Fear of ventilator shortages has encouraged experimentation for workable alternatives, like repurposed sleep apnea machines. While combatting shortages is one goal, there is also the prospect of finding better solutions for severe COVID-19 cases.
Survival rates for patients with coronavirus on ventilators is low, with New York City hospitals reporting an 80% mortality rate. Additionally, ventilator use introduces issues such as sedation risks when inserting the equipment and increased labor needs for monitoring ventilated patients. Prolonged ventilation can cause severe lung damage, but removing a patient too early can be deadly.
Some doctors are experimenting with other forms of intubation. Hugh Cassiere, MD, a pulmonologist at Northwell Health in New York, repurposed his hospital’s stores of CPAP and BiPAP machines, used to treat sleep apnea and other respiratory diseases, by 3D-printing adapters and adding HEPA filters to make them usable as ventilators. These devices sustained more than 100 patients at North Shore University Hospital on Long Island, NY, and Rhode Island officials began a drop-off campaign for used CPAPs. New York’s Mount Sinai Health System is also adapting another sleep apnea machine, VPAP, by retrofitting 200 donated by Tesla.
However, these experimental devices are not without drawbacks. A 2017 study found up to 80% of patients with moderate respiratory distress attached to CPAP machines experienced lung damage from taking large breaths over an extended period.
Italy and China found success with positive pressure hoods, which fit over a patient’s head and push oxygen into the lungs while preventing the spread of pathogens. No such device is FDA approved, but doctors at the University of Chicago Medical Center are testing a helmet-like instrument with patients on the verge of needing ventilation. Although hoods were critical for Italian hospitals fighting COVID-19, Giacomo Bellani, MD, a critical care doctor at the University of Milan – Bicocca, warns that these devices are not a cure-all.
“The hoods can buy you time when you’re short on ICU beds,” Dr. Bellani told The New York Times. “But there is a drawback because in some patients you are just postponing intubation and the longer the delay, the greater the risk that some patients won’t make it.”