The ventilators most sought after for COVID-19 treatment can help patients survive and recover from respiratory distress caused by the virus. There are different degrees of lung damage, so the patient, depending on the complexity of the course of the disease, may need different help.
In the most difficult cases, the patient certainly needs fans that push air and oxygen into and out of the person’s lungs through tubes inserted through the mouth and trachea.
The available supply of invasive mechanical ventilators is inadequate to fulfill the anticipated demand for these devices. They are required to support patients who present with acute hypoxemic respiratory failure secondary to viral infection. The recent development of approaches to modify invasive ventilators to support two patients may extend the supply of devices available to treat selected patients, yet it is unlikely to completely meet demand.
The President and Chief Operating Officer at The Mount Sinai Hospital, David Reich, has published a working protocol, which details how they converted non-invasive bi-level ventilators into devices that can be monitored ventilation to patients with acute hypoxemic respiratory failure. ResMed ventilators were provided to the hospital by Tesla, as part of a donation.
Very grateful to Tesla for providing Resmed ventilators that our team was able to convert to critical care-capable. Innovation by The Mount Sinai Hospital's team in a crisis! https://t.co/ZH6zCuiL1l— David L. Reich, MD (@DrDavidReich) April 2, 2020
The availability of these devices for repurposing is such that supply will be sufficient to better position hospitals to meet the anticipated ventilation device demand during the COVID-19 pandemic, written in the protocol.
Experience accumulated from a long history of non-invasive ventilation by mask and anecdotal use of these systems with intubated patients suggests that these devices can provide adequate ventilation in a crisis.
"We have determined that bi-level ventilators intended for non-invasive use can deliver adequate ventilator pressures to support most patients with acute hypoxemic respiratory failure. Virus aerosolization and subsequent exposure of healthcare workers to the virus is a significant risk associated with use of non -invasive ventilators in the setting of COVID-19. This risk is mitigated by replacing the porous mask interface with a closed circuit delivering tidal volume via an endotracheal tube and by use of expiratory port filters. The ResMed VPAP ST device can be modified to add monitoring devices to allow for precise measurement and display of inspired oxygen concentration, tidal volume delivery, and expired carbon dioxide levels so that the adequacy of ventilation support can be assessed continuously from outside of the patient's room."
This device has been tested in the Simulation HELPS Center at Mount Sinai, and the protocol has been validated in a clinical setting. They suggest that this system to repurpose noninvasive ventilators for invasive support of COVID-19 patients with acute hypoxemic respiratory failure can be utilized in the situation in which there is an insufficient supply of conventional respiratory ventilators.
To date, the situation with СOVID-19 is very tense. Virtually the entire world suffers from a lack of protective equipment for nursing staff and ventilators for patients. In this situation, any help provided is very valuable, because it can save lives. In these difficult times, people, doctors and states must act together. We should be grateful for any help that is provided.