New York State is facing a shortage of tens of thousands of ventilators in the coming days. City and state officials are rapidly trying to source more of the machines, which help the sickest patients breathe when they’re critically ill with COVID-19.
But they’re also resorting to novel measures, like using one ventilator for two patients, or using machines usually used for people with sleep apnea. Officials are even considering the use of ventilators reserved for animals.
At Northwell Health, a hospital network with 23 hospitals scattered across Staten Island, Brooklyn Queens and Long Island, they’ve begun using BiPap machines, typically used to help people with sleep apnea breath at night, to use on COVID-19 patients if ventilators at one facility are low while they’re waiting for reinforcements for another location.
“These machines were not being used, they were basically collecting dust in the hospital,” said Dr. Hugh Cassiere, the medical director for respiratory therapy services at North Shore University Hospital on Long Island. They’d heard from doctors in Italy and China, that patients weren’t responding to BiPap machines using the usual face mask, that sleep apnea patients use. Plus there’s an added concern that the virus can aerosolize and spray into the air through the mask.
So Cassiere adapted the BiPap machine. He attached a filter and a regular breathing tube, used with ventilators, to the BiPap machine, using a little connecting piece. When supply of that connector ran low, the hospital began 3D printing its own, and now they’re using the innovation across the system, when an individual hospital is running low on ventilators and is waiting for backup.
“We’ve started using them in emergency cases,” Cassiere said. “We’re not recommending ventilating the world with it. We’re saying you have two choices, no ventilator and the patient dies, or use this method, and that’s the approach we’re taking.”
At his hospital, he estimated they currently had hundreds of patients admitted with COVID-19, more than 90 of whom were on ventilators. Across the New York, more than 10,000 people are hospitalized with COVID-19. More than 2,700 people are in intensive care units.
As the number of critically ill New Yorkers continues to balloon, other rarely-used measures, like splitting the use of a single ventilator for two patients, are also likely to become more widespread as New York’s resources dwindle.
Governor Andrew Cuomo approved the experimental measure last week and it is already being experimented with in at least one New York Hospital, according to Craig R Smith, the surgeon in chief at New York Presbyterian.
“The [intensive care unit] teams have been working night and day to implement split-ventilation experiments that will allow one ventilator to support more than one patient. The obvious challenge presented by patients with differences in airway resistance will initially require careful patient selection,” Smith wrote in one of his daily updates to staffers, where he described how doctors used the technique after the Las Vegas mass shooting. “Why do I mention this? The history of health care shows that wars are times of rapid acceleration in the art and science of surgery.”
The state could need anywhere between 20,000 and 40,000 ventilators by the time the outbreak peaks, which is projected to occur between four and 20 days from now, according to estimates from the governor’s office. The state has secured 4,400 ventilators from the federal government, has about 6,500 on hand, and has ordered 17,000 more, though they’re weeks away from being delivered.
Cuomo’s office also said Tuesday they’d ordered 2,750 BiPap units as a stopgap when ventilators run out.
On Wednesday, the governor said that only 20 percent of COVID-19 patients who are placed on ventilators get well enough to stop using them.
At a press conference Tuesday, Mayor Bill de Blasio put out a desperate call for anyone and everyone sitting on a ventilator to temporarily turn it over to the city.
“Oral surgeons have ventilators for when they perform surgery, plastic surgeons have ventilators wherever they perform surgery, veterinarians, yes, veterinarians have in many cases, ventilators that we could use every single one of them,” he said, telling the public to do so through a city website. Some veterinarian schools, like Cornell University College of Veterinary Medicine, have already loaned their ventilators.
“If you've got a ventilator in your office, in your operating room, we need it now. It should not be sitting there doing nothing,” de Blasio said. “This is a war effort everyone needs to contribute.”
