Rethinking ventilation
Ventilators are needed for patients with severe COVID-19 symptoms, but hospitals and health systems hit hard with cases are having to rethink how they can use other devices in their network with similar functionalities.
In late March, the Food and Drug Administration eased guidance allowing providers to use alternative devices as ventilators for those experiencing shortages. Anesthesia and sleep apnea machines are being used, but there are considerations to be made, according to experts.
Home-use bilevel positive airway-pressure sleep apnea machines, known as or BiPAP machines, likely won’t help a severe COVID-19 patient because they are low-end ventilators that can’t deliver high oxygen concentration levels, said Richard Branson, a respiratory therapist at University of Cincinnati College of Medicine. The machines will likely be better in situations where medical ventilators are in short supply and a patient’s condition isn’t yet severe.
BiPAP machines in hospitals differ from home models because they deliver higher concentrated levels of oxygen and therefore can likely offer a better alternative for providers, Branson said. Most hospitals have these machines, which offer noninvasive ventilation through a face mask. “They won’t ventilate the sickest patients and they don’t have all the alarms and monitoring and features that an ICU ventilator does, but in a pinch, these can be repurposed,” he said.
BiPAP machines are the most promising alternative Northwell Health in New York is exploring. The system briefly looked into the possibility of putting more than one patient on a ventilator “but it’s psychologically not appropriate,” said Dr. David Battinelli, chief medical officer at Northwell.
Many medical societies have come out against the practice. The main concern is that ventilators only allow for one setting, and it’s unlikely any two patients require the same level of oxygen for their lung capacity. Over- or under-oxygenating lungs can be deadly.
Dr. Marcus Schabacker, CEO of ECRI, said of the practice, “That is a disaster waiting to happen.”