The US Strategic National Stockpile Ventilators in Coronavirus Disease 2019
2020; Elsevier BV; Volume: 159; Issue: 2 Linguagem: Inglês
10.1016/j.chest.2020.09.085
ISSN1931-3543
AutoresRich Branson, Jeffrey R. Dichter, Henry Feldman, Asha V. Devereaux, David J. Dries, Joshua O. Benditt, Tanzib Hossain, Marya Ghazipura, Mary A. King, Marie R. Baldisseri, Christian Sandrock, Guillermo Domínguez‐Cherit, Kiersten Henry, Anne Marie O. Martland, Meredith Huffines, Doug Ornoff, Jason Persoff, Dario Rodriquez, Ryan C. Maves, Niranjan Kissoon, Lewis Rubinson,
Tópico(s)Respiratory Support and Mechanisms
ResumoBackgroundEarly in the coronavirus disease 2019 (COVID-19) pandemic, there was serious concern that the United States would encounter a shortfall of mechanical ventilators. In response, the US government, using the Defense Production Act, ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities, and whether all are able to support COVID-19 patients is not evident.Research QuestionEvaluate ventilator requirements for affected COVID-19 patients, assess the clinical performance of current US Strategic National Stockpile (SNS) ventilators employed during the pandemic, and finally, compare ordered ventilators' functionality based on COVID-19 patient needs.Study Design and MethodsCurrent published literature, publicly available documents, and lay press articles were reviewed by a diverse team of disaster experts. Data were assembled into tabular format, which formed the basis for analysis and future recommendations.ResultsCOVID-19 patients often develop severe hypoxemic acute respiratory failure and adult respiratory defense syndrome (ARDS), requiring high levels of ventilator support. Current SNS ventilators were unable to fully support all COVID-19 patients, and only approximately half of newly ordered ventilators have the capacity to support the most severely affected patients; ventilators with less capacity for providing high-level support are still of significant value in caring for many patients.InterpretationCurrent SNS ventilators and those on order are capable of supporting most but not all COVID-19 patients. Technologic, logistic, and educational challenges encountered from current SNS ventilators are summarized, with potential next-generation SNS ventilator updates offered. Early in the coronavirus disease 2019 (COVID-19) pandemic, there was serious concern that the United States would encounter a shortfall of mechanical ventilators. In response, the US government, using the Defense Production Act, ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities, and whether all are able to support COVID-19 patients is not evident. Evaluate ventilator requirements for affected COVID-19 patients, assess the clinical performance of current US Strategic National Stockpile (SNS) ventilators employed during the pandemic, and finally, compare ordered ventilators' functionality based on COVID-19 patient needs. Current published literature, publicly available documents, and lay press articles were reviewed by a diverse team of disaster experts. Data were assembled into tabular format, which formed the basis for analysis and future recommendations. COVID-19 patients often develop severe hypoxemic acute respiratory failure and adult respiratory defense syndrome (ARDS), requiring high levels of ventilator support. Current SNS ventilators were unable to fully support all COVID-19 patients, and only approximately half of newly ordered ventilators have the capacity to support the most severely affected patients; ventilators with less capacity for providing high-level support are still of significant value in caring for many patients. Current SNS ventilators and those on order are capable of supporting most but not all COVID-19 patients. Technologic, logistic, and educational challenges encountered from current SNS ventilators are summarized, with potential next-generation SNS ventilator updates offered. Although the current number of mechanical ventilators in the United States remains unknown, a 2010 survey of US hospitals estimated approximately 62,000 full-feature ventilators, reflecting a ratio of less than 1 ventilator per each US ICU bed.1Rubinson L. Vaughn F. Nelson S. et al.Mechanical ventilators in US acute care hospitals.Disaster Med Public Health Prep. 2010; 4: 199-206Crossref PubMed Scopus (57) Google Scholar,2Niska R.W. Burt C.W. Emergency response planning in hospitals, United States: 2003-2004.Adv Data. 2007; : 1-13Google Scholar The same assessment also identified nearly 100,000 additional less featured positive-pressure devices. Some of these devices had sufficient capabilities to be useful if a surge in mechanical ventilation were required, and others have limited utility. Until the current coronavirus disease 2019 (COVID-19) pandemic, no event had exhausted modern health-care systems or mechanical ventilation capacity, so the utility of these surge devices remained speculative and untested. In the spring of 2020, a number of these devices were used during the initial response to COVID-19, and despite their use, the need for effective positive-pressure devices were anticipated to exceed demand. In addition to the devices held at US hospitals, thousands of sophisticated transport ventilators were deployed from the US Strategic National Stockpile (SNS) to assist hospitals in need. Because many communities requested additional ventilators simultaneously, it became apparent that the existing stockpile of approximately 20,000 ventilators may not be sufficient to meet national demand. As the event rapidly unfolded, the US federal government used the Defense Production Act to create new ventilators under an Emergency Use Authorization (EUA).3Emergency Use Authorization for Ventilators 2020; Enforcement Policy for Ventilators and Accessories and Other Respiratory Devices During the Coronavirus Disease 2019 (COVID-2019) Public Health Emergency: Guidance for Industry and Food and Drug Administration Staff.https://www.fda.gov/media/136318/downloadDate accessed: August 22, 2020Google Scholar Through this process, the United States ordered approximately 200,000 ventilatorsdevices with tremendous variation in capabilities (Figs 1 and 2).Figure 2Full-function ventilators (in white) vs ventilators for (primarily) less severely ill patients (in yellow), noninvasive ventilation (NIV in red), or transport (in green)50CareFusion LTV 2 2200/2150 Ventilator Operators Manual. 2020.https://www.vyaire.com/products/ltv2tm-series-ventilatorsDate accessed: August 22, 2020Google Scholar, 51Carescape R860 Ventilator Users Reference Manual 2013.https://www.gehealthcare.com/-/jssmedia/f96ef53464d6430d93c22fcf643aec9f.pdf?la=en-usDate accessed: August 20, 2020Google Scholar, 52Hamilton-C3 Ventilator Manual. 2017.https://www.hamilton-medical.com/dam/jcr:5687919f-6926-4268-aa7c-f935b513fc5b/HAMILTON-C3-ops-manual-SW2.0.x-en-624446.03.pdfDate accessed: August 20, 2020Google Scholar, 53Hamilton T1 Ventilator Operators Manual. 2020.https://www.hamilton-medical.com/dam/jcr:bef584f1-2fad-448c-81de-e83921f412da/HAMILTON-T1-ops-manual-SW2.2.x-en-USA-10078282.00.pdfDate accessed: August 20, 2020Google Scholar, 54Hamilton-C1 Ventilator Operators manual. 2019.https://www.hamilton-medical.com/dam/jcr:fb63acb2-87c1-477d-add9-21fe559bf9e9/HAMILTON-C1-ops-manual-SW2.2.x-en-USA-10078281.00.pdfDate accessed: August 20, 2020Google Scholar, 55Trilogy Evo Universal Instructions for Use.Phillips Respironics. 2018; https://usermanual.wiki/Respironics/1127941-3851091.pdfDate accessed: August 31, 2020Google Scholar, 56pNeuton transport ventilator Model A Manual (Airon). 2011.https://aironusa.com/wp-content/uploads/2017/10/CD-A-005-Rev-I-pNeuton-Users-Manual-Model-A-English.pdfDate accessed: August 20, 2020Google Scholar, 57Puritan Bennet 560 Ventilator Manual.http://www.industrie.gov.dz/IMG/pdf/Manual_-_User_PB560_-_English.pdfDate accessed: August 20, 2020Google Scholar, 58ResMed ventilator manual Astral series. 2020.https://www.resmed.com/us/dam/documents/products/machine/astral-series/user-guide/astral-100-150_user-guide_amer_eng.pdfDate accessed: August 20, 2020Google Scholar, 59SAVe II+ ventilator operators guide.http://ehyadarman.com/files/upload/product-brochure/admin-Operator_Manual_SAVe_II-eng-1543759244.pdfDate accessed: August 20, 2020Google Scholar, 60VOCSN V+ PRO Ventilator clinical and technical manual (ventec). 2020.https://www.venteclife.com/assets/Resources/VOCSN_Clinical_Manual.pdfDate accessed: August 20, 2020Google Scholar, 61Koninkijke Philips N.V. Phillips Trilogy EV 300: ventilator instructions for use. 2019. Murraysville, PA: Phillips Respironics; 2019.Google Scholar, 62Zoll Ventilator operators guide, model EMV+, AEV, and Eagle II.https://www.zoll.com/-/media/public-site/products/ventilators/906-0731-01-05-sf_b.ashx/Date accessed: August 20, 2020Google Scholar, 63Hill Rom Life2000 ventilator clinician instructions for use.https://www.breathetechnologies.com/wp-content/uploads/2020/04/PL-20-0049-A.pdfDate accessed: August 20, 2020Google Scholar (based on data presented in Table 3). The designation of full-featured requires the measurement of exhaled tidal volume, display of pressure volume and flow waveforms, and precise delivery of a constant Fio2 from 0.21 to 1.0. SNS = Strategic National Stockpile.View Large Image Figure ViewerDownload Hi-res image Download (PPT) This statement has three objectives. First, it is intended to evaluate the ventilator requirements for COVID-19 and the performance of current SNS ventilators employed during this pandemic. Second, this statement will provide a comparison of devices that have been ordered under the EUA and appropriate usage for patient situations. Surplus devices are in consideration for deployment to other countries, and this review will assist those nations to appreciate the features and limitations of the equipment received.4Becoming 'King of Ventilators' may result in unexpected glut.Modern Healthcare. 2020; https://www.modernhealthcare.com/government/becoming-king-ventilators-may-result-unexpected-glutDate accessed: August 22, 2020Google Scholar Finally, the technologic, logistic, and educational challenges of current SNS ventilators are summarized and potential future design updates proposed. A ventilator is a device used to provide oxygenation and respiratory support in settings in which the patient's own pulmonary system is compromised.5Tobin M.J. Advances in mechanical ventilation.N Engl J Med. 2001; 344: 1986-1996Crossref PubMed Scopus (377) Google Scholar Fundamentally, ventilator mechanics involve a mode of operation that incorporates four basic parameters: pressure or volume, Fio2, respiratory rate, and end-expiratory pressure. Ventilator modes vary based on patients' individual physiologic needs and are set often based on lung compliance, gas exchange, and minute ventilation.6Singer B.D. Corbridge T.C. Basic invasive mechanical ventilation.South Med J. 2009; 102: 1238-1245Crossref PubMed Scopus (32) Google Scholar In addition, standard ventilators are expected to sense when a patient attempts to breathe and deliver the appropriate breath accordingly. Full-feature mechanical ventilators used to support critically ill patients have advanced instrumentation that gather and display data on the patient's pulmonary mechanics. These data inform how the ventilator's mode and basic parameters can be adjusted to achieve clinical improvement and liberation from the ventilator.7Walter J.M. Corbridge T.C. Singer B.D. Invasive mechanical ventilation.South Med J. 2018; 111: 746-753Crossref PubMed Scopus (41) Google Scholar,8Tobin M.J. Physiologic basis of mechanical ventilation.Ann Am Thorac Soc. 2018; 15: S49-S52Crossref PubMed Scopus (17) Google Scholar In contrast, positive-pressure ventilation devices (eg, anesthesia machines, noninvasive CPAP and bilevel positive pressure devices, and so forth) have a limited number of operational modes and are of limited utility for the prolonged management of patients with COVID-19-associated respiratory failure. Investigators have described multiple phases of respiratory insufficiency associated with COVID-19.9Marini J.J. Gattinoni L. Management of COVID-19 respiratory distress.JAMA. 2020; 323: 2329-2330Crossref PubMed Scopus (695) Google Scholar Soon after development of respiratory distress, patients often retain high pulmonary compliance despite poor oxygenation. Minute ventilation in these patients is typically high, and they may not demonstrate overt respiratory distress despite significant hypoxemia. These individuals may be managed with tidal volumes (VT) above the typical 4 to 6 mL/kg ideal body weight used for ARDS. Some patients may progress to more classic patterns of hypoxemic respiratory failure with reduced compliance, increased requirements for positive end-expiratory pressure (PEEP), and optimal use of smaller tidal volumes.10Gattinoni L. Chiumello D. Caironi P. et al.COVID-19 pneumonia: different respiratory treatments for different phenotypes?.Intensive Care Med. 2020; 46: 1099-1102Crossref PubMed Scopus (1153) Google Scholar, 11Einav S. Hick J.L. Hanfling D. et al.Surge capacity logistics: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.Chest. 2014; 146: e17S-e43SAbstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar, 12Brower R.G. Matthay M.A. et al.Acute Respiratory Distress Syndrome NetworkVentilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.N Engl J Med. 2000; 342: 1301-1308Crossref PubMed Scopus (10374) Google Scholar, 13Adachi T. Chong J.M. Nakajima N. et al.Clinicopathologic and immunohistochemical findings from autopsy of patient with COVID-19, Japan.Emerg Infect Dis. 2020; 26: 2157-2161Crossref Scopus (91) Google Scholar Operationally, COVID-19 patients require a wide spectrum of the four different ventilator support parameters described previously. Since 2007, the Centers for Disease Control and Prevention, the American Association for Respiratory Care, the Society of Critical Care Medicine, and the Task Force for Mass Critical Care have advocated a list of standard criteria for ventilators in case of a mass casualty respiratory failure event similar to severe acute respiratory syndrome (SARS) which resulted in ARDS.11Einav S. Hick J.L. Hanfling D. et al.Surge capacity logistics: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.Chest. 2014; 146: e17S-e43SAbstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar Development of these criteria were not device- or price-based, but rather performance-based.12Brower R.G. Matthay M.A. et al.Acute Respiratory Distress Syndrome NetworkVentilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.N Engl J Med. 2000; 342: 1301-1308Crossref PubMed Scopus (10374) Google Scholar As noted previously, infection by COVID-19 can cause progressive hypoxemic respiratory failure characterized by diffuse alveolar damage (clinical ARDS).13Adachi T. Chong J.M. Nakajima N. et al.Clinicopathologic and immunohistochemical findings from autopsy of patient with COVID-19, Japan.Emerg Infect Dis. 2020; 26: 2157-2161Crossref Scopus (91) Google Scholar, 14Barton L.M. Duval E.J. Stroberg E. Ghosh S. Mukhopadhyay S. COVID-19 autopsies, Oklahoma, USA.Am J Clin Pathol. 2020; 153: 725-733Crossref PubMed Google Scholar, 15Menter T. Haslbauer J.D. Nienhold R. et al.Post-mortem examination of COVID19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings of lungs and other organs suggesting vascular dysfunction.Histopathology. 2020; 77: 198-209Crossref PubMed Scopus (815) Google Scholar The type of ventilator needed for these critically ill patients must be capable of ventilating patients with severe ARDS, with respiratory system compliance between 25 and 50 mL/cm H2O, for a period of several weeks.12Brower R.G. Matthay M.A. et al.Acute Respiratory Distress Syndrome NetworkVentilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.N Engl J Med. 2000; 342: 1301-1308Crossref PubMed Scopus (10374) Google Scholar,16Arentz M. Yim E. Klaff L. et al.Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.JAMA. 2020; 323: 1612-1614Crossref PubMed Scopus (1523) Google Scholar, 17Bhatraju P.K. Ghassemieh B.J. Nichols M. et al.Covid-19 in critically ill patients in the Seattle region: case series.N Engl J Med. 2020; 382: 2012-2022Crossref PubMed Scopus (1722) Google Scholar, 18Ziehr D.R. Alladina J. Petri C.R. et al.Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.Am J Respir Crit Care Med. 2020; 201: 1560-1564Crossref PubMed Scopus (310) Google Scholar In Table 1, patients treated in the ARDSnet ARMA trial with 6 mL/kg vs 12 mL/kg predicted ideal body weight VT are compared with patients with COVID-19 treated at Massachusetts General Hospital.12Brower R.G. Matthay M.A. et al.Acute Respiratory Distress Syndrome NetworkVentilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.N Engl J Med. 2000; 342: 1301-1308Crossref PubMed Scopus (10374) Google Scholar,18Ziehr D.R. Alladina J. Petri C.R. et al.Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.Am J Respir Crit Care Med. 2020; 201: 1560-1564Crossref PubMed Scopus (310) Google Scholar COVID-19 patients received similar initial PEEP settings but had higher Fio2 requirements.18Ziehr D.R. Alladina J. Petri C.R. et al.Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.Am J Respir Crit Care Med. 2020; 201: 1560-1564Crossref PubMed Scopus (310) Google Scholar The continuum of care requires lung-protective ventilation, assuring patient-ventilator synchrony, and adequate monitoring to evaluate the patient's response.Table 1Data From the ARDSnet ARMA Trial (Day 1)12Brower R.G. Matthay M.A. et al.Acute Respiratory Distress Syndrome NetworkVentilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.N Engl J Med. 2000; 342: 1301-1308Crossref PubMed Scopus (10374) Google Scholar and MGH COVID-19 Report18Ziehr D.R. Alladina J. Petri C.R. et al.Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study.Am J Respir Crit Care Med. 2020; 201: 1560-1564Crossref PubMed Scopus (310) Google ScholarSettingsDay 1MGH COVID-19PEEP (cm H2O)9.4 ± 3.6 (6-13)10 (8-12)Fio2 (%)0.56 ± 0.19 (0.35-0.75)0.70VE (L/min)12.9 ± 3.6 (10-18)9.1PIP (cm H2O)32 ± 8 (20-40)21 (19-26)aPlateau pressure.Respiratory frequency (b/min)29 ± 7 (12-35)20.5a Plateau pressure. Open table in a new tab As of March 2020, the SNS previously supported by the Centers for Disease Control and Prevention, and now centrally by the US Department of Health and Human Services, maintains the following ventilators (those present in the SNS prior to 2020 include the Coviden Puritan Bennett LP10, Vyaire CareFusion LTV 1200, and Zoll Impact Instrumentation Univent 754)19ASPR—Public Health Emergency. SNS-held ventilator resources. 2020. https://www.phe.gov/emergency/events/COVID19/SNS/ventilators/Pages/training.aspx Accessed August 22, 2020.Google Scholar:Tabled 1· Covidien (Puritan Bennett) LP10· GE CARESCAPE R860 Ventilator· GE/Ford pNeuton Model A-E· GM/Ventec V+ Pro· Hamilton C-1· Hamilton C-3· Hamilton T-1· Hamilton Military T-1· Hillrom Life 2000· Philips EV300· ResMed Astral 150· Vyaire (CareFusion) LTV1200· Zoll EMV+ 731 Ventilator· Zoll (Impact Instrumentation)· Univent 754 Open table in a new tab These ventilators are not commonly used in ICU settings, are designed and packed to withstand delivery by helicopter, and are delivered with an instruction card, video or CD, and a manual (Fig 3). The website has extensive links to training; however, because of the rapidity of the surge of COVID-19 patients and the novelty of the organism and its pathogenesis, there was little time for just-in-time education in use of SNS ventilators. Although these ventilators are intended to be used in austere settings by non-intensivists, the physiology of COVID-19 created challenges for the user. These ventilators have been used by the military in transporting critically ill patients, with prior complaints including limited battery life, monitor display limits, and inaudible alarms. During the Spring 2020 deployment to meet ICU surges, additional lessons included reports of battery pack challenges, missing hoses and tubing, and need for equipment repair. However, when implemented in ICUs, the challenges have not been merely technical, as highlighted by the description from New York (Fig 4, Table 5).20Elliott J. Waldman A. Kaplan J. How New York City's emergency ventilator stockpile ended up on the auction block. 2020.https://www.propublica.org/article/how-new-york-city-emergency-ventilator-stockpile-ended-up-on-the-auction-blockDate accessed: July 11, 2020Google Scholar, 21Rahhal N. New York is putting two coronavirus patients on one ventilator and making them out of anesthesia machines as Cuomo warns patients could be on them for 21 days. 2020.https://www.dailymail.co.uk/health/article-8157185/New-York-splitting-ventilators-converting-anesthesia-machines-coronavirus-patients.htmlDate accessed: July 11, 2020Google Scholar, 22Norton A. How U.S. hospitals cope with ventilator shortages. 2020.https://www.webmd.com/lung/news/20200330/how-us-hospitals-cope-with-ventilator-shortages#1Date accessed: July 11, 2020Google Scholar, 23Haina K.M.K.J. Use of anesthesia machines in a critical care setting during the coronavirus disease 2019 pandemic.A & A Practice. 2020; 14: e01243Crossref Scopus (7) Google Scholar, 24New York State Task Force on Life and the Law New York State Department of HealthVentilator Allocation Guidelines 2015.https://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdfDate accessed: July 11, 2020Google Scholar, 25Dwyer C. "This Is A Big Deal": New York Hails Ventilator Deliveries From China and Oregon. 2020.https://www.npr.org/sections/coronavirus-live-updates/2020/04/04/827314791/this-is-a-big-deal-new-york-hails-ventilator-deliveries-from-china-and-oregonDate accessed: July 11, 2020Google Scholar, 26The Official Website of the City of New YorkMayor de Blasio announces James O'Neill as COVID-19 Senior Advisor. 2020.https://www1.nyc.gov/office-of-the-mayor/news/215-20/mayor-de-blasio-james-o-neill-covid-19-senior-advisor#/0Date accessed: July 11, 2020Google Scholar, 27Sanger D.E. Zolan K.-Y. Kulish N. A ventilator stockpile, with one hitch: thousands do not work. 2020.https://www.nytimes.com/2020/04/01/us/politics/coronavirus-ventilators.htmlDate accessed: July 11, 2020Google ScholarFigure 4SNS Ventilator Lessons Learned: New York City and the LTV 1200. See Figure 2 for expansion of abbreviation.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Since the original purchase of SNS ventilators approximately 10 years ago, the standard of care in ICUs now includes ventilators with graphic display of pressure and volume for evaluation of patient response. Based on the crisis in New York, the Food and Drug Administration (FDA) issued an EUA in late March 2020 permitting the use of respiratory devices not routinely used as ventilators, such as anesthesia machines, to meet the needs of ICU patients.3Emergency Use Authorization for Ventilators 2020; Enforcement Policy for Ventilators and Accessories and Other Respiratory Devices During the Coronavirus Disease 2019 (COVID-2019) Public Health Emergency: Guidance for Industry and Food and Drug Administration Staff.https://www.fda.gov/media/136318/downloadDate accessed: August 22, 2020Google Scholar A number of devices considered in the EUA are purported to support recovery, whereas ICU full-feature ventilators are triaged to the sickest patients. On April 2, 2020, President Trump invoked the Defense Production Act to increase production of ventilators.28Defense Production Act authorization for Ventilators. 2020.https://www.whitehouse.gov/presidential-actions/memorandum-order-defense-production-act-regarding-purchase-ventilators/Google Scholar These federal actions drew well-meaning and skilled individuals from disciplines outside of medicine to develop devices for a projected mechanical ventilator shortage. This marshalling of expertise and goodwill has provided positive results; however, many of these devices provide limited capabilities. Systems such as "bag squeezing" devices rely on automatic compression of a resuscitation bag replacing manual ventilation (a human squeezing the bag) with precision, consistency, and without user fatigue. The first mass respiratory failure event, the 1950s polio epidemic in Denmark, relied on manual ventilation by volunteers.29Lassen H. Management of Life-Threatening Poliomyelitis. Edinburgh and London: E.& S. Livingstone Ltd., Copenhagen, Denmark1956Google Scholar These devices previously had been suggested for temporary use in limited-resource environments, but a device incapable of meeting patient requirements for pressure, volume, oxygen delivery, and minute ventilation is not a solution during the COVID-19 pandemic. There were 198,890 ventilators initially ordered by the federal government at a cost of just over 2.9 billion dollars.30Release HPHHS Announces New Ventilator Contracts, Orders Now Totaling Over 130,000 Ventilators. 2020.https://www.hhs.gov/about/news/2020/04/13/hhs-announces-new-ventilator-contracts-orders-now-totaling-over-130000-ventilators.htmlDate accessed: July 12, 2020Google Scholar, 31Release HPHHS Announces Ventilator Contract with GE Under Defense Production Act. 2020.https://www.hhs.gov/about/news/2020/04/16/hhs-announces-ventilator-contract-with-ge-under-defense-production-act.htmlDate accessed: July 13, 2020Google Scholar, 32Release HPHHS Announces Ventilator Contract with GM under Defense Production Act. 2020.https://www.hhs.gov/about/news/2020/04/08/hhs-announces-ventilator-contract-with-gm-under-defense-production-act.htmlDate accessed: July 12, 2020Google Scholar, 33Release HPHHS Announces Ventilator Contract with Philips under Defense Production Act. 2020.https://www.hhs.gov/about/news/2020/04/08/hhs-announces-ventilator-contract-with-philips-under-defense-production-act.htmlDate accessed: July 12, 2020Google Scholar Table 2 compares the technical specifications for each ventilator ordered, and Table 3 the indications and potential uses for COVID-19, data also shown graphically in Figures 1 and 2. On analysis of the technical data, ventilators may be divided into those that have the full technical sophistication to support severe COVID-19 patients and those that do not. Ventilators unable to fully support severe COVID-19 patients may still be used on less severely ill patients, for noninvasive ventilation (NIV), or as transport ventilators.Table 2Technical Assessment of Ventilators Ordered in the Current EUA Compared With the Criteria Outlined by the 2014 Mass Critical Care Task Force Panel50CareFusion LTV 2 2200/2150 Ventilator Operators Manual. 2020.https://www.vyaire.com/products/ltv2tm-series-ventilatorsDate accessed: August 22, 2020Google Scholar, 51Carescape R860 Ventilator Users Reference Manual 2013.https://www.gehealthcare.com/-/jssmedia/f96ef53464d6430d93c22fcf643aec9f.pdf?la=en-usDate accessed: August 20, 2020Google Scholar, 52Hamilton-C3 Ventilator Manual. 2017.https://www.hamilton-medical.com/dam/jcr:5687919f-6926-4268-aa7c-f935b513fc5b/HAMILTON-C3-ops-manual-SW2.0.x-en-624446.03.pdfDate accessed: August 20, 2020Google Scholar, 53Hamilton T1 Ventilator Operators Manual. 2020.https://www.hamilton-medical.com/dam/jcr:bef584f1-2fad-448c-81de-e83921f412da/HAMILTON-T1-ops-manual-SW2.2.x-en-USA-10078282.00.pdfDate accessed: August 20, 2020Google Scholar, 54Hamilton-C1 Ventilator Operators manual. 2019.https://www.hamilton-medical.com/dam/jcr:fb63acb2-87c1-477d-add9-21fe559bf9e9/HAMILTON-C1-ops-manual-SW2.2.x-en-USA-10078281.00.pdfDate accessed: August 20, 2020Google Scholar, 55Trilogy Evo Universal Instructions for Use.Phillips Respironics. 2018; https://usermanual.wiki/Respironics/1127941-3851091.pdfDate accessed: August 31, 2020Google Scholar, 56pNeuton transport ventilator Model A Manual (Airon). 2011.https://aironusa.com/wp-content/uploads/2017/10/CD-A-005-Rev-I-pNeuton-Users-Manual-Model-A-English.pdfDate accessed: August 20, 2020Google Scholar, 57Puritan Bennet 560 Ventilator Manual.http://www.industrie.gov.dz/IMG/pdf/Manual_-_User_PB560_-_English.pdfDate accessed: August 20, 2020Google Scholar, 58ResMed ventilator manual Astral series. 2020.https://www.resmed.com/us/dam/documents/products/machine/astral-series/user-guide/astral-100-150_user-guide_amer_eng.pdfDate accessed: August 20, 2020Google Scholar, 59SAVe II+ ventilator operators guide.http://ehyadarman.com/files/upload/product-brochure/admin-Operator_Manual_SAVe_II-eng-1543759244.pdfDate accessed: August 20, 2020Google Scholar, 60VOCSN V+ PRO Ventilator clinical and technical manual (ventec). 2020.https://www.venteclife.com/assets/Resources/VOCSN_Clinical_Manual.pdfDate accessed: August 20, 2020Google Scholar, 61Koninkijke Philips N.V. Phillips Trilogy EV 300: ventilator instructions for use. 2019. Murraysville, PA: Phillips Respironics; 2019.Google Scholar, 62Zoll Ventilator operators guide, model EMV+, AEV, and Eagle II.https://www.zoll.com/-/media/public-site/products/ventilators/906-0731-01-0
Referência(s)