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Old June 24th, 2006, 02:01 PM
Bruce Bruce is offline
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Posts: 317
Default Re: NY Times: Too Few Ventilators for Bird Flu Crisis

Positive-Pressure Ventilation Equipment for Mass Casualty
Respiratory Failure
LEWIS RUBINSON, RICHARD D. BRANSON, NICKI PESIK, and DANIEL TALMOR
EXTENSIVE EFFORTS are being undertaken to prepare
the medical community for a moderate to severe influenza
pandemic. If the currently circulating H5N1 virus
causes the next human pandemic, and if the clinical conditions
of the approximately 180 people infected as of
mid-March 2006 are representative of the pandemic
strain’s virulence, then many people will develop severe
acute respiratory failure (ARF).1
In countries where advanced medical care is widely
available, patients with severe ARF who cannot maintain
adequate blood levels of oxygen despite noninvasively
delivered supplemental oxygen, or who have elevated
blood levels of carbon dioxide and a low pH, are treated
with positive-pressure ventilation (PPV). Most patients
with severe ARF who receive PPV survive, in spite of
their severe illness, when treatment includes full-feature
mechanical ventilators used within intensive care units
(ICUs) or specialized hospital wards. Even 35%–65%
of patients with acute respiratory distress syndrome
(ARDS) survive.2–8 By comparison, without PPV, almost
all patients with severe ARF, except when it is caused by
conditions immediately correctable by pharmacologic
antidotes (e.g., naloxone for opiate overdose), are likely
to die.
Hospitals typically have sufficient numbers of ventilators
to meet everyday demand but not enough for demand
peaks, when they are forced to rent additional equipment.
During a large mass casualty event when a region’s ventilator
supply is already allocated and rental inventories
are depleted, a state can request distribution of additional
mechanical ventilators from the Centers for Disease Control
and Prevention’s Strategic National Stockpile (SNS).
The SNS maintains thousands of Impact Uni-Vent Eagle
754 and Puritan Bennett LP-10 ventilators and is considering
accumulating thousands of additional ventilators.
These portable ventilators have limited functions when
Lewis Rubinson, MD, PhD, is Health Officer, Deschutes County Health Department, and Attending Physician, Pulmonary and
Critical Care Medicine, Bend Memorial Clinic, Bend, Oregon; Richard D. Branson, MS, RRT, is Associate Professor of Surgery,
University of Cincinnati, Cincinnati, Ohio; Nicki Pesik, MD, is Senior Medical Officer and Team Lead, Preparedness and Response
Team, Bioterrorism Preparedness and Response Program, Centers for Disease Control and Prevention, Atlanta, Georgia;
and Daniel Talmor, MD, MPH, is Director of Trauma Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, and Assistant
Professor of Anaesthesia, Harvard Medical School, Boston, Massachusetts.
1
In the event of an influenza pandemic, patients with severe acute respiratory failure (ARF) due to influenza
will require positive-pressure ventilation (PPV) in order to survive. In countries with widely
available critical care services, PPV is delivered almost exclusively through use of full-feature mechanical
ventilators in intensive care units (ICUs) or specialized hospital wards. But the supply of
these ventilators is limited even during the normal course of hospital functioning. Purchasing and
maintaining additional full-feature mechanical ventilators to be held in reserve and used only during
mass casualty events is too expensive to allow the stockpiling of such equipment. Consequently, planning
and preparedness efforts to respond to a severe influenza pandemic have stimulated consideration
of limited-feature, less-expensive ventilation devices to augment traditional PPV capacity. This
article offers guidance to authorities charged with preparing for mass casualty PPV in deciding
which PPV equipment would be adequate for ventilating patients for days, weeks, or even months
during a medical catastrophe......Continues in PDF
http://www.biosecurityjournal.com/RUBINSON.pdf
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Old February 28th, 2007, 10:07 PM
Possibilities Possibilities is offline
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Posts: 523
Default Re: NY Times: Too Few Ventilators for Bird Flu Crisis

Bumping this article. The importance of the article is not that there are an inadequate number of ventilators. The importance is that CPAP devices might be used in lieu of respirators. Now is the time to consider what alternative forms of respiration we might give patients. For those that don't know, CPAP devices are used by people with sleep apnea. Since they're cheap and available, they might serve as an alternative.

I found an article about CPAP devices here:
http://adc.bmj.com/cgi/content/abstract/68/5/570

I'm also wondering about decontaminating the devices post usage by other patients.

Bagging was mentioned in the article. That's obviously not a long term effective treatment, but it does make me think. In many parts of Africa, when the patient goes in the hospital, the patient's family does much of the work of maintaining a clean area, cooks for the patient, etc. In the event of a crisis, we might consider using the patient's family as volunteers in the hospital to assist in case of shortages of personnel. Most hospital rooms will have an overflow of patients, so it might significantly assist us.
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