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Clinicians Report Ventilator Shortages

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.




Posted: 8/28/2020 | 1 comments

Comments
Beth
Veterinary emergency and specialty hospitals around the country do have life support ventilators that we use for dogs and cats. They are the same types of machines as used in people, although we often have older models that we have bought refurbished. So far during COVID, at least 25 veterinary hospitals have loaned their ventilators for human use. This google spreadsheet has veterinary hospitals who have ventilators and has contact information and location. https://docs.google.com/spreadsheets/d/1h2R8pJJFprsSc_uinHWSoFMgyR-NY2KC9kojHY3H0FU/edit#gid=316371506.

The spreadsheet shouldn't be shared with the public but we are here to help for people in need.

Beth Davidow, DVM DACVECC
President-Elect, American College of Veterinary Emergency and Critical Care
8/28/2020 7:34:46 PM


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