4/6/2020 Chicago
As COVID-19 cases - and the need for mechanical ventilators - continue to rise, so does the ripple effect of needs and implications associated with intubation.
It’s not just the short supply of mechanical ventilators that continue to impact patients needing intubation – it’s the other issues associated with this use – as opposed to helmet-based noninvasive ventilation. And that includes sedatives – many already on backorder.
If a COVID-19 patient has been determined in need of mechanical ventilation, their condition already is considered dire. Many of those diagnosed with the virus are being treated at home via quarantine/isolation. Only those deemed critical – and tested positive for the virus – are being admitted to hospitals and considered for mechanical ventilation.
According to reports, only 20% of intubated patients can be expected to survive. But that road – should the patient get there – is a bumpy one, according to recent reports.
One of those bumps is the need to sedate the patient, as intubation causes distress and discomfort for the patient.
The Food and Drug Administration recently included midazolam – a sedation drug being used for intubated patients – on its shortage list, according to an article in NBC News. Other drugs used to sedate these patients include fentanyl, propofol, and paralytic drugs.
Why? Intubation is an invasive and painful procedure requiring the insertion of a tube down the patient’s airway which will allow the machine to take over the breathing. Patients who are intubated often try and pull the breathing tube out; therefore, it is necessary to use sedation to keep the patient calm. It’s painful. And if they fight it and work against the machine, there can be even more damage to their already compromised lungs. A patient is an awake state and restrained would not be able to tolerate mechanical intubation, according to some reports. And patients on mechanical ventilators tend to need to stay on them longer – meaning more drugs, more staff, and more challenges to survival.
Another report from Stat News said there has been a more than 51% increased use of these and other sedatives due to the need for mechanical ventilators for COVID-19 hospitalized patients. And, yet, some reports, including one from Vizient, a company providing analysis and advisory services for health systems - indicate the fill rate has dropped to at least 25%. This means some hospitals are unable to get the full amount of medications ordered, adding to an already overstressed situation.
More patients. More mechanical ventilators. More drugs. More ICU trained staff.
Is there an alternative? Yes -- helmet-based noninvasive positive pressure ventilation. This system can be a solution to many of the above-stated challenges.
Helmet-based ventilation does not require intubation, thus eliminating the need for sedation. It also requires less intensive medical care, which can also contribute to less risk and less stress for medical providers. It provides more comfort for the patient and is more cost-effective. Studies have shown patients using the helmet-based ventilation system recover faster, as well. Using helmet-based ventilation can also free up more beds in intensive-care units, as well. Using this method also can free up mechanical ventilators, as the helmet system attaches to wall gases and can also be used with BiPAP machines.
Using helmet-based ventilation can not only free up many sources facing demand vs. supply as the COVID-19 continues to peak before a decrease can be expected, it can also be much more comfortable and provide successful outcomes for the patient. As studies from other countries – like Italy, which is starting to emerge from the grips of the virus – show, 20 to 30% of patients with COVID-19 can avoid intubation by using helmet-based ventilation.