April 22, 2020

How hospitals are tackling ventilator shortages: Hair dryers, lawn sprinklers, and PVC pipes

Daily Briefing

    Hospitals nationwide are facing a shortage of ventilators, which are used to treat patients with Covid-19, forcing some providers to get creative and either utilize other machines to serve as ventilators—or to build their own.

    3 ways to bolster ventilator supply—when you can't access more traditional ventilators

    How hospitals are getting creative and building their own ventilators

    Ventilators have generally been thought of as a last resort for patients with respiratory conditions because the intubation process carries a variety of risks, the New York Times reports. Susan Wilcox, chief of critical care in emergency medicine at Massachusetts General Hospital, said, typically, "[y]ou never want to intubate a patient unless it's absolutely necessary."

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    But the country's epidemic of Covid-19, the disease caused by the new coronavirus, has led to a shortage of ventilators nationwide as many patients with the disease require ventilators.

    The shortage has forced some hospitals to improvise how they're providing needed care. At the University of Florida, for example, engineers have developed a ventilator device using PVC pipe and valves from lawn sprinklers.

    "We're just on an 'as fast as possible' timetable at this point," Tod Corlett, an industrial designer and professor at the Thomas Jefferson University who built a prototype ventilator, said. "No one knows how long we have."

    Meanwhile, Hugh Cassiere, a pulmonologist at Northwell Health, worked with colleagues to figure out how to convert CPAP and BiPAP machines—which are traditionally used to treat patients with sleep apnea—to help providers cope with ventilator shortages. Cassiere and colleagues used 3D printers to make adapters that could connect the sleep apnea machines to endotracheal tubes and HEPA filters. According to the Times, North Shore University Hospital has successfully treated around 100 patients using the machines, and Cassiere said he's also used the machines on non-Covid-19 patients to free up traditional ventilators. "I'd rather have more regular ol' ventilators, but this could be a viable option if a hospital is running low," he said.

    Some hospitals also are using breathing machines like CPAPs and BiPAPs to increase patients' oxygen levels and hopefully prevent intubation altogether. Experts say the positive air pressure that the machines pump out can dislodge fluid in a patient's lungs, which allows for better oxygen absorption, the Times reports. According to the Times, doctors have reported that the machines are helpful for Covid-19 patients whose lung function is moderately impaired.

    Mount Sinai Health System has reconfigured 200 machines known as VPAPs, which were provided by Tesla, to trap contagions that patients have exhaled and to work as air pumps for intubation. Charles Powell, director of the Mount Sinai-National Jewish Health Respiratory Institute, said the machines aren't powerful enough to use on patients experiencing severe respiratory distress, but they've been useful for Covid-19 patients with moderate respiratory symptoms.

    Engineers at New York University even have modified hooded hair dryers typically found in salons to serve as negative pressure chambers that can supply patients with oxygen and limit the new coronavirus' spread, the Times reports. And doctors at some hospitals—including Bhakti Patel, a doctor at the University of Chicago Medical Center—have started using positive pressure hoods that fit over a patient's head to prevent the virus' spread while air is pushed into the patient's lungs, according to the Times.

    Substandard careor solutions for a desperate time?

    Ken Lyn-Kew, a pulmonologist at National Jewish Health, said he worries about the use of improvised ventilators, which might not be as effective as ventilators, themselves.

    "I find it terrifying and concerning because we know if we're doing that, we're going to be providing substandard care to people in an attempt to give care," he said, asking, "Is it better to give one person good care or two people really bad care?"

    Giacomo Bellani, a critical care doctor at San Gerardo Hospital and University of Milan Bicocca in Italy, said positive pressure hoods have been frequently used in Italian hospitals overwhelmed by Covid-19 patients. "The hoods can buy you time when you're short on ICU beds," he said.

    However, Bellani also noted that the hoods don't always prevent a patient from needing to be placed on a ventilator—and delaying ventilation could hurt the patient's outcome. "[T]here is a drawback because in some patients you are just postponing intubation and the longer the delay, the greater the risk that some patients won't make it," Bellani said.

    Similarly, Wilcox noted that using CPAP machines as ventilators can present risks, citing a 2017 study that found up to 80% of patients with moderate respiratory symptoms who were attached to a CPAP machine damaged their lungs by taking in large breaths over a long period of time. Wilcox said she's preferred using prone positioning, a process in which providers turn a patient in respiratory distress onto their stomachs, and she's seen encouraging results. "It's all anecdotal at this point, but patients tell us they feel better."

    But Rohith Malya, an assistant professor at the Baylor College of Medicine, said desperate times call for desperate measures. "At the point when hospitals are asking people to bring in their home BiPAP machines" and "[t]he alternative is sure death," providers need to think creatively, Malya said.

    The key for these improvised ventilators is reliability, Corlett said. "If it's not going to quickly and quietly and reliably and safely do its job so our doctors can get on with patient care, it's not something that's worth putting in place" (Jacobs, New York Times, 4/17; Ducharme, TIME, 4/6; Avril, Philadelphia Inquirer, 3/30).

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