OP339 Virtual COVID Ward: The Use Of Telehealth In The Emergency Response To COVID-19

IntroductionWith unprecedented times, comes accelerated change. Hospitals in our region have begun to facilitate safe discharge for COVID-19 patients in the form of “The virtual COVID ward”. This has enabled patients to be monitored safely in the community using pulse oximetry, Florence (a telehealth mobile app) and remote consultations. Our objective is to expand upon this model by providing home oxygen therapy for these patients facilitated by telemedicine.MethodsPatients were discharged with an oxygen concentrator if they had an oxygen requirement equal to or less than four litres/minute. Fraction of inspired oxygen needed to be stable and an early warning score of less than four was also required. Once admitted, the Florence app and daily remote consultations were crucial to closely monitor the patient's clinical status. The patient was instructed to enter oxygen saturations and heart rate into the app four times daily. The app would then alert our team if any patients observations deteriorate, triggering immediate assessment.ResultsWe have discharged ninety patients to the virtual ward, fifty-six of these with home oxygen. The average age was fifty-seven and the Clinical Frailty Score ranged between one and six. At present, ten patients have been re-admitted, four with increasing oxygen requirements, and six with unrelated symptoms. Two patients had oxygen concentrators installed at home after we were alerted to their desaturation by the Florence App. The re-admission rate is eleven percent, which mirrors that of other virtual wards (who do not provide home oxygen). In total, the ward has saved the trust 627 hospital inpatient ‘days’. Patients report increased satisfaction at playing a meaningful role in monitoring their own healthcare using the app.ConclusionsOur novel model of supported discharge with oxygen therapy using telehealth demonstrates that it is possible to manage such patients, safely, in the community. Other trusts could utilise this model to reduce inpatient bed occupancy. Looking to the future, could telehealth be utilised further to facilitate other “Virtual wards” in the community?

In Vitro Evaluation of a Nasal Interface Used to Improve Delivery from a Portable Oxygen Concentrator

Portable oxygen concentrators (POCs) are widely used to administer long-term oxygen therapy (LTOT) and employ pulsed delivery modes to conserve oxygen. Efficient pulsed delivery requires that POCs are triggered by patient inhalation. Triggering is known to fail for some patients during periods of quite breathing, as occurs during sleep. The present article describes a new nasal interface designed to improve triggering of pulsed oxygen delivery from portable oxygen concentrators (POCs). In vitro experiments incorporating realistic nasal airway replicas and simulated breathing were conducted. The pressure monitored via oxygen supply tubing (the signal pressure) was measured over a range of constant inhalation flow rates with the nasal interface inserted into the nares of the nasal airway replicas, and compared with signal pressures measured for standard and flared nasal cannulas. Triggering efficiency and the fraction of inhaled oxygen (FiO2) were then evaluated for the nasal interface and cannulas used with a commercial POC during simulated tidal breathing through the replicas. Higher signal pressures were achieved for the nasal interface than for nasal cannulas at all flow rates studied. The nasal interface triggered pulsed delivery from the POC in cases where nasal cannulas failed to trigger. FiO2 was significantly higher for successful triggering cases than for failed triggering cases. The nasal interface improved triggering of pulsed oxygen delivery from a POC and presents a simple solution that could be used with commercially-available POCs to reliably supply oxygen during periods of quiet breathing.

Role of oxygen concentrators in covid pandemic

The need for oxygen, as well as the scarcity caused by the second wave of the Corona epidemic, has caused everyone to reconsider the sustainability and self-sufficiency of oxygen. Medical oxygen therapy is a standard treatment for patients with severe Covid manifestations. Ensuring a consistent supply of oxygen to meet the rising demand for oxygen must be planned at the national, state, and institutional levels. In this article we would like to emphasise the importance of oxygen adequacy. This narrative review covers the methods of estimating oxygen requirements of a hospital, and the alternate oxygen sources available, highlighting the role of oxygen concentrators in a low resource settings. Oxygen concentrators specially as pressure swing adsorption plants can be used by hospitals as a main source of oxygen being both economical, as well as reducing the dependency on refilling and transport. Planning the oxygen resources for a hospital should include primary, secondary and reserve sources, among all these the oxygen concentrator plays a vital role both being economical in the long run as well as making the hospital largely independent of logistic issues.

A Novel Ventilator Design for COVID-19 and Resource-Limited Settings

There has existed a severe ventilator deficit in much of the world for many years, due in part to the high cost and complexity of traditional ICU ventilators. This was highlighted and exacerbated by the emergence of the COVID-19 pandemic, during which the increase in ventilator production rapidly overran the global supply chains for components. In response, we propose a new approach to ventilator design that meets the performance requirements for COVID-19 patients, while using components that minimise interference with the existing ventilator supply chains. The majority of current ventilator designs use proportional valves and flow sensors, which remain in short supply over a year into the pandemic. In the proposed design, the core components are on-off valves. Unlike proportional valves, on-off valves are widely available, but accurate control of ventilation using on-off valves is not straightforward. Our proposed solution combines four on-off valves, a two-litre reservoir, an oxygen sensor and two pressure sensors. Benchtop testing of a prototype was performed with a commercially available flow analyser and test lungs. We investigated the accuracy and precision of the prototype using both compressed gas supplies and a portable oxygen concentrator, and demonstrated the long-term durability over 15 days. The precision and accuracy of ventilation parameters were within the ranges specified in international guidelines in all tests. A numerical model of the system was developed and validated against experimental data. The model was used to determine usable ranges of valve flow coefficients to increase supply chain flexibility. This new design provides the performance necessary for the majority of patients that require ventilation. Applications include COVID-19 as well as pneumonia, influenza, and tuberculosis, which remain major causes of mortality in low and middle income countries. The robustness, energy efficiency, ease of maintenance, price and availability of on-off valves are all advantageous over proportional valves. As a result, the proposed ventilator design will cost significantly less to manufacture and maintain than current market designs and has the potential to increase global ventilator availability.

The use of dual oxygen concentrator system for mechanical ventilation during COVID-19 pandemic in Sabah, Malaysia

Sabah in Malaysian Borneo is among the Malaysian states which reported a high number of detected COVID-19 cases during the current pandemic. Due to geographical challenges and limited resources, clinicians developed novel strategies for managing patients. The use of a dual oxygen concentrator system for mechanical ventilation is one of the innovations developed by retrieval team members from the Emergency Department (ED) of the Sabah Women and Children’s Hospital. Due to conditions requiring isolation of patients suspected of or positive for COVID-19, high-risk patients were treated in an ED extension area that lacked central wall oxygen. Direct access to oxygen tanks became the only viable option, but ensuring a continuous supply was laborious. The novel setup described within this paper has been used on intubated patients in the ED extension area with moderate to high ventilator settings successfully. This simple setup, designed to meet the limited resources within a pandemic environment, needed only a turbine-driven ventilator, two oxygen concentrators, a 3-way connector, and three oxygen tubing. The application of this setup could potentially save more critically ill patients who are being managed in resource-limited conditions such as in smaller district hospitals or out in the field.

Technical results from a trial of the FREO2 Low-Pressure Oxygen Storage system, Mbarara Regional Referral Hospital, Uganda

Increased access to reliable medical oxygen would reduce the global burden of pneumonia. Oxygen concentrators have been shown to be an effective solution, however they have significant drawbacks when used in low-resource environments where pneumonia burden is the heaviest. Low quality grid power can damage oxygen concentrators and blackouts can prevent at-risk patients from receiving continual oxygen therapy. Gaps in prescribed oxygen flow can result in acquired brain injuries, extended hypoxemia and death. The FREO2 Low-Pressure Oxygen Storage (LPOS) system consists of a suite of improvements to a standard oxygen concentrator which address these limitations. This study reports the technical results of a field trial of the system in Mbarara, Uganda. During this trial, oxygen supplied from the LPOS system was distributed to four beds in the paediatric ward of Mbarara Regional Referral Hospital. Over a three-month period, medical-grade oxygen was made available to patients 100% of the time. This period was sufficient to quantify the ability of the LPOS system to deal with blackouts, maintenance, and an unscheduled repair to the LPOS store.