The Ventilator Management Team: Repurposing Anesthesia Workstations and Personnel to Combat COVID-19

Canelli, Robert; Spence, Nicole Z.; Kumar, Nisha; Rodríguez, Gerardo Blanco; Gonzalez, Mauricio

doi:10.1177/0885066620942097

Cited by 14 publications

(18 citation statements)

References 3 publications

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“…A unique feature of Anesthesia Machines is the ability to regulate an inlet of fresh gas flow, altering the amount of rebreathed exhaled gas via a scavenger system. While the use of filters and a closed system might be attractive options during the pandemic to limit viral contamination of the room and to spare medical gases, long-term use of Anesthesia Machines could also pose several complications [ 3 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice. Methods We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group. Results Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75–9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns. Conclusions Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic. Clinical trial number Not applicable.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“… 1 Due to a shortage of ICU mechanical ventilators, many hospitals worldwide needed to deploy anesthesia machines for ICU ventilation (which is off-label use). 2 In a community effort, guidance was written by scientific societies and experts 2 – 7 and manufacturers 8 – 10 to ensure safe application of anesthesia machines for long-term ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…This entailed a fast adjustment of the location to ICU needs, for example technical facilities for gas delivery, room ventilation and availability of all the other medical equipment needed in ICU setting. 5 , 11 – 14 …”

Section: Introductionmentioning

confidence: 99%

Comparing Ventilation Parameters for COVID-19 Patients Using Both Long-Term ICU and Anesthetic Ventilators in Times of Shortage

Dijkman

Acht

Akkeren

et al. 2021

J Intensive Care Med

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In the first months of the COVID-19 pandemic in Europe, many patients were treated in hospitals using mechanical ventilation. However, due to a shortage of ICU ventilators, hospitals worldwide needed to deploy anesthesia machines for ICU ventilation (which is off-label use). A joint guidance was written to apply anesthesia machines for long-term ventilation. The goal of this research is to retrospectively evaluate the differences in measurable ventilation parameters between the ICU ventilator and the anesthesia machine as used for COVID-19 patients. In this study, we included 32 patients treated in March and April 2020, who had more than 3 days of mechanical ventilation, either in the regular ICU with ICU ventilators (Hamilton S1), or in the temporary emergency ICU with anesthetic ventilators (Aisys, GE). The data acquired during regular clinical treatment was collected from the Patient Data Management Systems. Available ventilation parameters (pressures and volumes: PEEP, Ppeak, Pinsp, Vtidal), monitored parameters EtCO2, SpO2, derived compliance C, and resistance R were processed and analyzed. A sub-analysis was performed to compare closed-loop ventilation (INTELLiVENT-ASV) to other ventilation modes. The results showed no major differences in the compared parameters, except for Pinsp. PEEP was reduced over time in the with Hamilton treated patients. This is most likely attributed to changing clinical protocol as more clinical experience and literature became available. A comparison of compliance between the 2 ventilators could not be made due to variances in the measurement of compliance. Closed loop ventilation could be used in 79% of the time, resulting in more stable EtCO2. From the analysis it can be concluded that the off-label usage of the anesthetic ventilator in our hospital did not result in differences in ventilation parameters compared to the ICU treatment in the first 4 days of ventilation.

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“…Several authors and societies have advocated using Anesthesia Machines in COVID-19 patients at institutions faced with resource limitations. 3,4,5 Critical care ventilators are designed to function as mostly unattended devices. Alarms are usually integrated with an overhead monitoring system and trigger personnel from a distance.…”

mentioning

confidence: 99%

“…While the use of lters and a closed system might be attractive options during the pandemic to limit viral contamination of the room and to spare medical gases, long-term use of Anesthesia Machines could also pose several complications. 3,7 Overall, Anesthesia Machines can provide life-sustaining mechanical ventilation, but they were not originally designed to support critically ill patients for prolonged times. 8 At the start of the 2020 pandemic, a registry was formed to understand patterns and trends in the critical care being delivered to patients with COVID-19 requiring mechanical ventilation.…”

mentioning

confidence: 99%

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

Bottiroli

Calini

Pinciroli

et al. 2021

Preprint

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BackgroundThe surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice.MethodsWe designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group.ResultsComplete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75–9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns.ConclusionsOur results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic.Clinical Trial NumberNot applicable

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The Ventilator Management Team: Repurposing Anesthesia Workstations and Personnel to Combat COVID-19

Cited by 14 publications

References 3 publications

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

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

Comparing Ventilation Parameters for COVID-19 Patients Using Both Long-Term ICU and Anesthetic Ventilators in Times of Shortage

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

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