Critical Connections Blog

8/28/2020

Clinicians responding to the COVID-19 pandemic have experienced shortages of mechanical ventilators, according to a rapid-cycle survey distributed by the Society of Critical Care Medicine (SCCM). Survey respondents reported having to secure additional ventilators from the Strategic National Stockpile or other sources, such as private suppliers. A small percentage even said they declined care because they did not have enough ventilators or placed two patients on one ventilator.

Clinicians responding to the COVID-19 pandemic have experienced shortages of mechanical ventilators, according to a rapid-cycle survey distributed by the Society of Critical Care Medicine (SCCM). Survey respondents reported having to secure additional ventilators from the Strategic National Stockpile, donations from local government or private agencies, or by purchasing from U.S. and non-U.S. suppliers. A small percentage even said they declined care because they did not have enough ventilators or reported placing two patients on one ventilator.

SCCM’s rapid-cycle surveys are meant to assess the reality in the field for critical care clinicians and better understand their needs. Other significant insights include:

Proning increased for both ventilated and nonventilated patients, demonstrating a shift in care strategies since the start of the pandemic.
Significant surges in personnel, space, and equipment were necessary. Impacted hospitals report managing surge more than 50% of the time.
Nurses, respiratory therapists, physicians, and advanced practice providers (APPs) needed more additional staffing than pharmacists and dietitians.
There was an increase in staff overseeing the process of donning and doffing personal protective equipment to ensure proper use.
More ICU teams were created, but trainees were often not included in teams and not as involved in the care of patients with COVID-19.

The latest rapid-cycle survey was distributed in July and garnered 587 respondents, the majority (95%) of whom cared for patients with COVID-19. Previous rapid-cycle surveys highlighted ICU readiness and clinician stress.

Download the Full Executive Summary.

SCCM Rapid Cycle Survey 3: Summary Response Table

	n	%
Critical Care Setting
Academic center	158	26.9
Community hospital	393	67.0
Government hospital	21	3.6
Other	15	2.6
Primary ICU setting
Metropolitan	406	69.2
Micropolitan	138	23.5
Rural	43	7.3
Practicing in United States	N = 586
No*	16	2.7
Yes	570	97.3
Cared for presumed or confirmed COVID-19-positive patients in ICU	N = 479
No	22	4.6
Yes	457	95.4
Profession	N = 489
Intensivist	20	4.1
Nonintensivist physician	3	0.6
Nurse	279	57.1
Nurse practitioner	6	1.2
Pharmacist	4	0.8
Respiratory therapist	170	34.8
Other	7	1.4

*1 from Armenia, 3 from Canada, 1 from Egypt, 1 from Sweden, and 1 from United Arab Emirates.

Availability of critical care-trained staff to support pandemic response in ICUs
	n	%
Nurses	N = 483
Additional ICU nurses were assigned to help with increased demands.	110	22.8
Additional non-ICU nurses (e.g., medical-surgical, stepdown ) were assigned to help with increased demands.	276	57.1
Additional nurses-in-training (nursing students) were assigned to help with increased demands.	5	1.0
Patient care needs did not increase sufficiently in my hospital; no change in nurse staffing was needed.	25	5.2
There were increased patient care demands, but routine nurse staffing was sufficient to meet the demand.	48	9.9
Unsure	19	3.9
Physicians	N = 479
Additional intensivists were assigned to help with increased demands.	111	23.2
Additional nonintensivist physicians (e.g., hospitalists) were assigned to help with increased demands.	94	19.6
Additional physicians-in-training (residents, fellows) were assigned to help with increased demands.	43	9.0
Patient care needs did not increase sufficiently in my hospital; no change in physician staffing was needed.	35	7.3
There were increased patient care demands, but routine intensivist staffing was sufficient to meet the demand.	140	29.2
Unsure	56	11.7
APPs (nurse practitioners and physician assistants)	N = 478
Additional APPs-in-training (APP students and fellows) were assigned to help with increased demands.	17	3.6
Additional critical care APPs were assigned to help with increased demands.	86	18.0
Additional non-ICU APPs (e.g., hospitalist, emergency, surgical specialty) were assigned to help with increased demand.	99	20.7
Patient care needs did not increase sufficiently in my hospital; no change in APP staffing was needed.	47	9.8
There were increased patient care demands, but routine APP staffing was sufficient to meet the demand.	129	27.0
Unsure	100	20.9
Respiratory therapists (RTs)	N = 481
Additional non-ICU RTs were assigned to help with increased demands.	89	18.5
Additional RTs were assigned to help with increased demands.	213	44.3
Additional RTs-in-training (students) were assigned to help with increased demands.	15	3.1
Patient care needs did not increase sufficiently in my hospital; no change in RT staffing was needed.	24	5.0
There were increased patient care demands, but routine RT staffing was sufficient to meet the demand.	94	19.5
Unsure	46	9.6
Pharmacists	N = 476
Additional ICU pharmacists were assigned to help with increased demands.	51	10.7
Additional non-ICU pharmacists (e.g., general ward) were assigned to help with increased demands.	27	5.7
Additional pharmacists-in-training (students) were assigned to help with increased demands.	4	.8
Patient care needs did not increase sufficiently in my hospital; no change in pharmacist staffing was needed.	43	9.0
There were increased patient care demands, but routine pharmacists staffing was sufficient to meet the demand.	178	37.4
Unsure	173	36.3
Physical therapists (PTs)	N = 478
Additional PTs-in-training (students) were assigned to help with increased demands.	3	.6
Additional PTs were assigned to help with increased demands.	56	11.7
Patient care needs did not increase sufficiently in my hospital; no change in PT staffing was needed.	78	16.3
There were increased patient care demands, but routine PT staffing was sufficient to meet the demand.	143	29.9
Unsure	198	41.4
Registered dietitians	N = 476
Additional ICU RDs were assigned to help with increased demands.	15	3.2
Additional non-ICU RDs (e.g., general ward) were assigned to help with increased demands.	10	2.1
Additional RDs-in-training (students) were assigned to help with increased demands.	2	.4
Patient care needs did not increase sufficiently in my hospital; no change in RD staffing was needed.	83	17.4
There were increased patient care demands, but routine RD staffing was sufficient to meet the demand.	161	33.8
Unsure	205	43.1

Specific ICU Staffing modifications implemented to manage COVID-19 pandemic (N = 587) (multiple choices possible)
	n	%
Shortened shifts	8	1.4
Lengthened shifts	103	17.5
More frequent breaks	23	3.9
More nurse aid staffing	80	13.6
Donning/doffing oversight staffing	181	30.8
More ICU teams overall	151	25.7
More ICU team members in-house at night	97	16.5
Elimination of students from teams	224	38.2
Elimination of trainees from teams	106	18.1
Increased tele-critical care coverage (more beds covered)	104	17.7
Nighttime intensivist in-house	89	15.2
Other	93	15.8

Spaces converted into novel ICU spaces (N = 587) (multiple choices possible)
	n	%
Did not create any new ICU space	96	16.4
Acute care floor	269	45.8
Postanesthesia care unit rooms	177	30.2
Emergency department rooms	104	17.7
Temporary tent space	60	10.2
Operating rooms	36	6.1
Other	99	16.9
If yes to any of the above:
Were these novel ICU spaces effective for providing critical care?	N = 385
Yes	213	55.3
Not sure	90	23.4
No	82	21.3
If no (multiple choices possible):	N = 82
Inadequate monitoring	61	74.4
Difficulty finding supplies	56	68.3
Difficulty being alerted to alarms	48	58.5
Difficulty maintaining infection control precautions	48	58.5
Inadequate space	47	57.3
Lack of team space	36	43.9
Lack of privacy for patients	34	41.5
Difficulty summoning medical emergency response team aid	26	31.7
Too far from medication room	22	26.8
Difficulty renaming spaces to ICU space in electronic health record	20	24.4
Wireless connectivity failure	16	19.5
Difficulty obtaining portable imaging	15	18.3
Other	9	11.0

Mechanical Ventilation and Prone Positioning
	n	%
Mechanical ventilators	N = 383
We had enough existing invasive ventilators for patient demand.	172	44.9
We used nonstandard invasive ventilators (e.g., transport ventilators, anesthesia ventilators) for bedside care in the ICU.	83	21.7
We adapted noninvasive ventilation devices for invasive ventilation.	25	6.5
Due to a lack of devices we have not offered invasive or noninvasive ventilation to all patients with acute respitory failure.	6	1.6
We needed to place more than one patient on a single ventilator.	2	0.5
We procured additional ventilators.	95	24.8
From where were additional ventilators procured?	N = 95
Strategic National Stockpile	18	18.9
Donation from local government agency	14	14.7
Donation from a private entity	23	24.2
Purchased from U.S. supplier	22	23.2
Purchased from non-U.S. supplier	1	1.1
Other	35	36.8
Prone positioning (multiple choices possible)	N = 461
No changes to how or how often we prone patients	48	10.4
Proning nonventilated patients	266	57.7
Proning more patients than usual on mechanical ventilation	345	74.8
Made modifications to practice of proning, such as use of prone teams	161	34.9

Acknowledgement: SCCM Rapid Cycle COVID-19 Work Group:
Ruth Kleinpell, PhD, RN, FCCM1; Lewis J. Kaplan, MD, FACS, FCCP, FCCM2; Ryan C. Maves, MD, FCCP, FIDSA, FCCM3; Sandra L. Kane-Gill, PharmD, MS, FCCP, FCCM4; Richard Branson, MSc, RRT, FAARC, FCCM5; Steven Greenberg, MD, FCCP, FCCM6; Jeffrey Dichter, MD7; David M. Ferraro, MD, FCCP, FCCM.8
1 Vanderbilt University School of Nursing, Center for Research & Scholarship Development, Nashville, Tennessee.

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Clinicians Report Ventilator Shortages

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