Reliability and limits of transport-ventilators to safely ventilate severe patients in special surge situations

Savary, Dominique; Lesimple, Arnaud; Beloncle, François; Morin, François; Templier, F.; Broc, Alexandre; Brochard, Laurent; Richard, Jean Christophe; Mercat, Alain

doi:10.1186/s13613-020-00782-5

Cited by 14 publications

(13 citation statements)

References 20 publications

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“…We found that the Osiris3 performed worse than any other ventilator. In a previous bench study, this ventilator over-delivered V T at F I O 2 70%, as in the present study, but matched the target V T at 100%F I O 2 , 6 suggesting that the Venturi system was not optimal. Another bench study found that the Osiris3 tended to under-deliver V T , especially in case of airway obstruction.…”

Section: Editorsupporting

confidence: 54%

Assessment of open-source, intermediate and ICU ventilators to face the COVID-19 pandemic

Guérin

Cour

Degivry

et al. 2022

European Journal of Anaesthesiology

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comprising disciplines allied to intensive care (such as anaesthesiology) will be important for recruitment during any kind of crisis wherein intensive care medicine is challenged. Harmonised education and training permit international mobility of all-rounder intensive care physicians from multiple disciplines. In Austria, this system proved particularly resilient during the COVID-19 pandemic. In many parts of the country, ICUs were occupied with COVID-19 critically ill patients and intensive care medicine was delivered in recovery rooms and even operating theatres. As most elective surgery was postponed during this time, intensive care patients could be treated by specialists in anaesthesiology and intensive care medicine who primarily work in operating theatres. This strategy helped to cope with the pandemic in face of severely limited intensive care resources and effectively avoided situations of triage even at the peaks of the pandemic. In contrast, primary intensive care physicians are not rapidly recruitable in crises.

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Section: Editorsupporting

confidence: 54%

Assessment of open-source, intermediate and ICU ventilators to face the COVID-19 pandemic

Guérin

Cour

Degivry

et al. 2022

European Journal of Anaesthesiology

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“…L'Her et al classified emergency and transport ventilators according to their performances and technical reliability, even ergonomics: whereas Monnal T75 ® (Air Liquide Healthcare) was classified as "ICU-like emergency and transport-ventilators", Monnal T60 ® (Air Liquide Healthcare) and Elisée 350 ® (ResMed) were classified as "sophistical emergency and transport ventilators" [17,18]. In assist-control mode, three of the four tested transport ventilators both accurately controlled the volume delivered and had acceptable trigger delays in a recent bench study (Michigan test lung); two of the three were the Monnal T60 ® and Elisée 350 ® used in our transient ICUs [51]. Despite these bench tests results, using transport ventilators for ARDS management had never been achieved so far in clinical management for such a large number of patients who required a long invasive MV time.…”

Section: Discussionmentioning

confidence: 99%

Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Ferré

Marquion

Delord

et al. 2022

Ann. Intensive Care

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Background To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France. Results We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55–73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11–32] vs. 21 [13–37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14–40] vs. 27 [15–44] days, respectively; P = 0.44). Conclusions In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.

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“…Indeed, it is not possible to precisely titrate FiO 2 on a point-by-point basis but only to adjust per five percent increase or decrease. In addition, adjustments and monitoring of the I/E ratio are different from, and far less precise than, those for an ICU ventilator [20]. At the end of March 2020, the French government had to choose between two options: either organize the transfer of ICU workers from empty regions to overcrowded regions, or transfer patients already in ICUs.…”

Section: The Necessity To Help Overcrowded Areasmentioning

confidence: 99%

Impact of Air Transport on SpO2/FiO2 among Critical COVID-19 Patients during the First Pandemic Wave in France

Bouillon‐Minois

Roux

Jabaudon

et al. 2021

JCM

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During the first wave of the COVID-19 pandemic, some French regions were more affected than others. To relieve those areas most affected, the French government organized transfers of critical patients, notably by plane or helicopter. Our objective was to investigate the impact of such transfers on the pulse oximetric saturation (SpO2)-to-inspired fraction of oxygen (FiO2) ratio among transferred critical patients with COVID-19. We conducted a retrospective study on medical and paramedical records. The primary endpoint was the change in SpO2/FiO2 during transfers. Thirty-eight patients were transferred between 28 March and 5 April 2020, with a mean age of 62.4 years and a mean body mass index of 29.8 kg/m2. The population was 69.7% male, and the leading medical history was hypertension (42.1%), diabetes (34.2%), and dyslipidemia (18.4%). Of 28 patients with full data, we found a decrease of 28.9 points in SpO2/FiO2 (95% confidence interval, 5.8 to 52.1, p = 0.01) between the starting and the arrival intensive care units (SpO2/FiO2, 187.3 ± 61.3 and 158.4 ± 62.8 mmHg, respectively). Air medical transfers organized to relieve intensive care unit teams under surging conditions during the first COVID wave were associated with significant decreases in arterial oxygenation.

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Reliability and limits of transport-ventilators to safely ventilate severe patients in special surge situations

Cited by 14 publications

References 20 publications

Assessment of open-source, intermediate and ICU ventilators to face the COVID-19 pandemic

Assessment of open-source, intermediate and ICU ventilators to face the COVID-19 pandemic

Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Impact of Air Transport on SpO2/FiO2 among Critical COVID-19 Patients during the First Pandemic Wave in France

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