An Assessment of the Philippine Hospital Resources as Predictors of the Case Fatality Rate of COVID – 19

In the heightened effects of the pandemic, health resources have been in constant limbo as supplies and availability of hospital resources take a toll as COVID-19 cases surge, resulting in shortages. Thus, health systems are overwhelmed, resulting in a higher fatality rate since the capacity to provide medical attention is diminished. In this paper, hospital resources refer to mechanical ventilators, ICU, isolation, and ward beds which are the critical factors of the case fatality rate (CFR) of COVID-19 in the Philippines. Data were retrieved from the Department of Health (DOH) Case Bulletins from October 26, 2020, to June 30, 2021, with 248 total observations. This research used the Ordinary Least Squares (OLS) Multiple Regression to determine if hospital resources are the predictors of the case fatality rate of COVID-19. Furthermore, the results show a significant relationship between the hospital resources and the case fatality rate of COVID-19 in the Philippines. This study can become a framework for further research concerned about hospital resources as the predictors of case fatality rates of different diseases in a pandemic.

Clinical impact of pneumothorax in patients with Pneumocystis jirovecii pneumonia and respiratory failure in an HIV-negative cohort

Background Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can result in development of pneumothorax during treatment. This study aimed to identify the incidence and related factors of pneumothorax in patients with PCP and acute respiratory failure and to analyze their prognosis. Methods We retrospectively reviewed the occurrence of pneumothorax, including clinical characteristics and results of other examinations, in 119 non-human immunodeficiency virus patients with PCP and respiratory failure requiring mechanical ventilator treatment in a medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019. Results During follow up duration, twenty-two patients (18.5%) developed pneumothorax during ventilator treatment, with 45 (37.8%) eventually requiring a tracheostomy due to weaning failure. Cytomegalovirus co-infection (odds ratio 13.9; p = 0.013) was related with occurrence of pneumothorax in multivariate analysis. And development of pneumothorax was not associated with need for tracheostomy and mortality. Furthermore, analysis of survivor after 28 days in ICU, patients without pneumothorax were significantly more successful in weaning from mechanical ventilator than the patients with pneumothorax (44% vs. 13.3%, p = 0.037). PCP patients without pneumothorax showed successful home discharges compared to those who without pneumothorax (p = 0.010). Conclusions The development of pneumothorax increased in PCP patient with cytomegalovirus co-infection, pneumothorax might have difficulty in and prolonged weaning from mechanical ventilators, which clinicians should be aware of when planning treatment for such patients.

Reducing Ventilator Alarms Through Decreased Rainout in Ventilator Circuits: A Bench Study

Background:Alarm fatigue is a significant problem in healthcare, particularly in high acuity settings such as intensive care, surgery, and emergency departments. Alarms are triggered by various devices such as anesthesia machines, ventilators, patient monitors or humidifiers. Heated humidifiers (HH) used with mechanical ventilators, while necessary to prevent other complications associated with mechanical ventilator, may cause condensation in the ventilator circuit, prompting occlusion alarms indicating a risk for the patient. Technological advances in heated humidifier (HH) circuits may reduce rainout and therefore occlusion alarms. Methods:Bench experiments measured alarms and rainout of two commercially available humidifiers (AirLife DuoTherm™ and Fisher & Paykel MR850) and four different pediatric and adult patient’s breathing. The tests examined condensation accumulation after 24 hours of low-, nominal-, or high-flow rates of gas at low-, nominal-, and high-ambient temperature settings. Dual-limb designs of adult- and neonate-sized circuits underwent evaluation. Data on alarms was collected for each system.Results:Low temperature and occlusion alarms were statistically significantly lower in DuoTherm vs. MR850 HH circuits (6 vs. 68 alarms, respectively; p<nn). DuoTherm products accumulated significantly less rainout for all three circuit sizes at all ambient temperatures. In general, the set flow rate did not dramatically affect the amount of rainout for adult and infant circuits, but low versus high ambient temperatures yielded increased rainout for all circuit types (p < 0.02). Conclusions:The DuoTherm HH device and patient circuits developed significantly less alarms due to rainout and low temperatures compared to those from MR850 under all the conditions tested. Such reduction in patient alarms should help reduce alarm fatigue among healthcare workers in critical care settings.

Evaluation of a Pneumatic Vest to Treat Symptoms of ARDS Caused by COVID-19

Critical care patients who experience symptoms of acute respiratory distress syndrome are commonly placed on mechanical ventilators to increase the oxygen provided to their pulmonary systems and monitor their condition. With the pulmonary inflammation typically accompanying ARDS, patients can experience lower ventilation-perfusion ratios resulting in lower blood oxygenation. In these cases, patients are typically rotated into a prone position to facilitate improved blood flow to portions of the lung that were not previously participating in the gas exchange process. However, proning a patient increases the risk of complications, requires up to seven hospital staff members to carry out, and does not guarantee an improvement in the patient's condition. The low-cost vest presented here was designed to reproduce the effects of proning while also requiring less hospital staff than the proning process. Additionally, the V/Q Vest helps hospital staff predict whether patients would respond well to a proning treatment. A pilot study was conducted on nine patients with ARDS from Coronavirus disease 2019 (COVID-19). The average increase in oxygenation with the V/Q Vest treatment for all patients was 19.7 ± 38.1%. Six of the nine patients responded positively to the V/Q Vest treatment, exhibiting increased oxygenation. The V/Q Vest also helped hospital staff predict that three of the five patients that were proned would experience an increase in oxygenation. An increase in oxygenation resulting from V/Q Vest treatment exceeded that of the proning treatment in two of these five proned patients.

Tidal Volume in Pediatric Ventilation: Do You Get What You See?

Mechanical ventilators are increasingly evolving into computer-driven devices. These technical advancements have impact on clinical decisions in pediatric intensive care units (PICUs). A good understanding of the design of mechanical ventilators can improve clinical care. Tidal volume (TV) is one of the corner stones of ventilation: multiple technical factors influence the TV and, thus, influence clinical decision making. Ventilator manufacturers make various design choices regarding the phase, site and conditions of TV measurement as well as algorithmic processing choices. Such choice may impact the measurement and subsequent display of TV. A software change of the TV measuring algorithm of the SERVO-i® (Getinge, Solna, Sweden) at the PICU of the University Medical Centre Utrecht was studied in a prospective cohort. It showed, as example, a clinically significant impact of 8% difference in reported TV. Design choices in both the hardware and software of mechanical ventilators can have a clinically relevant impact on the measurement of tidal volume. In our search for the optimal TV for lung-protective ventilation, such choices should be taken into account.

History of Intermittent Mandatory Ventilation prior to 1972. Part one. Special Article

Medical history is often overlooked as advances keep moving forward. Seldom is it that advances in medicine are truly new, unique ideas, but rather built on ideas that have been considered before. Even our latest developments will become history or forgotten as science and medicine advance. This history of intermittent mandatory ventilation (IMV) is a two-part article in which the first part attempts to show that the concepts and apparatus that involve the now common mode of ventilation have been considered and described for nearly 200 years, if not earlier. This older history is not brought forward to diminish what has been done in the last 50 years, but to enhance awareness of how ideas and even mechanical ventilators change over time. The second part will describe how those ideas and mechanics changed into what we now call IMV in its many forms. Keywords: Intermittent Mandatory Ventilation, IMV, History of mechanical ventilation

Public Opinion on Priorities Toward Fair Allocation of Ventilators During COVID-19 Pandemic: A Nationwide Survey

Background: The rapidly growing imbalance between supply and demand for ventilators during the COVID-19 pandemic has highlighted the principles for fair allocation of scarce resources. Failing to address public views and concerns on the subject could fuel distrust. The objective of this study was to determine the priorities of the Iranian public toward the fair allocation of ventilators during the COVID-19 pandemic.Methods: This anonymous community-based national study was conducted from May 28 to Aug 20, 2020, in Iran. Data were collected via the Google Forms platform, using an online self-administrative questionnaire. The questionnaire assessed participants' assigned prioritization scores for ventilators based on medical and non-medical criteria. To quantify participants' responses on prioritizing ventilator allocation among sub-groups of patients with COVID-19 who need mechanical ventilation scores ranging from −2, very low priority, to +2, very high priority were assigned to each response.Results: Responses of 2,043 participants, 1,189 women, and 1,012 men, were analyzed. The mean (SD) age was 31.1 (9.5), being 32.1 (9.3) among women, and 29.9 (9.6) among men. Among all participants, 274 (13.4%) were healthcare workers. The median of assigned priority score was zero (equal) for gender, age 41–80, nationality, religion, socioeconomic, high-profile governmental position, high-profile occupation, being celebrities, employment status, smoking status, drug abuse, end-stage status, and obesity. The median assigned priority score was +2 (very high priority) for pregnancy, and having &lt;2 years old children. The median assigned priority score was +1 (high priority) for physicians and nurses of patients with COVID-19, patients with nobel research position, those aged &lt;40 years, those with underlying disease, immunocompromise status, and malignancy. Age&gt;80 was the only factor participants assigned −1 (low priority) to.Conclusions: Participants stated that socioeconomic factors, except for age&gt;80, should not be involved in prioritizing mechanical ventilators at the time of resources scarcity. Front-line physicians and nurses of COVID-19 patients, pregnant mothers, mothers who had children under 2 years old were given high priority.

Multiple Mechanical Ventilation: historical review and cost analysis

In times of crisis in public health where the resources available in the hospital network are scarce and these must be used to the fullest, innovative ideas arise, which allow multiplying the use of existing resources, as artificial mechanical ventilators can be. These can be used in more than one patient, by attaching a device to distribute the mixture of air and oxygen from the ventilator being used simultaneously (multiple mechanical ventilation). This idea, although innovative, has generated controversy among the medical community, as many fear for the safety of their patients, because attaching such devices to the ventilator loses control over the mechanical ventilation variables of each patient and can only maintain general vigilance over the ventilator. These misgivings about the device have led several researchers to take on the task of verifying the reliability of this flow splitter connector. It is for this reason that this article presents a thorough review of the studies carried out on the subject and additionally shows an analysis of comparative costs between the acquisition of a mechanical ventilator and the flow division system.

Reducing Ventilator Alarms Through Decreased Rainout in Ventilator Circuits: A Bench Study

Background:Alarm fatigue is a significant problem in healthcare, particularly in high acuity settings such as intensive care, surgery, and emergency departments. Alarms are triggered by various devices such as anesthesia machines, ventilators, patient monitors or humidifiers. Heated humidifiers (HH) used with mechanical ventilators, while necessary to prevent other complications associated with mechanical ventilator, may cause condensation in the ventilator circuit, prompting occlusion alarms indicating a risk for the patient. Technological advances in heated humidifier (HH) circuits may reduce rainout and therefore occlusion alarms. Methods:Bench experiments measured alarms and rainout of two commercially available humidifiers (AirLife DuoTherm™ and Fisher & Paykel MR850) and four different pediatric and adult patient’s breathing. The tests examined condensation accumulation after 24 hours of low-, nominal-, or high-flow rates of gas at low-, nominal-, and high-ambient temperature settings. Dual-limb designs of adult- and neonate-sized circuits underwent evaluation. Data on alarms was collected for each system.Results:Low temperature and occlusion alarms were statistically significantly lower in DuoTherm vs. MR850 HH circuits (6 vs. 68 alarms, respectively; p<nn). DuoTherm products accumulated significantly less rainout for all three circuit sizes at all ambient temperatures. In general, the set flow rate did not dramatically affect the amount of rainout for adult and infant circuits, but low versus high ambient temperatures yielded increased rainout for all circuit types (p < 0.02). Conclusions:The DuoTherm HH device and patient circuits developed significantly less alarms due to rainout and low temperatures compared to those from MR850 under all the conditions tested. Such reduction in patient alarms should help reduce alarm fatigue among healthcare workers in critical care settings.

Corporate entrepreneurs and collaborative innovation in crisis: The case of the Covid-19 ventilator shortage

This teaching case focuses on corporate entrepreneurship and collaborative innovation during an unprecedented crisis – the shortage in mechanical ventilators when the Covid-19 pandemic began. Based on secondary data sources, the case outlines the challenges of designing and manufacturing mechanical ventilators and introduces four initiatives, consisting of organisations with often limited experience in medical device manufacturing that attempted to address the predicted shortage of ventilators. By comparing the approaches used in these initiatives, the case sensitises students to the challenges of pursuing opportunities outside a firm's established domain of expertise and how inter-organisational collaboration affects such attempts. Although the case centres on an unprecedented event, the insights it develops make it suitable for a range of innovation and entrepreneurship-related under- and post-graduates courses.