As the title mentioned, we had been preparing the worst scenarios , should we shutdown some regular ICU beds to free mechanical ventilators or should we keep the same numbers and setting patients in isolations with Transport Ventilator( IMPACT EMV+) continuously .
Wards/Beds are available, but equipment arrangement have to be prioritised. Safety is crucial as well. Report from vendor is that once there's continued power inlet, transport vent can be used 24/7 for adult usual ventilation but not defined the settings eg.ARDS high PEEP with difficult ventilation patients cohort.
If patients require invasive mechanical ventilation and only the portable ventilators are available I would have no choice but to use them. Before using portable ventilators I would use the anaesthetic machine ventilators in operating theatres. In the UK many operating theatres have an adjacent anaesthetic room which also contains an anaesthetic machine and ventilator. This would also allow the use of anaesthetic vapours for sedation of these patients. This may be critical when supplies of propofol and opiates are limited.
The availability of portable ventilators is also limited. Portable ventilators are usually reserved for intra- and inter-facility transfer of patients. Once these transport ventilators have been deployed the last resort would be to use medical students to manually ventilate patients as in the Polio epidemic in Copenhagen in 1952. Whilst that incident resulted in the birth of modern intensive care units I sincerely hope that we do have to face that scenario.
Article Checklist Proformas to Guide and Document the Assessment of ...
The anaesthetic and portable ventilators are not as effective as intensive therapy unit (ITU) ventilators. Rather than using the same settings as we would with ITU ventilators, I therefore recommend that we adjust the settings on these ventilators according to frequent measurements of oxygen saturation, end tidal carbon dioxide, arterial blood gases, lactate and haemodynamic parameters. This is labour intensive and will require the assistance of staff who regularly care for ventilated patients but do not routinely work in ITU (i.e. anaesthetists).
So, as the COVID 19 pandemic progresses we will need to upskill colleagues to facilitate the assessment and treatment of critically ill patients with and without COVID 19. This may be achieved by face-to-face education sessions. However this is very labour intensive and may result in spread of COVID 19 amongst healthcare professionals.
An alternative approach would be to use standardised checklist proformas for the assessment of critically ill patients (see link below).
Article Checklist Proformas to Guide and Document the Assessment of ...
The use of checklist proformas can facilitate the management of critically ill patients by staff who do not routinely work in intensive therapy units. This could improve outcomes in this high risk cohort of patients and improve the confidence of staff redeployed to ITU from other care areas.
Thank so much, Rajkumar Rajendram for the sharing , means prior using portable ventilators , to covert anaesthetic room with anaesthetic ventilators for covid19 critical patients? are the anaesthetic machine /ventilators are able to function continuously ? any suggestions on how can I ensure which is safer than the other
Appreciate for the discussion and the sharing on the checklist.
.
http://rc.rcjournal.com/content/57/3/399
Another alternative is to ventilate several patients via a single ventilator using any pressure controlled mode of ventilation.
However all the patients would have to be deeply sedated to prevent triggering. Patients with similar needs for oxygenation and ventilation would have to be cohorted.
Modern intensive care ventilators are much more sophisticated than those used in operating theatres. ICU ventilators have many more modes of ventilation than operating theatre ventilators.
Some portable transfer ventilators are much more sophisticated than those used in operating theatres (e.g. Hamilton T1) and have the full functionality of intensive care ventilators. Some portable ventilators are less sophisticated (e.g. Oxylog 2000) than even the operating theatre ventilators.
Anaesthetic ventilators can function continuously and even allow the use of anaesthetic vapours for sedation. This may be relevant if supplies of propofol and fentanyl etc are depleted.
So whether it is safer to use the portable ventilator or the operating theatre ventilator depends on which of each type of ventilators you have. Regardless, in my experience, the humidification of gases using a HME (as is standard in the operating theatre and with portable ventilators) is not as effective as the wet circuit commonly used with ICU ventilators. So the risk of mucus plugging is higher.
In conclusion: in principle I would prefer to use the operating theatre ventilators before the portable ventilators so that I could still perform inter- and intra-hospital transfers of ventilated patients.
The society of critical care medicine has just provided some guidance on the use of Anesthesia Machines as ICU Ventilators.
https://www.asahq.org/in-the-spotlight/coronavirus-covid-19-information/purposing-anesthesia-machines-for-ventilators
It is extremely helpful
I would greatly value your consideration of a question I have just posed.
https://www.researchgate.net/post/We_urgently_need_to_train_more_staff_to_work_in_intensive_care_units_to_treat_critically_ill_patients_with_Covid-19_How_can_we_do_this_now
Thank you
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