Unintended Consequences of An Analog Fix in A Digital Era: Transport Ventilators Associated with Significantly Longer Duration of Intubation for Critically Ill COVID-19 Patients

Abstract

Background:The first wave of the COVID-19 pandemic heavily impacted New York City, and stretched healthcare resources to the limits. The sudden spike in acutely ill patients with respiratory failure required the mobilization of the national stockpile of ventilators and a multitude of providers without expert ventilator training to meet the needs of patients. These ventilators do not display easily interpretable parameters of the ventilator-patient interaction, which could have a negative impact on patient care.Methods:A retrospective review of all adult patients admitted for at least 24 hours and requiring mechanical ventilation at a heavily impacted urban hospital in New York City during the first wave of the COVID-19 pandemic was undertaken. The type of ventilator (standard vs transport – or limited in display) was evaluated with respect to mortality, hospital length of stay, and factors associated with prolonged intensive care management of acute respiratory distress syndrome (sedation, analgesia, paralytics). Regression analysis was performed to evaluate for confounding factors.Results:From March 2, 2020 through May 9, 2020, 313 patients were included. Overall mortality was 84%. When compared to standard ventilators, patients placed on transport ventilators had significantly longer length of stay (17 days vs 9 days, p = 0.001), more days intubated (11 days vs 5 days, p = 0.007), longer duration of prone-positioning (5 days vs 3 days, p = 0.05), a greater need for sedation / analgesia (p < 0.001), and greater need for vasopressor support (p = 0.002). No difference in mortality (p = 0.41), barotrauma (p = 0.29), successful extubation (p = 0.77) or tracheostomy (p = 0.36) was observed.Conclusions:The lack of proper ventilation equipment is associated with prolonged hospitalization and critical illness. Given the economic and human burden that results from prolonged acute-care, it would benefit both patients and the healthcare system to recognize the infrastructure requirements required to respond to health crises of the future.