NEW YORK (Reuters) – At least one New York hospital has started putting two patients on a single ventilation machine, an experimental protocol in crisis mode that some doctors fear is too risky but others deemed necessary because the epidemic of coronavirus is straining medical resources.
The coronavirus causes a respiratory disease called COVID-19 which, in severe cases, can damage the lungs. He has killed at least 281 people in a matter of weeks in New York, which has one of the largest workloads in the world with nearly 22,000 confirmed cases.
A tool of last resort which consists in threading a tube into the patient’s windpipe, a mechanical ventilator can support a person who can no longer breathe without help. The city has only a few thousand and is trying to find tens of thousands more.
Dr. Craig Smith, chief surgeon at New York-Presbyterian / Columbia University Medical Center in Manhattan, wrote in a staff newsletter that the anesthesiology and intensive care teams worked “day and night” to start the experiment fractional ventilation. .
On Wednesday, he wrote, there were “two patients treated with care on one ventilator.”
New York Governor Andrew Cuomo, who says his staff are struggling to find enough machines on the market, presented the adaptation as a potential rescuer. “It is not ideal,” he told reporters, “but we think it is achievable.”
The U.S. Food & Drug Administration, which regulates manufacturers of medical devices, issued an emergency authorization on Tuesday authorizing the modification of ventilators using a separator tube to serve multiple COVID-19 patients, although manufacturers should always share safety information with regulators.
Some medical associations oppose the unproven method.
On Thursday, the Society of Critical Care Medicine, the American Association for Respiratory Care and four other groups of practitioners released a joint statement saying that the practice “should not be attempted because it cannot be practiced safely with current equipment “.
It is quite difficult to fine-tune a ventilator to keep even a patient with acute respiratory distress syndrome (ARDS) alive, the statement said; sharing it among multiple patients would worsen the results for all. They proposed that doctors choose the ventilator patient who is considered the most likely to survive.
At Columbia, Smith noted that they could not divide a ventilator between two COVID-19 patients, but that they matched only patients with sufficiently similar respiratory needs.
Across Manhattan, Mount Sinai Hospital told staff in an email that officials were “trying to figure out” if they could split the fans. The hospital ordered the necessary adapters, a nurse said in an interview on condition of anonymity because she was not allowed to speak to reporters.
FILE PHOTO: A ventilator is seen at the New York emergency management warehouse, where 400 ventilators have arrived and before being dispatched for distribution, due to concerns about the rapid spread of coronavirus disease (COVID- 19) in the Brooklyn district of New York City, United States, March 24, 2020. REUTERS / Caitlin Ochs / File Photo
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Columbia experts reported a 2006 study in which researchers, using lung simulators, concluded that a single ventilator could support four adults in an emergency scenario.
One author of this study, Dr. Greg Neyman, cautioned against application in COVID-19 cases in part because the lungs themselves are infected. If a patient’s lungs deteriorate more quickly, he said, it could cause imbalances in the closed system. One patient could starve while the other patient’s lungs increased pressure.
“Unless they are watched very very closely, such a configuration could end up doing more harm than good,” Neyman wrote in an email to Reuters.
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