LETTERS TO EDITOR
Year : 2020 | Volume
| Issue : 3 | Page : 415-416
The ventilator solution for COVID -19 patient at rural tertiary care hospital
Akshaya N Shetti
Department of Anaesthesiology and Critical Care, Rural Medical College, PIMS, Loni, Maharashtra, India
Dr. Akshaya N Shetti
Department of Anaesthesiology and Critical Care, Rural Medical College, PIMS, Loni - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
|Date of Submission||26-Mar-2020|
|Date of Acceptance||26-Mar-2020|
|Date of Web Publication||30-May-2020|
|How to cite this article:|
Shetti AN. The ventilator solution for COVID -19 patient at rural tertiary care hospital. Saudi J Anaesth 2020;14:415-6
Indian population is affected by COVID-19 commonly known as coronavirus. As per the data published by the Government of India on 25th March 2020 at 1.00 pm, the total number of cases affected is 512, total mortality is 09, and recovered are 41. Day by day the number of cases are increasing. Being a developing nation with a huge population, it is very challenging to meet the expected healthcare services. Since the rural area will face a higher challenge to cater to the COVID-19 affected patients, all precautionary measures for healthcare workers become an important aspect. The lifesaving equipment like ventilators is a prime thing which every hospital started accumulating throughout the nation. In rural parts of India, we do have limited resources and hence this innovative idea came to my mind. Though this innovation passed all the tests we still need ethical permission to use on patients. Therefore, this letter is written to create awareness among the critical care physician to understand the concept and overcome the ventilator deficiency-related problems if at all need arises.
As per the data published by the author Silvio A Ñamendys-Silva, on 27th February 2020, out of 710 patients with confirmed COVID-19 admitted to an intensive care unit (ICU) in Wuhan, China; 52 patients were on a ventilator while 29 (56%) of 52 patients were put on noninvasive ventilation, of whom 22 (76%) required further orotracheal intubation i.e., invasive mechanical ventilation. Though the incidence of the requirement of a ventilator seems to be relatively low one must be prepared for a higher number of ventilators. In India especially the rural population has poor nutrition and poor hygiene, which makes them more prone to such severe types of pneumonia.
I did modify the ventilator connection and evaluated the same so that it can be connected to more than one patient. The main concept in this is, inspiration is active and expiration is passive. The inspiratory and expiratory limbs of breathing circuits are connected using t connection as shown in [Figure 1]a and [Figure 1]b. Both the breathing circuits were connected to Savina 300 ventilator of Drager company make. The t connections were done using the routine plumbing pipe. The breathing circuits were connected to the inspiratory and expiratory ventilator ports as shown in [Figure 1]c. The test lungs were connected to the breathing circuits in [Figure 1]d. The pre-use check of the ventilator and breathing circuit check for both circuits was done and successfully both were passed [Figure 1]e and [Figure 1]f. The machine was checked in the volume control- assist control mode, and synchronized intermittent mandatory ventilation. The ventilator perfectly worked. The probable disadvantage with this ventilator setting is that the compliance and airway resistance of both the lung of the patient should be nearly the same to achieve the desired result. We do not know exactly how much volume of the tidal volume was delivered in each test lung. Further studies and ethical clearance are required before it can be used on any patient. However, the Drager company does not recommend to use a single ventilator for two patients simultaneously.
|Figure 1: The assembly and ventilator check details. (a-b) t connection; (c) t connection connected to ventilator; (d) test lung connected to the breathing circuit; (e-f) ventilator and breathing circuit check details|
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