Coronavirus Crisis Will Openly Test Which Regulations Actually Matter

The most common reason for COVID-19 patient admission to the ICU is severe hypoxic respiratory failure requiring mechanical ventilation.

A recent AHA estimate for COVID-19 projected that 4.8 million patients would be hospitalized, 1.9 million of these would be admitted to the ICU, and 960,000 would require ventilatory support. This would be fifteen times beyond the normal level of ICU respiratory capacity. We might be able to surge four times normal levels but we will have to relax every rule and regulation to get to what can work.

How can we push up ventilators and trained staff to safely and effectively operate ventilators?

The addition of older hospital ventilators, SNS ventilators, and anesthesia machines increases the absolute number of ventilators to possibly above 200,000 units. The older units may not good enough for patients with severe acute respiratory failure.

A shortage of ICU physicians, advanced practice providers, respiratory therapists, and nurses trained in mechanical ventilation would limit the maximum number of ventilated
patients to approximately 135,000.

One ICU doctor could watch over 96 patients on ventilators. An ICU doctor could watch over four non-ICU doctors who would oversee eight respiratory therapists, four ICU nurses and 12 non-ICU nurses.

Rules could be further loosened to allow fourth-year medical students with crash-course training to assist.

Details on Using Old Equipment and Other Equipment

Supply of mechanical ventilators in U.S. acute care hospitals: Based on a 2009 survey of AHA hospitals, U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators. About 46% of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full-featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply. The older devices include 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8,567 continuous positive airway pressure (CPAP) units.

The SNS has an estimated 8,900 ventilators for emergency deployment. These devices are not full-featured but offer basic ventilatory modes. Accessing the SNS requires hospital administrators to request that state health officials ask for access to this equipment. SNS can deliver ventilators within 24-36 hours of the federal decision to deploy
them. States may have their own ventilator stockpiles as well. Respiratory therapy departments also rent ventilators from local companies, further expanding the supply. Additionally, many modern anesthesia machines are capable of ventilating patients and can be used to increase hospitals’ surge capacity.

The U.S. Department of Health and Human Services (HHS) estimated in 2005 that 865,000 U.S. residents would be hospitalized during a moderate pandemic (as in the 1957 and 1968 influenza pandemics) and 9.9 million during a severe pandemic (as in the 1918 influenza pandemic).

SOURCES – Society of Critical Care Medicine
Written By Brian Wang,