a stretcher that was pivoted on a fulcrum placed at waist level. The patient then was rocked up and down approximately 45 degrees in either direction. Eve noted that the “weight of the viscera pushed the flaccid diaphragm alternatively up and down,” achieving artificial respiration.1 The technique was adopted subsequently by the British Navy as the recommended means of resuscitation for drowning victims.2 Later studies demonstrated that this tilting method compared quite favorably with other resuscitation methods of the day, and it remained an acceptable means of resuscitation until mouth-to-mouth resuscitation gained acceptance during the 1960s.3,4
Automatic rocking beds were first introduced as ventilatory aids during the late 1940s. Wright5 was the first to describe the management of respiratory insufficiency using an oscillating bed that had been designed originally to assist circulation. This experience led to the development of the McKesson Respiraid rocking bed, which was accepted by the Council on Physical Medicine and Rehabilitation in 1950.6 Intended mainly as an aid to weaning patients with poliomyelitis from dependence on the tank respirator,7 it facilitated nursing care and enhanced patient freedom but was quite noisy, bulky, and heavy (455 kg).6,7 The Emerson rocking bed (J. H. Emerson Co., Cambridge, MA), also introduced during the late 1940s, was quieter and lighter than the McKesson bed and became the dominant model during the 1950s. Hundreds of rocking beds were manufactured between 1950 and 1960 (Emerson JH, personal communication), but after introduction of the Salk and Sabin vaccines and control of the polio epidemics, demand fell drastically. Many survivors of the polio epidemics continued to use rocking beds for ventilator support, sometimes for decades,8 but most have since died or switched to other ventilators, and present-day use is rare.
The intermittent abdominal pressure respirator or insufflator (pneumobelt) was introduced at the end of ...