Along with trained and dedicated staff, technology is crucial to an Intensive Care Unit. This page highlights some technological innovations and uses at Winnipeg General Hospital/Health Sciences Centre since the opening of the ICU in 1966.
Monte Raber, head of the Biomedical Engineering Department, was central to developing much of the innovative technology used in the ICU.
Spacelabs Monitoring System
This state-of-the-art monitoring system was first conceived of in 1963 to meet the needs of intensive care. Suggestions were made by Winnipeg General Hospital medical and para-medical staff working in critical care, and the system was designed by Monte Raber, head of the Biomedical Engineering Department at WGH. The contract to build the monitoring systems was given to Spacelabs in California, which also provided instruments for the Apollo Moon landings.
The monitoring system was unique in that they monitored six vital functions and, because the system was made up of individual modules, these modules could be removed or replaced without affecting the overall functionality of the monitoring system. The system monitored electrocardiogram, heart rate, arterial blood pressure (systolic, diastolic, and mean), mean venous pressure, and temperature. All data was displayed on the oscilliscope, or screen. The system was extremely flexible, and all or one of the above could be monitored at a time depending on the needs of the patient.
Alarm indicators could be set by the nurse according to the needs of a particular patient. For example, if the rate rose or dropped, a loud whistle would sound and a red alarm light would turn on. The alarm could not be turned off by remote. It required nurses to physically turn off the alarm, thus ensuring that no emergencies were overlooked. A central monitoring unit was also kept in the nurses’ centre in the middle of the Unit so that patients could also be monitored from there.
In 1967, prototypes for four beds were created and tested; final alterations and improvements were made in 1968 for the final design based on these prototypes. Monitors for twenty-two beds were installed in the ICU at a cost of $125,000, which was made possible through a donation from the James A. Richardson Sr. fund and the funding was approved by his wife.
This monitoring system remained in operation in the ICU until 1985 when MICU and CCU installed the Marquette system. Again, the Marquette system was considered to be the most advanced monitoring equipment being used in a Canadian hospital at the time.
The Kevin Keough Story
The story of Kevin Keough is one of the best examples of how technology became fully embedded in care within the Intensive Care Unit.
In 1971, at the age of 8, Kevin Keough was paralyzed from the chin down while watching a snowmobile race in Kildonan, Manitoba. Kevin was initially sent to the Children’s Hospital, but was later transferred to the ICU in the Winnipeg General Hospital, where he lived in a tailored room for 11 years. The Winnipeg General Hospital newsletter, The Generator, described his room in the following way:
There’s a corner in the Intensive Care Unit that could double as a boy’s playroom. Colourful penants hang on the wall, an aquarium of fish is atop a bedside cupboard, and games, toys and books are much in evidence. In the most prominent spot is an autographed football, bearing the names of the Blue Bombers. It’s a reflection of the sympathy and affection that is felt for 9-year-old Kevin Keough, by the staff of the ICU and by the entire community.
Kevin’s room, aside from resembling a boy’s playroom, was also a modern care unit tailored for his specific medical needs. It featured an alarm system, a telephone headset, and a breath-activated buzzer. Any deviation from his normal breathing pattern would trigger an alarm in the central nursing station in the ICU. There was also a closed-circuit television camera on Kevin at all times, which displayed on a screen in the nursing station. Kevin could also call nurses using the breath-activated buzzer: by blowing into the attached tube, he was able to speak to a nurse at the central station using the telephone headset installed by Manitoba Telecom Services. Kevin could also use this headset to talk to his family and friends outside of the hospital.
Kevin also learned to use many other forms of technology during his time in the ICU. He learned to use a mouth-stick, to paint by holding a paintbrush in his mouth, to type on a special typewriter that worked by shining a flashlight on the keys, to use a page-turner in order to read books, and for Christmas in 1971, the staff in Medical Electronics at HSC modified a road racing set that allowed him to control a toy car by blowing into a tube.
As a result of his accident, Kevin required a ventilator to breathe at all times. Long-term ventilation was provided by a tracheostomy and a small positive pressure respirator, which could be operated by a battery and was therefore portable. The respirator he used was built by Monte Raber, Head of Biomedical Engineering, and Don Hatch of Medical Electronics. Much of Kevin’s equipment was designed by the Rehabilitation Engineering Department specifically for him, and Kevin also tested out many new pieces of equipment that the Respiratory Therapy Department was considering purchasing.
Kevin’s tetraplegia was a result of a snowmobile accident, however some of the experiences and knowledge gained through his care was applied to patients who had contracted polio in the early 1950s and who were, by the 1960s, experiencing further difficulties. One such Home Care patient had been on long-term ventilation during the night in an iron lung, however over time, this was no longer a sufficient method of treatment due to age and bouts of infection. Drawing on their experiences in treating Kevin Keough, hospital staff were able to develop a similar solution for this patient: a tracheostomy and a ventilator that is battery-powered and small enough to be portable. This solution – long term mechanical ventilation (LMV) – has been applied to patients with spinal poliomyelitis, traumatic quadriplegia, motor neuron diseases, restrictive lung disease, obstructive lung disease, and nocturnal hypoventilation. Manitoba is likely the first place to have pioneered the use of uncuffed tracheostomy tubes for treatment of long-term respiration. Uncuffed tracheostomy tubes have the distinct advantage of ensuring that patients will still be able to easily talk, which is a major concern with patients who have polio paralysis.
This portable long-term mechanical ventilation technology was used in Kevin’s custom 200-pound electric wheelchair, which was described by an HSC department head as “a miniature intensive care unit.” The chair was unique and was reportedly the first self-propelled chair with a life-support system and environmental control to be built for someone with a limited mobility like Kevin. The chair was designed and built by a team made up of individuals from the Physics Department, Cancer Centre, Rehabilitation Engineering Department, Rehabilitation Centre, and the ICU, which was frequently consulted. The chair propelled Kevin by blowing into a tube which was positioned in front of his face while he watched an attached electronic scanner with eight small lights on it. Each light corresponded to a different command. For instance, if Kevin blew into the tube when the forward light was on, he would move forward. The harder he would blow into the tube, the faster the chair would move.
Creation of this chair was a two year project with planning beginning in January 1974. Representatives from Biomedical and Rehabilitation Engineering departments, the Shriner’s Hospital, the Paraplegic Association, and from Cancer Care met with Dr. Bryan Kirk at the ICU to discuss the possibilities of such a chair. There was not a suitable chair on the market, so it was decided that they would design and build one themselves. Aside from a few components that were available commercially, the entire chair was designed and constructed at HSC by HSC staff. The chair was built specifically for Kevin, but also with the hope that it might be used as a prototype for other people in similar condition.
Kevin moved out of the ICU and into his own home in 1987. He died in 2006 at the age of 44.
In November 1969, Lynne Derksen, a student at the Canadian Mennonite Bible College in Winnipeg, fell from a hayride and her chest was crushed. She was brought to the Intensive Care Unit at the Winnipeg General Hospital, which arranged for an oxygenator to be flown in from San Francisco, California. Operating staff also accompanied the machine to the Winnipeg General Hospital to operate the new equipment. The equipment functions by exchanging oxygen and carbon dioxide in the blood in the case that there is an interruption to blood flow during a surgical procedure.
Unfortunately, Lynne Dersken died two weeks following her accident. However, her death encouraged a fund-raising campaign (the Lynne Derksen Oxygenator Fund) under the guidance of the Canadian Mennonite Bible College and contributed to by other groups. In an approximately 12 month period, $18,000 was raised to go towards the purchase of an oxygenator for the hospital – at the time, the total cost of the machine with standby lung and other associated equipment would cost between $25,000 and $30,000. $8,000 of this sum came from the Niverville Pop Festival in 1970 – a Woodstock-style music festival hosted in Niverville, about 30km south of Winnipeg. Tickets to the festival cost $1. The purchase of the equipment was postponed due to the rapid developments in the field of oxygenation. Eventually it was decided to use the money raised to create an education fund rather than purchasing the equipment.
In 1971, the machine was again flown in to Winnipeg to help treat a 17 year-old girl whose lungs had been damaged by pneumonia and could no longer oxygenate her blood. The equipment was brought to Winnipeg from California in a U.S. Coast Guard Hercules aircraft, with qualified operating staff: the call was placed at 4am, and in less than an hour an a half, the oxygenator and the staff had boarded the plane. The oxygenator was used to by-pass the patient’s damaged lungs for period of time to allow them to heal.
At the time, the machine was considered to be the only one of its kind in North America. It was developed by M.L. Bramson, who accompanied the oxygenator to Winnipeg.
“We developed some minor modifications – like the bellows that went up and down that told you how much air had been in the patient’s lungs didn’t have an alarm, so we developed an alarm at Biomedical Engineering. And the next time the salesman came in, we showed it to him and he said ‘Where’d you get that?’ ‘Well, we made it.’ And what we would do then – we didn’t worry about patents – we’d just say ‘You take this, take it back to the company, and all we ask is when you start making them, we get the first ones.’”
Dr. Bryan Kirk
[quotation from oral history]
“Winnipeg pioneered some of the weaning techniques. Weaning of mechanical ventilation means when you’ve had a patient on mechanical ventilator for days, weeks, how do you stop that? How do you convert them back into breathing normally? And in the early days, all we could do was to stop [the ventilator] and allow them to breathe for a short period of time, maybe a few times a day, and then slowly increase that. But it was always a transition from you’re supported or you’re on your own, which was very disconcerting for the patients. So the whole idea of trying to develop a ventilator that would allow you to breathe on your own was very complicated because one is a pressurized system and the other is just breathing in the atmosphere. Winnipeg developed one with a timer that at certain times would allow to bridge from one to the other. And that was a collaborative effort from the ICU, Biomedical Engineering, and Respiratory Therapy.
We called it the ‘Winnipeg Weaner’ and that was a precursor of the synchronized intermittent mandatory ventilation, which is widely used. And then in later years when Dr. Magdy Younes was here we developed, again in a collaborative way with a respiratory investigation unit, biomed engineering, and respiratory, the Proportional Assist Ventilator, which was then taken over by Puritan-Bennett and is widely used around the world. That was only possible because we had that collaboration and we had ready guinea pigs: that was us! The fellows who worked there were the guinea pigs for many of these trials, but there was a very positive side to that because you could see what patients were going through yourself.”
Dr. Luis Oppenheimer
[quotation from oral history]
You can view more photographs of technology and equipment here.