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March 29, 2020

Shortage of ventilators can damage the most in case of severe outbreak

Islamabad

March 29, 2020

Rawalpindi : Due to the growing number of patients being affected by coronavirus in the country, the biggest concern of the health department and government is how to cope with the deficiency of health resources. Being a third world country, Pakistan with an already overburdened health care system, is not well equipped with resources to deal with the situation of crisis especially the deficiency of artificial breathing machines called ventilators.

The Biomedical Department of Rawalpindi Institute of Cardiology under the leadership of Executive Director of RIC Major General (r) Azhar Mahmood Kayani devised a method to use one ventilator to support four patients during this emergency situation.

This was expressed through a statement issued by Rawalpindi Institute of Cardiology that has carried out a test on artificial lungs to demonstrate the possibility of such arrangement. The test was successful on all types of the available ventilators in the hospital, reads the statement.

Talking to ‘The News’, General (r) Azhar Kayani suggested that all hospitals should be aiming at this kind of arrangement during the emergency situation. The biomedical department of RIC is happy to provide all support and guidance to other hospitals and doctors in this regard thus contributing as much as they can during this difficult time, he said.

Moreover he pointed out that this method should only be encouraged in situations where we fall short of ventilators to support the patients and should not be used as a first line strategy. He further explained that in this method, to maximise the benefit, patients should be carefully chosen to have the same body weight and height approximately. By using this strategy we can overcome the deficiency of ventilators across the country and maximise the effective use of available resources, he said.

Ventilator is a machine that is used to provide breathing support mechanically by delivering oxygen through a tube placed in the mouth, nose or a hole in the neck to patients who are unable to breathe normally or incapable of breathing sufficiently, in most of the cases due to malfunctioning of lungs.

It is important to mention here that every year, thousands of patients lose lives because of unavailability of ventilator supported beds at public sector hospitals in the country. Majority of these patients are already admitted in wards and their call is sent to intensive care units for want of ventilators but they expire because of not having vacancy in ICUs.

A number of senior health experts have been expressing to ‘The News’ that in case, the COVID-19 outbreak gets severe in Pakistan that seems evident, the maximum damage would be because of shortage of ventilators and due to the problem, public sector healthcare facilities even in bigger cities of the country including the federal capital would be unable to save a huge number of lives.

On the other hand, the idea floated by General Kayani may not work properly in Pakistan because of shortage of trained staff to handle ventilator. The idea of reconfiguring ventilators so that these lifesaving devices can serve two or four patients simultaneously instead of one patient has come under discussion once again last week in the United States that was actually a 2006 feasibility study published in the journal ‘Academic Emergency Medicine’ and was written in the aftermath of 9/11 and Hurricane Katrina. In essence, the study shows that a ventilator can be modified with adapters and T-shaped tubes so that it has four ports for four patients.

General (r) Kayani, however while talking to ‘The News’ on Saturday said it is time for public sector healthcare facilities to get the required staff trained on handling ventilators while staff must be given training regarding intensive care and infectious diseases. Senior doctors, medical universities and College of Physicians and Surgeons Pakistan must launch one-week intensive training courses for doctors, nurses and paramedics immediately as we have little time before the COVID-19 outbreaks his population more severely, he said.

After the COVID-19 crisis, New York-Presbyterian Hospital in Manhattan began practicing ventilator sharing last week putting two people on a single ventilator according to ‘The New York Times’ but in a statement released on March 26, medical societies across the US including Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anaesthesiologists (ASA), Anaesthesia Patient Safety Foundation (ASPF), American Association of Critical Care Nurses (AACN) and American College of Chest Physicians (CHEST) came out strongly against this idea stating “Sharing mechanical ventilators should not be attempted because it cannot be done safely with current equipment.”

Even the experts supporting the idea are of the view that using a ventilator for multiple people may not be easy as doctors would have to pair together patients with similar lung sizes. Using the same ventilator for multiple people could spread germs but this setup is designed to be a temporary one, used only when there is a disaster surge involving multiple casualties with respiratory failure.

General Kayani, when asked said the staff at RIC is capable of using one ventilator to support multiple patients in need and his staff would extend all possible support particularly on training of staff to other public healthcare facilities in the country.