Modified Sleep Apnea Machines May Ease the Ventilator Crunch
Poor says they haven’t yet had to deploy modified sleep apnea machines turned ventilators, but just knowing they are ready is a big relief. “The one situation that terrifies me is having to make a decision with two patients and one ventilator and having to decide who gets it,” says Poor. “Having these extra machines reduces the chance I would have to make that decision.”
Hospitals in New York, Chicago, and Boston are also repurposing anesthesia gas machines that are normally only used during surgical procedures, according to Mary Dale Peterson, president of the American Society of Anesthesiologists and a pulmonary pediatric physician at Driscoll Children’s Hospital in Corpus Christi, Texas.
Peterson says that many hard-hit hospitals are doing the best they can as ventilators run short, but we shouldn’t forget that medical workers need to be trained on new machines, or repurposed ones. “Under normal conditions, you would want enough time for enough testing and vetting, time to train the staff on how to manage those ventilators, because on every piece of machinery you have to learn where the buttons are,” Peterson says. “But we are not dealing with ideal conditions. I’m hoping we are getting through the crisis without having to resort to things that are totally brand new or haven’t been tested.”
The ventilator shortage has also attracted novel designs that still must get approval from the FDA before being used on patients. A Mississippi doctor built a breathing bag from parts he bought at a local hardware store, while a team of Rice University engineering students designed an automated breathing bag that can be used by first responders or emergency room doctors that can be built with 3D printed parts for about $150.
“Maybe you have a hospital that runs out of ventilators, or someone in an ER needs to be intubated,” says Rohith Ramachandra Malya, an assistant professor of medicine at Baylor School of Medicine who advised the Rice University students. “Rather than pulling someone off an existing ventilator, this device buys you time.”
At the same time that doctors and engineers are coming up with new breathing machine designs, some medical experts are beginning to question whether doctors are putting too many coronavirus patients on hospital ICU ventilators. In social media and online discussions, some emergency medicine physicians suggest that existing Covid-19 protocols may need to change and that with some patients, ventilators may do more harm than good. They say that some patients have low blood oxygen levels that trigger the use of a ventilator according to existing medical protocols, even if the patients are not gasping for air or having heart problems.
This debate played out this week on an episode of the MedScape podcast, in which John Whyte, chief medical officer of the WebMD website interviewed New York emergency room physician Cameron Kyle-Sidell. Kyle-Sidell said he’s noticing that many of his coronavirus patients are in a state of hypoxia, or low oxygen, a condition similar to what happens to hikers or skiers who get altitude sickness. Most of the time, when patients hit that level of hypoxia, they can barely talk, but he spoke about a patient who could, and who said she did not want a breathing tube.
“So she asked that we put it in at the last minute possible,” Kyle-Sidell said during the MedScape podcast interview. “It was this perplexing clinical condition: When was I supposed to put the breathing tube in? When was the last minute possible? All the instincts as a physician—like looking to see if she tires out—none of those things occurred. It’s extremely perplexing. But I came to realize that this condition is nothing I’ve ever seen before.”
