Massachusetts Medicaid MassHealth, Boston, Massachusetts.
Boston Medical Center, Boston, Massachusetts.
Ann Am Thorac Soc. 2021 Mar;18(3):408-416. doi: 10.1513/AnnalsATS.202004-317CME.
The novel coronavirus disease (COVID-19) has exposed critical supply shortages both in the United States and worldwide, including those in intensive care unit (ICU) and hospital bed supply, hospital staff, and mechanical ventilators. Many of those who are critically ill have required days to weeks of supportive invasive mechanical ventilation (IMV) as part of their treatment. Previous estimates set the U.S. availability of mechanical ventilators at approximately 62,000 full-featured ventilators, with 98,000 non-full-featured devices (including noninvasive devices). Given the limited availability of this resource both in the United States and in low- and middle-income countries, we provide a framework to approach the shortage of IMV resources. Here we discuss evidence and possibilities to reduce overall IMV needs, discuss strategies to maximize the availability of IMV devices designed for invasive ventilation, discuss the underlying methods in the literature to create and fashion new sources of potential ventilation that are available to hospitals and front-line providers, and discuss the staffing needs necessary to support IMV efforts. The pandemic has already pushed cities like New York and Boston well beyond previous ICU capacity in its first wave. As hot spots continue to develop around the country and the globe, it is evident that issues may arise ahead regarding the efficient and equitable use of resources. This unique challenge may continue to stretch resources and require care beyond previously set capacities and boundaries. The approaches presented here provide a review of the known evidence and strategies for those at the front line who are facing this challenge.
新型冠状病毒病（COVID-19）暴露了美国乃至全球在重症监护病房（ICU）和医院床位供应、医院工作人员和呼吸机等方面的关键供应短缺。许多重症患者在治疗过程中需要数天到数周的支持性有创机械通气（IMV）。之前的估计认为，美国大约有 62000 台全功能呼吸机，98000 台非全功能设备（包括无创设备）。鉴于美国和中低收入国家这种资源的供应都很有限，我们提供了一个方法来解决 IMV 资源短缺的问题。在这里，我们讨论了减少整体 IMV 需求的证据和可能性，讨论了最大限度地增加可用于有创通气的 IMV 设备的可用性的策略，讨论了文献中创建和制作新的潜在通气源的基本方法，这些方法可供医院和一线供应商使用，并讨论了支持 IMV 所需的人员配备。大流行已经使纽约和波士顿等城市在第一波疫情中远远超过了之前的 ICU 容量。随着全国各地和全球热点地区的继续发展，显然在资源的有效和公平使用方面可能会出现问题。这一独特的挑战可能会继续消耗资源，并需要超出之前设定的能力和界限的护理。这里提出的方法为那些面临这一挑战的一线人员提供了对已知证据和策略的回顾。
