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  • Writer's pictureLungtreater

Steve's Approach to our shortage of Ventilators and Ventilator care

Here is my game plan for the deficit in Mechanical Ventilators.

My thoughts are based on being a Respiratory Therapist (technical director and manager), commercializing some of the most famous ventilators in history (7200, 840, Inspiration), and co-founding my own ventilator company (eVent Medical).

Where we are:

  • The current at-risk population (people over 60 and pertinent comorbidities) in the USA can be estimated at 100M.

  • Concentrating on the geographic hotspots of risk population drops this number to 28M.

  • Applying the case fatality so far would indicate that we need approximately 800,000 ventilators installed in the USA.

  • One can estimate that our hospital installed base of appropriate Mechanical Ventilators is approximately 120,000 units.

  • Estimates of our reserve of ventilators and emergencies like ventilators are between 60,000 to 80,000 units.

  • Total vents in hand are about 200K.

  • So using my back of the envelope assessment tells us we are 600,000 ventilators short.

  • This assessment may underestimate the need if we poorly control the exposure to the 2019 nCoV and may overestimate the need if we properly bend the curve.

Some basics:

  • Our healthcare system is currently overwhelmed when considering the history of consolidation and rationalization of healthcare, the number of available Physicians, Registered Respiratory Therapists, and nurses.

  • Hospital beds are also considered short however without personnel these beds are insignificant.

  • Ventilators are complicated and ventilating people is a high-risk proposition. - My analogy for the layman is always – who among us would tape a hose to our mouth when thirsty and allow our most trusted family member to control the faucet. - The FDA requires all ventilators pre-market submissions to include a rigorous Human Factors and Usability study and unless we are willing to say this is yet another un-needed regulation, then we must consider this as an important consideration to provide safe and effective care.

  • Not all ventilators are equal – see my Linked in - articles. I am not a fan of blower ventilators for the sickest of patients. I would never allow my family members to be on a blower-based unit if they were suffering from adult respiratory distress syndrome. I do understand that there has been an improvement in modern blower based ventilator systems that employ a multi-control approach –see my article.

  • Other “bridging devices and therapies” such as high flow nasal therapy or BiPAP/CPAP may offer a solution to patients who respond well to fluid and pharmaceutical therapy.

  • Many current producers in the USA of these breathing products are experiencing supply chain problems. - I have heard reports that critical valves and sensors are hard to get now. - I have heard that other global regions are prohibiting the export of items they may need.

The need for Precision and Speed:

  • I am using the term precision here to mean logical and meaningful actions.

  • We all know the race we are in.

  • Our healthcare workers (Physicians, Registered Respiratory Therapists, and Nurses) do not have time to learn new ventilation devices.

  • They are currently overwhelmed with the caseloads.

  • Anything offered to facilities must be easy to use.

  • Anything offered to first responders must be simple enough to employ that a 3rd grader could do it.

  • New Startup Ventilator companies will easily take more than a year to achieve meaningful production and will still face user training requirements.

My recommendation to regulators and government:

  1. Support Hospital Physicians, Respiratory Therapists, and Nurses on the frontline.

  2. Support Family physicians as gatekeepers to the hospital.

  3. Have a centralized approach to allocation of new ventilators and respiratory support devices.

  4. Assist those US-based companies with suitable devices and a current installed base to increase their supply chain and production.

  5. Solicit needed devices from non-US companies that can supply high volumes of devices and meet the ease of use criteria.

  6. Entertain ease-to-use solutions for high flow oxygen therapies and BiPap CPAP therapies.

  7. Solicit low-cost solutions for the future – we don't need $20K ventilators in storage. Rather devices that can initially respond to respiratory difficulty and be deployed in the field make more sense to me. Such devices should be solicited and stored by our government agencies.

  8. Devices that can be operated and controlled in isolation areas through wireless technology also may protect the caregiver from exposure.

  9. Long term support ventilation technologies that reduce the length of ICU stay and Ventilator days.

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1 Comment

Bob Smallwood
Bob Smallwood
Mar 23, 2020

Can we identify a limited feature set for these ventilators? And, without partnering with a current vent manufacturer and limited FDA oversight, how is someone like GM expected to make a substantial contribution in a few months?

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