Mechanical-Ventilation Supply and Options for the COVID-19 Pandemic. Leveraging All Available Resources for a Limited Resource in a Crisis

Abstract

The novel coronavirus disease (COVID-19) has exposed critical supply shortages both in the United States and worldwide, including those in intensive care unit (ICU) and hospital bed supply, hospital staff, and mechanical ventilators. Many of those who are critically ill have required days to weeks of supportive invasive mechanical ventilation (IMV) as part of their treatment. Previous estimates set the U.S. availability of mechanical ventilators at approximately 62,000 full-featured ventilators, with 98,000 non–full-featured devices (including noninvasive devices). Given the limited availability of this resource both in the United States and in low- and middle-income countries, we provide a framework to approach the shortage of IMV resources. Here we discuss evidence and possibilities to reduce overall IMV needs, discuss strategies to maximize the availability of IMV devices designed for invasive ventilation, discuss the underlying methods in the literature to create and fashion new sources of potential ventilation that are available to hospitals and front-line providers, and discuss the staffing needs necessary to support IMV efforts. The pandemic has already pushed cities like New York and Boston well beyond previous ICU capacity in its first wave. As hot spots continue to develop around the country and the globe, it is evident that issues may arise ahead regarding the efficient and equitable use of resources. This unique challenge may continue to stretch resources and require care beyond previously set capacities and boundaries. The approaches presented here provide a review of the known evidence and strategies for those at the front line who are facing this challenge.

SWIFT: A Deep Learning Approach to Prediction of Hypoxemic Events in Critically-Ill Patients Using SpO2 Waveform Prediction

“…This waveform prediction allows for the forecasting of the magnitude of hypoxic events rather than their occurrence alone. This may have implications for patient management, especially in the context of limited ICU beds and shortages of ventilation machinery during the COVID-19 pandemic (Dar et al, 2020).…”

“…SWIFT may be especially useful in the context of the COVID-19 pandemic or future similar pandemics with high numbers of patients experiencing hypoxemia and limited supplies of ventilators and ICU beds. Strategies to reduce the demand for mechanical ventilation have been identified as a priority for resource management during the pandemic (Dar et al, 2020). To this end, SWIFT can help identify patients likely to experience imminent hypoxemic events versus patients likely to remain stable and offer insights into the magnitude of the potential hypoxemic event.…”

“…Prediction of Hypoxemic Events 11 This waveform prediction allows for the forecasting of the magnitude of hypoxic events rather than their occurrence alone. This may have implications for patient management, especially in the context of limited ICU beds and shortages of ventilation machinery during the COVID-19 pandemic (Dar et al, 2020 In each box-and-whisker plot, the box extends from Q1 to Q3. The orange line represents the median value and the green triangle represents the mean value.…”

“…These patients often require advanced life support measures including invasive mechanical ventilation, hospitalization in ICUs and even extra-corporeal membrane oxygenation (ECMO). During the COVID-19 pandemic, ventilators and ICU beds have become scarce resources with insufficient capacity in the hardest hit regions (Dar et al, 2020). As the COVID-19 pandemic continues to exact a heavy mortality toll with at least half a million deaths directly attributed to the disease in the United States alone and herd immunity by vaccination remains months away, it is important to find ways to manage these scarce resources and identify patients unable to maintain oxygen saturation without intervention.…”

Artificial Intelligence helps triage and monitoring of COVID-19 Intensive Care patients

“…They may be directed to intermediate care, while others should stay monitored carefully because of a high intubation risk. Secondly, COVID-19 patients are highly hypoxic and experience during their stay profound desaturation episodes that may lead to premature intubation in a constrained pandemic situation [9] all the more that intubation is at risk and debated [10,11]. During an episode of desaturation, a low S 24 may help to postpone intubation.…”