May FY20

[kristenhorsman]

The May journal article is presented by Julienne Chandler. Click the link to find the article from AANA Journal titled: Using the Anesthesia Workstation as a Ventilator for Critically Ill Patients: Technical Considerations. The article reviews the differences between ICU and Anesthesia ventilators, management, design and long-term use pit-falls, as well as solutions for short-term use in critically-ill patients. As JHH explores all avenues of providing ventilators to patients if we do have a surge, this article provides a concise and clear rundown of the capabilities and shortcomings of using the Anesthesia machine for Covid patients. Additionally, this information keeps the CRNA informed and part of the conversation of whether we use our machines in any capacity or duration for covid care.

Here is the link.

Please answer the following 2 questions:

In what circumstances or capacity do you see it feasible to use the anesthesia machine/workstation as a ventilator for covid-positive patients requiring mechanical ventilation?

2.Will using the anesthesia machine/workstation be a sustainable solution for any part of the covid-positive patients' disease course considering staffing needs and need for continuous supervision?

[A Schutter]

I enjoyed reading this article, especially since I am currently serving in the RT role.
1. I feel it will only be feasible to use our anesthesia machines as ventilators for the covid (+) patients if there are not any other options or ventilators avail for use under extreme emergencies. As described in this article there are many restrictions to our ventilators, however with diligence, a few changes to our set-up using bacterial filters etc. and constant monitoring by an anesthesia provider it could be done.
2. I do not think using the anesthesia machine will be a sustainable solution for the long term not only due to the staffing requirements and the continuous need for monitoring by an anesthesia provider, but also because these ventilators are not made to be used for long term ventilation purposes. However certainly in extreme circumstances the anesthesia machine is a viable option for use.

[Kelly Rechtin]

1. I am actually working on a project right now to educate nurses on how to use our anesthesia machines in the ICU, in the event of a surge of critically ill covid patients. This would be for an emergency scenario only, if all other vents were in use and we needed to use our machines, especially since they are not all currently being used in the OR. It would definitely be feasible, but not optimal, since many modifications would have to be made for our anesthesia machines to be used in the ICU.

2. This would not be a sustainable solution for long term, but rather a short term solution. ICU RN's and RT's could be trained to maintain our anesthesia machines, with anesthesia resources available, if necessary for a surge of vented patients. However, once elective procedures return, we will need the machines in the OR. Fortunately, the timing of a decreased surge would most likely align with the reintroduction of elective cases.

[Kels]

In emergency circumstances or when ventilators are in extreme limited numbers / no other ventilator is available is when I see it as an option to use the anesthesia machine / workstation as a ventilator for covid patients requiring mechanical ventilation . Of course this option is not ideal and comes with some changes to the machine.

I do not see using the anesthesia machine/ workstation as a sustainable solution for the covid- positive patients however using it short term is better than nothing and if nothing else is available using it long term is better than nothing.

[aileenm4]

hi all, hope everyone is well, good article

1. I think we have close to 100 ventilators in the OR and out of OR area and should be used if needed in case of a surge which overwhelms the ICU ventilator numbers. they would have to implement some changes like an alarm system which can ring the phone of the provider to alert them as is done in the ICU. then one provider can care for more than 1 patient at a time.

2. I think we should use our ventilators if absolutely needed in a crisis for a temporary time for ICU patients, and agree we will need our vents for OR cases as some that were elective a few weeks ago have now become more urgent and need to get done.

[Vania Milnes]

I definitely think using the anesthesia ventilators is a good shirt-term plan for taking care of COVID patients in the event of a surge/need. The modifications don’t seem too extreme, and while it may not be ideal, I certainly think it should be considered an option.

While not a sustainable option, it certainly could help bridge the gap between high demand and the eventual (hopefully) decline in need. As Kelly mentioned, it may work out that the need for the ventilators to be transitioned back to the OR for elective cases will coincide with the decline in need for COVID patients.
.

[Dahlia Rouchon]

1. Working with COVID patients on the various ventilators we have at Hopkins I do I believe it would not be safe to use anesthesia machines for ventilation because of some reasons including:
- need for 24hr reboot of anesthesia machines (COVID pts. cannot go without ventilation as they are PEEP dependent)
- per the article, they do not recommend active humidification for anesthesia machines and COVID patients require humidification due to the copious mucus plugs they produce. Dry circuits clot and clog up the airway putting the patient is respiratory arrest
- need for scavenge in anesthesia machines and CO2 absorbers (COVID patients have hypercarbia and it worsens as the disease progresses leading to acidosis)
- as ARDS worsens, many need APRV with high I:E ratios 9:1 or 8.8:1 which I am unsure whether our anesthesia machines can provide this ventilation
- frequently we measure driving pressures and I do not know whether we can do static measurements of inspiratory holds to be able to further guide how to improve the ventilation for COVIDs
- anesthesia ventilators create excessive humidity when using CO2 absorbers which can fail flow sensors easily on circuits used at our institution
- anesthesia ventilators require a trained provider to be immediately available for emergent changes which logistically in the current care models we typically have 3-4:1 or even 10:1 cross covering for breaks of patients to RT; not to mention ratios in surge scenarios. This is a safety risk that there is delayed response time
- some COVIDs require high PEEP of +14 to +16 which we would need to be able to adjust alarm settings for PIP to a higher level than accustomed.
2. In conclusion I would defer using an anesthesia ventilator for COVID cases given the high level of care the anesthesia machines require in consideration with which the high level of morbidity COVID patients present.

[Anne McNulty CRNA]

Apr 30, 2020 13:55:44 GMT -5 kristenhorsman said:

The May journal article is presented by Julienne Chandler. Click the link to find the article from AANA Journal titled: Using the Anesthesia Workstation as a Ventilator for Critically Ill Patients: Technical Considerations. The article reviews the differences between ICU and Anesthesia ventilators, management, design and long-term use pit-falls, as well as solutions for short-term use in critically-ill patients. As JHH explores all avenues of providing ventilators to patients if we do have a surge, this article provides a concise and clear rundown of the capabilities and shortcomings of using the Anesthesia machine for Covid patients. Additionally, this information keeps the CRNA informed and part of the conversation of whether we use our machines in any capacity or duration for covid care.

Here is the link.

Please answer the following 2 questions:

In what circumstances or capacity do you see it feasible to use the anesthesia machine/workstation as a ventilator for covid-positive patients requiring mechanical ventilation?

2.Will using the anesthesia machine/workstation be a sustainable solution for any part of the covid-positive patients' disease course considering staffing needs and need for continuous supervision?

I think it is feasible use use anesthesia machines to ventilate patients during a crisis or shortage.  This is not a long term solution.    As soon as a conventional ventilator is available, the patient should be placed on a vent that can be serviced easily . 

[Christine Velarde]

1. If necessary the anesthesia machine/ventilator should be used to treat COVID-19 patients if no ventilators are available. Many small community hospitals do not have the capacity to own the needed amount of ventilators that are needed during this crisis. It should be operated by an anesthesia provider that knows the machine so the ventilator can be used properly. As previously mentioned, there are differences with ventilators and anesthesia machines such as CO2 cannisters/ alarms that must be maintained by the anesthesia provider. What has come from this crisis is the ability to deploy anesthesia personnel to the ICU and ICU-conversion areas that utilize the anesthesia machines.
2. Will anesthesia machines be a sustainable solution? The COVID-19 crisis has hospitals count the anesthesia machine as a possible ventilator due to the large number of patients needing intubation at the beginning of this crisis. The preventable measures of staying at home, self quarantine, using proper PPE/ N-95 masks and 6 feet distancing have flatten the curve so that anesthesia machines do not have to be used.
Our group has deployed the CRNA's to the new make shift ICU's as well as our colleagues across the nation. The hope is that we will start our non-emergent cases and go back to the OR's, thus needing our anesthesia machines.

[Ben Waldbaum]

1.) Anesthesia ventilators should only be used if no other regular ventilators are available

2.) No. it is too resource heavy.

[Jocelyn Datud]

The anesthesia machine can be used as a back up if the hospital runs out of ventilators. However, it is not a good option for long term use due to it's design, capabilities, and resources needed such as required operator (anesthesia provider). Also, the medical providers who will be using it (intensivists, respiratory therapist, etc) will need an extra training to be familiar with it. Luckily, even with the COVID peak, we have enough ventilators available for patients.

[Jackie Howell]

1. Anesthesia ventilators should only be used as a last resort.
2. No, it is not a sustainable long term solution.

[Katya]

1. I agree with Dahlia that it wouldn't be safe to use anesthesia machines for COVID patient's ventilation because of above reasons: need for APRV ventilation, 24 hr reboot requirement, no humidification, and need for a trained provider to be immediately available.
2. I don't think it is a solution for long term but it might be used for short term until long term solution can be found.

[clawry]

In what circumstances or capacity do you see it feasible to use the anesthesia machine/workstation as a ventilator for covid-positive patients requiring mechanical ventilation?


I see it feasible to use the anesthesia machine as a ventilator for covid + patients only in emergency situations. If all of the ventilators and ICUs were full at the hospital and it was a true crisis we would need to adapt and do whatever we can to properly care for this critically ill population. It would only be after all other resources in the hospital have been exhausted. It would take extra man power and possibly housing these patients in the OR which may not be ideal logistically.


2.Will using the anesthesia machine/workstation be a sustainable solution for any part of the covid-positive patients' disease course considering staffing needs and need for continuous supervision?
It would need to be a 1 to 1 provider to patient ratio. The alarms may not be heard if the provider has more than 1 patient. The anesthesia machine is designed to have a trained anesthesia provider present at all times. These machines do not continue working if alarms are sounded and they are not attended to promptly which may lead to bad outcomes for this extremely vulnerable patient population.

Thanks Jules for this excellent article. Very relevant to our current pandemic situation!

[emedina1]

After reading this article, It will make me think twice to reach out for this equipment. Its has a lot to think about. However in the circumstances that we I am
stuck, I am stuck, just have too the best. This article give me pointers what to do.

This is a hard decision for me. Staffing is one consideration since a lot of the anesthesia provider is spread thin. The article points out it is not sustainable
to keep tents on this ventilator for longer time.