Why those COVID-authorized devices may be unusable for your non-COVID-19 critical care patients post-pandemic
As the world struggled to have enough ventilators, some ventilators that were COVID-19 specific came to market that did not have as much versatility as other models of ventilator. As the pandemic gets under control (hopefully), hospital departments need to rethink what their ventilator fleet should be capable of in breadth and depth for a return to “normal” healthcare battles.
Just after COVID-19 burst on the international scene in January-March 2020, a New England Journal of Medicine article from April, 2020 mentioned that the estimates for what was needed regarding mechanical ventilators in the U.S. ranged “from several hundred thousand to as many as a million”.1 Estimates for how many ventilators were available in the U.S. ranged from 60,000 to 160,000.1 As a result, facing what looked like an impending crisis, many hospitals and respiratory departments moved to rent or buy ventilators. At the same time, on the national level, the federal government pushed manufacturers to produce ventilators to meet the need. At the onset of the pandemic, the U.S. Strategic National Stockpile held approximately 20,000 ventilators, which many figured, would not be enough to meet the demand as the virus moved through the population.2
Under the Defense Production Act, the federal government called for 200,000 ventilators to be produced by 11 different manufacturers.1 The manufacturers included many well-known names for the respiratory care world but also included some sources that were very new to the ventilator scene. The major players in the group of manufacturers included Medtronic, Hill-Rom, Hamilton, Philips, General Electric, Zoll, General Motors/Ventac, GE/Ford/Airon, ResMed, and Vyaire.2 The price for the ventilators in this pool ranged from $4000 to $30,000 – and the features offered across these ventilators range from very limited (a notch above manually ventilating with a resuscitator bag) to having all the features of the current critical care ventilators.
The crisis in ICU was felt in several major metropolitan areas, but the nation moved forward with COVID-19 vaccinations which blunted the severity of the viral infection, and we learned new strategies to deal more effectively with patients having COVID-19 respiratory failure. As a result, the impending crisis in ventilator demand did not materialize across the nation at the depth that initial estimates speculated.1 However, some of the new “COVID-19 ventilators” that were purchased by hospitals and the government were found to be inadequate when dealing with those patients with severe infection – particularly in those patients who developed a classical ARDS pattern in their lung disease.1 In the current situation, as the pandemic has now become less intense, hospitals that purchased these machines now have to evaluate the usefulness of the COVID-19 fleet of ventilators in dealing with critically-ill patients needing mechanical ventilator (particularly in the pediatric and adult patients).
A special feature in Chest published in February, 2021 evaluated the fleet of COVID-19 ventilators regarding the features and functions of the some 200,000 ventilators that were ordered under the Defense Production Act.2 As the nation moved out of the shadow of the COVID-19 pandemic, many are finding that while several of the ventilator lines are what are deemed “full-function” machines, many are not sophisticated enough to provide adequate support for patients needing the most support due to ARDS or other complex and difficult-to-ventilate pulmonary diseases or trauma cases.1
The Chest article defined “full-function” as being able to measure exhaled tidal volume, display pressure, volume, and flow waveforms, and provide a constant FIO2 from 21% to 100%.2 Additionally, the machine needs to be able to sense a patient’s effort to breathe and respond by delivering the appropriate breath according to the timing of the breath and the patient’s demand. A full-function or full-feature device must have advanced monitoring systems in place to gather and display the patient’s pulmonary mechanics, and in doing so, help the team decide on which modes and what basic parameters can be set to provide optimum support during the course of the time on the ventilator. Finally, the machine needs to be capable of providing timely, appropriate weaning settings and adequate monitoring when the patient is recovering to allow for liberation form mechanical ventilation.2
As detailed in the Chest article, some of the COVID-19 machines are limited in the choice of mode and basic settings as well as limited in their monitoring capabilities.2 Some of the COVID-19 ventilators have drawbacks due to limited parts for maintenance and repair, inaudible or overly sensitive alarms, lack of ventilator graphics to display pressure, flow, and volume loops (now a standard of care in current critical care ventilators), or have limitations on the PEEP settings (with a maximum of 20 cmH20). A few of these ventilators were lacking apnea alarms, and several were not capable of ventilating pediatric patients.2 With the increase in manufacturers and ventilators, the RT community has found that several COVID-19 ventilators do not have interchangeable parts, so the machine-specific parts will need to be stockpiled to allow for maintenance and upkeep.2
It is estimated that nearly half of the new COVID-19 ventilators do not have the capabilities needed to treat the most severe cases of the disease.2 However, these machines may be useful in caring for patients with lower acuity who need ventilatory support. In the end, RT departments will likely retire the more basic ventilators in their inventory due to the limitations in features, lack of parts and support for maintenance or repair, or lack of capability to ventilate pediatric patients. As we come out of the ventilator crisis brought on by COVID-19, hopefully the lessons learned by this experience will guide future production of ventilators needed for handling our patients across the spectrum of acuity and patient age.
- Ranney ML, Griffeth V, Jha AK. Critical Supply Shortages—The Need for Ventilators and Personal Protective Equipment during the COVID-19 Pandemic. New England Journal of Medicine. 2020 Apr 30;382(18):e41.
- Branson R, Dichter JR, Feldman H, Devereaux A, Dries D, Perry Jr JF, Benditt J, Hossain T, Ghazipura M, King M, Baldisseri M. The US Strategic National Stockpile (SNS) Ventilators in Coronavirus Disease 2019: A Comparison of Functionality and Analysis Regarding the Emergency Purchase of 200,000 Devices. Chest. 2020 Sep 21.
About the author
Bill Pruitt, MBA, RRT, CPFT, AE-C, FAARC, is a writer, lecturer, and consultant and recently retired from over 20 years teaching at the University of South Alabama in Cardiorespiratory Care. He also volunteers at the Pulmonary Clinic at Victory Health Partners in Mobile, AL.