The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19)

Bottiroli, Maurizio; Calini, Angelo; Pinciroli, Riccardo; Mueller, Ariel; Siragusa, Antonio; Anelli, C.; Urman, Richard D.; Nozari, Ala; Mondino, Michele

doi:10.1186/s12871-021-01376-9

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…However, in this preliminary observation, 2 of 16 COVID-19 patients required a ventilator shift for high plateau pressure or hypercapnia [ 16 ]. Other teams have encountered greater difficulties: Bottoroli reported increased mortality in COVID-19 patients exclusively ventilated with anaesthesia ventilators and reported several incidents, mostly airway obstruction and sudden ventilator failure [ 17 ]. This finding might be related to the fresh gas flow ranging from 80% of minute ventilation in patients receiving halogenates to 100% of minute ventilation in patients without inhaled aesthetics, while we used 150% of minute ventilation and no inhaled aesthetics [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre

et al. 2022

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Background During the COVID-19 first wave in France, the capacity of intensive care unit (ICU) beds almost doubled, mainly because of the opening of temporary ICUs with staff and equipment from anaesthesia. Objectives We aim to investigate if the initial management in temporary ICU is associated with a change in ICU mortality and short-term prognosis. Design Retrospective single-centre cohort study. Setting Surgical ICU of the Bichat Claude Bernard University Hospital during the COVID-19 “first wave” (from 18 March to 10 April 2020). Patients All consecutive patients older than 18 years of age with laboratory-confirmed SARS-CoV-2 infection and/or typical radiological patterns were included during their first stay in the ICU for COVID-19. Intervention Patients were admitted to a temporary ICU if no room was available in the classical ICU and if they needed invasive mechanical ventilation but no renal replacement therapy or Extracorporeal Membrane Oxygenation (ECMO) in the short term. The temporary ICUs were managed by mixed teams (from the ICU and anaesthesiology departments) following a common protocol and staff meetings. Main outcome measure ICU mortality Results Among the 59 patients admitted, 37 (62.7%) patients had initial management in the temporary ICU. They had the same characteristics on admission and the same medical management as patients admitted to the classical ICU. ICU mortality was similar in the 2 groups (32.4% in temporary ICUs versus 40.9% in classical ICUs; p=0.58). SAPS-II and ECMO use were associated with mortality in multivariate analysis but not admission to the temporary ICU. Conclusion In an overload context of the ICU of a geographical area, our temporary ICU model allowed access to intensive care for all patients requiring it without endangering them.

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Section: Discussionmentioning

confidence: 99%

Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre

et al. 2022

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“…The hospital system had 263 prepandemic ventilators excluding anesthesia machines. 34 In this simulation study, a crisis period requiring ventilator triage per NYVAG was defined as once ventilator demand JAMA Network Open | Critical Care Medicine exceeded 95% prepandemic ventilators (250 patients). 35 Patients' SOFA scores were queried from the health record while ventilated, with missing SOFA subscores presumed normal (ie, scored as 0).…”

Section: Methodsmentioning

confidence: 99%

“…Adult patient medical records were retrospectively reviewed from a single academic hospital system from March 1, 2020, to July 1, 2020 (ie, during the surge), and included if they were ventilated. The hospital system had 263 prepandemic ventilators excluding anesthesia machines . In this simulation study, a crisis period requiring ventilator triage per NYVAG was defined as once ventilator demand exceeded 95% prepandemic ventilators (250 patients) .…”

Section: Methodsmentioning

confidence: 99%

Simulation of New York City’s Ventilator Allocation Guideline During the Spring 2020 COVID-19 Surge

Walsh,

Zhu,

Feng

et al. 2023

JAMA Netw Open

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ImportanceThe spring 2020 surge of COVID-19 unprecedentedly strained ventilator supply in New York City, with many hospitals nearly exhausting available ventilators and subsequently seriously considering enacting crisis standards of care and implementing New York State Ventilator Allocation Guidelines (NYVAG). However, there is little evidence as to how NYVAG would perform if implemented.ObjectivesTo evaluate the performance and potential improvement of NYVAG during a surge of patients with respect to the length of rationing, overall mortality, and worsening health disparities.Design, Setting, and ParticipantsThis cohort study included intubated patients in a single health system in New York City from March through July 2020. A total of 20 000 simulations were conducted of ventilator triage (10 000 following NYVAG and 10 000 following a proposed improved NYVAG) during a crisis period, defined as the point at which the prepandemic ventilator supply was 95% utilized.ExposuresThe NYVAG protocol for triage ventilators.Main Outcomes and MeasuresComparison of observed survival rates with simulations of scenarios requiring NYVAG ventilator rationing.ResultsThe total cohort included 1671 patients; of these, 674 intubated patients (mean [SD] age, 63.7 [13.8] years; 465 male [69.9%]) were included in the crisis period, with 571 (84.7%) testing positive for COVID-19. Simulated ventilator rationing occurred for 163.9 patients over 15.0 days, 44.4% (95% CI, 38.3%-50.0%) of whom would have survived if provided a ventilator while only 34.8% (95% CI, 28.5%-40.0%) of those newly intubated patients receiving a reallocated ventilator survived. While triage categorization at the time of intubation exhibited partial prognostic differentiation, 94.8% of all ventilator rationing occurred after a time trial. Within this subset, 43.1% were intubated for 7 or more days with a favorable SOFA score that had not improved. An estimated 60.6% of these patients would have survived if sustained on a ventilator. Revising triage subcategorization, proposed improved NYVAG, would have improved this alarming ventilator allocation inefficiency (25.3% [95% CI, 22.1%-28.4%] of those selected for ventilator rationing would have survived if provided a ventilator). NYVAG ventilator rationing did not exacerbate existing health disparities.Conclusions and RelevanceIn this cohort study of intubated patients experiencing simulated ventilator rationing during the apex of the New York City COVID-19 2020 surge, NYVAG diverted ventilators from patients with a higher chance of survival to those with a lower chance of survival. Future efforts should be focused on triage subcategorization, which improved this triage inefficiency, and ventilator rationing after a time trial, when most ventilator rationing occurred.

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“…As an example, many used mechanical ventilators designed for use in anaesthesia rather than intensive care. Use of such ventilators for supporting patients with covid-19 was associated with an increased risk of patient harm, including death 15…”

Section: Preparing Icus For the Pandemicmentioning

confidence: 99%

NHS hospital capacity during covid-19: overstretched staff, space, systems, and stuff

Fong,

Summers,

Cook

2024

BMJ

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The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19)

Cited by 12 publications

References 28 publications

Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre

Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre

Simulation of New York City’s Ventilator Allocation Guideline During the Spring 2020 COVID-19 Surge

NHS hospital capacity during covid-19: overstretched staff, space, systems, and stuff

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