GlobalRPh student writer
One of the major problems in most hospitals during the COVID-19 outbreak is the lack of sufficient ventilators for patients.
As of March 25, 2020, there are more than 400,000 cases of coronavirus globally and at least 18,000 deaths.
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Ventilators, also known as respirators, are breathing machines designed to provide mechanical ventilation and life support for patients who are unable or have trouble breathing. For people with critical COVID-19 cases, mechanical ventilation can mean the difference between recovery and death. The device works by helping the lungs get more oxygen and take carbon dioxide out. It also assists the lungs by pumping oxygen into the blood to our body’s vital organs, As of today, many hospitals are scrambling to find sufficient ventilators for the sick, especially for the ones suffering the most severe effects of the coronavirus.
The reality that there may not be enough ventilators for everyone is starting to grimly affect many health workers in the US. Hospitals are quietly preparing on how they would give limited lifesaving care during a shortage of ventilators, which means some people will be left to die because of medical incapacity. While we can solve this problem by simply manufacturing more ventilators, those things take time and right now fast solutions are what we need to save more lives. In this article, we’ll explore some possible solutions to increase ventilator capacity by two or even four times.
Solution #1: Increasing The Number of Patients with COVID19 who Can Be Ventilated
If we don’t currently have the means to manufacture and supply more ventilators in a short amount of time, the next smart solution would be to increase the number of patients who can be ventilated. Normally, one ventilator is only suited for one patient. Since most patients differ in oxygen need and pressure, using one ventilator for two people can result in one getting too little or too much oxygen. Ventilators adapt to the individuals using the machine, so if there are several people using a single ventilator, how would the machine know whom to adopt? If such cases occur, the machine can injure the lungs and even contaminate patients if one doesn’t have the virus. The idea that one ventilator can work for multiple patients is only used as a last resort and during the surge of patients in pandemic crises. Using a ventilator wisely can be a big lifesaving choice.
Can a ventilator save two, three, or even four lives? Many doctors and medical practitioners believe that the device can. The truth is that most full-featured ventilators go beyond their maximum level of air which allows multiple patients to use the device simultaneously. One full-featured ventilator can provide 2,000 millimeters of tidal volume which is more than enough power for four average-sized patients.
But how do you “split” a ventilator to route the air pumping capacity for multiple patients? A study in 2006 published by Dr. Greg Neyman and Dr. Charlene Babcok reveals how. Using a plastic tubing setup to minimize dead space volume, they were able to create a splitter to provide 12 hours of ventilator use to four lung simulators. They collected data for peak pressure, positive end-expiratory pressure, total minute ventilation, and total tide volume. Results were successful as published in the study.
Using splitters may be a probable solution but it doesn’t come with some issues. First off, sharing ventilators can increase the risk of cross-contamination. This is why it’s very important that ventilators should only be shared with people with confirmed positive cases. Doctors also have to wisely select the patients they will ventilate together. They should try to pair patients that are of matching gender, body size, age, and diagnosis.
Another issue would be the limited space for the patients. Most ICU rooms are designed for only one bed and one patient which means placing two to four under a small room and share a ventilator can be a problem for most hospitals.
Solution #2: Reprogram Sleep Apnea Machines as Ventilators
Home mechanical ventilators such as those used to treat sleep apnea should be used to handle less severe cases of COVID19. By studying the maximum capabilities of the devices, experts have found its potential for patient use. Based on a blog from EMCrit Project, a journal written by independent medical bloggers, most COVID19 patients need positive pressure and the best way to provide this is through the use of continuous positive airway pressure.
Continuous positive airway pressure (CPAP) is a type of noninvasive positive airway pressure designed to maintain constant pressure and stent the airways open in people who are breathing spontaneously. They listed some advantages of CPAP in treating the disease:
- CPAP devices can give the maximal amount of mean airway pressure without the need for intubation.
- CPAP encourages a safer and more “lung-protective ventilation pattern”.
- If used with a closed system with viral filters, it can provide less risk for viral transmission.
- There are far more existing CPAP machines today than ventilators plus they’re less expensive and easy to acquire
CPAP application maintains PEEP (positive end-expiratory pressure (PEEP) while maintaining the set pressure throughout a breathing cycle. This enlarges the alveolus and improves oxygenation. CPAP can be used to “maintain airway patency” for patients suffering from airway collapse which is a common problem for severe cases of COVID-19. The use of these noninvasive ventilation devices has been suggested as support for patients who have no ventilators because at the end of the day some oxygen is better than no oxygen.
Unfortunately, there is still a lot of opinions but no data on the use of CPAP. Hospitals aren’t using them because they can increase the risk of putting secretions into aerosol form meaning people who are caring or are near the patient can easily get infected. CPAP isn’t entirely the best treatment for all COVID-19 patients but it might be helpful for these situations: worsening hypoxemia with no organ failure, exhaustion of the supply of mechanical ventilators, or lack of team capable for intubating patients.