Hospital Hacks for COVID-19 Shortages Come With Promise, Warnings

What your doctor is reading on

MARCH 23, 2020 — Innovative workarounds by hospitals and clinicians are evolving amid the race to stay ahead of dwindling supplies as resource demands soar in the COVID-19 crisis.

In a JAMA interview reported on by Medscape Medical News, Kaiser Permanente’s COVID-19 response chief, Stephen Parodi, MD, said baby monitors are being used in rooms with COVID-19 patients to reduce coming and going by healthcare providers and to preserve personal protective equipment (PPE). A physician can virtually examine a patient with another practitioner in the room.

In Italy, Cristian Fracassi, founder of the engineering firm Isinnova, heard about the shortage of valves that connect oxygen masks to ventilators and his start-up, with 14 employees, quickly replicated 100 valves with 3D printing, as reported by Medscape Medical News.

“[T]he hospital tested them and told us they worked,” Fracassi said, and they delivered 100 of them at no cost to the hospital.

In a post in a private Facebook group, an advanced practice nurse at a hospital in Washington state (name withheld) who kept suiting up to tend to intravenous pumps, tossing goggles and masks each time, writes that she suggested moving the pumps into the hallway and running tubing extensions to the patient.

“The hospital implemented this and it will save thousands of valuable PPE sets,” she writes.

A Warning Against Multiple People on One Ventilator

Some have proposed sharing one ventilator for more than one patient, but Lewis Kaplan, MD, president of the Society of Critical Care Medicine (SCCM), told Medscape Medical News, “There are a host of problems and they are not minor.”

Charlene Babcock, MD, an emergency medicine physician in Detroit, Michigan demonstrates in a YouTube video how to adapt one ventilator for multiple patients and the video has been widely shared.

She emphasizes that the patients need to be paralyzed for this to work.

The idea was previously detailed in a study she coauthored in 2006 on using one ventilator for four people simultaneously.

Questions followed in response to the video about potential transmission of bacteria, how this could be done when settings are personalized for patient characteristics, and whether the ventilator can cope with the carbon dioxide eliminated from multiple patients at the same time.

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