Ventilator Type in a Respiratory Pandemic: Does It Make a Difference?

Abstract

Introduction: When COVID-19 was declared a pandemic by the WHO in early 2020, the United States was only beginning to focus on the potential impact of the disease. Elmhurst Hospital Center in New York City became the “epicenter of the epicenter” at the height of the first wave. In order to meet the demand of a large surge of acutely ill patients requiring mechanical ventilation for hypoxemic respiratory failure, widespread collaboration resulted in the use of different types of ventilators, including those designed primarily for patient transport. While typical ICU ventilators give extensive graphical and numeric information with respect to patient and vent parameters, travel ventilators do not. Therefore, utilization of these ventilators outside of their intended spectrum of use has the potential to compromise patient care. Barotrauma is a relatively common complication of ventilated patients with critical COVID-19 infections, which raises the concern that the use of travel ventilators could compound the risk. Materials and Methods: A retrospective analysis of patients with COVID-19 pneumonia admitted and intubated for respiratory failure from March 2 to May 9, 2020 was undertaken. Clinical and demographic information, incidence of barotrauma with respect to ventilator type, and mortality were evaluated using non-parametric analysis as appropriate. Time-to-event analysis was performed for both barotrauma and mortality with respect to ventilator type. Results: Of 335 patients identified, 313 had sufficient data available. Median age was 61 years and males made up 81.5% of the population. Overall mortality was 81%. Age was associated with greater mortality (p=0.047), but there was no mortality difference with respect to sex, BMI, or with respect to known comorbid risk factors. Travel ventilators were associated with longer length of stay (p=0.0002), a longer time intubated (p=0.0009), but also a longer time to intubation (p=0.014). No significant difference in incidence of barotrauma (p=0.18), pneumothorax (p=0.35), or mortality (p=0.52) by ventilator type was observed. Barotrauma was associated with a longer length of stay (p=0.0001) and days intubated (p=0.0001), but not with time from admission to intubation or increased risk mortality. Conclusion: Adaptation is required by healthcare providers during a pandemic, especially the utilization of available critical resources including ventilators. While adaptation to new equipment with different original intended uses and capabilities presents its own set of intrinsic challenges, the extended use of Transport Ventilators was not associated with an increase in barotrauma or mortality. (Table Presented).