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Sustained Mechanical Ventilation Outside of Traditional Intensive Care Units

This complimentary chapter from Fundamental Disaster Management aims to: describe the medical response capability needed for mass casualty respiratory failure, summarize the functional requirements of space to be adapted for disaster critical care, identify the essential characteristics of positive pressure ventilation equipment for use in a mass casualty incident, summarize the ancillary respiratory equipment recommended for use in mass casualty critical care.

Although mass casualty incidents occur frequently worldwide, few have generated hundreds or thousands of casualties with respiratory failure. Most acute disasters result in traumatic injuries rather than critical illness. Traumatic injuries that are severe enough to cause coma, shock, or respiratory failure are frequently fatal before rescue and stabilization can be achieved. Most survivors requiring ventilatory support are able to receive definitive positive pressure ventilation using existing local or regional capabilities. Even events associated with higher proportions of critically injured survivors, such as explosions in enclosed spaces or structure fires, usually result in relatively small numbers of victims who develop acute respiratory failure. Consequently, in nations with widespread critical care capabilities, there has been minimal need for delivery of mechanical ventilation outside of traditional intensive care units (ICUs) for extended periods of time.

Concerns about the emergence of novel respiratory pathogens, as occurred during the severe acute respiratory syndrome (SARS) epidemic of 2002 to 2003; the growing possibility of an intentionally created catastrophe; and the threat of an influenza pandemic have generated increased awareness that disaster planning must include preparation for delivery of sustained mechanical ventilation by means other than usual practice. Much recent attention has been focused on events that would cause large-scale, survivable respiratory failure but limit patient evacuation due to concerns about infection control challenges or other concerns. Inhalation of toxic chemicals, epidemics, detonation of nuclear fission devices, and natural disasters that cause aspiration pneumonia and septic shock are among the scenarios likely to result in mass respiratory failure. In such cases, the demand for mechanical ventilatory support could far exceed routine critical care capacity. Careful pre-event planning is essential to ensure that the numerous victims of such events have access to the potentially life-saving critical care that they need.

In this chapter, we discuss the key elements of planning for response to mass respiratory failure, including evaluation and use of appropriate treatment space, selected medical equipment, and professional staff. All 3 of these aspects must be carefully considered in the development of an effective plan for responding to mass respiratory failure. This chapter updates and extends the authors’ previous paper on this topic, “Mass casualty respiratory failure” (Curr Opin Crit Care. 2007;13(1):51-56).

Type: Book Chapter Read More