Making ventilators?

[Rosehip10]

Government says wants engineering firms to urgently start making medical equipment. Peston (itv) asks chief executive of rolls Royce (one of few large uk firms who may be able to do something like this rapidly) "has anyone been in touch at all?

Exec "no"

Maybe we can have them next (sort of like passing round the bag of maternity clothes) 😀

Sorry gallows humour

Our trust is talking 1:4 critical care, I think I assumed that would be uncomplcated NIV

Ours is talking about 1:4 for full-on ICU. We in renal have been asked to cut our outpatient dialysis patients to twice weekly (which is really REALLY not enough for most of them), to free up dialysis nurses to support ICU patients who need CVVH. The assumption is we won’t have capacity to offer RRT to all patients on ICU with AKI, especially if they are outlying in theatre and not even in ICU itself, so we’ll bring them down, tubed, to the dialysis unit with an anaesthetic escort instead.

The idea we’ll manage to maintain 1:1 nursing for ICU patients under those circumstances is pretty optimistic, IMO.

NIV is not an option.

Aerosol droplet contamination. Tubing and closed circuit will contain this to a greater extent.

Bilateral pneumonia, they are too sick and require full ventilation with high pressures and high o2 demands. NIV just won’t do the job.

The sheer number that will deluge through the doors will mean that only those survivable will be tubed.

Ventilators need o2 AND air ports. There are not these on out patient wards, or general wards (certainly at our trust)

Training is in depth, detailed, complex and vital in the safe use and management of ventilators.

To aid compliance, patients will be heavily sedated ( going completely against current practice to reduce delirium and decrease ventilation days). To keep them safe, in the bed, ventilating and allow the 1:4 ratio of nursing they will have to be tuned.

Fighting one or more hypoxic patients will be impossible to manage. They must be tubed.

I’m hoping that we have enough to cope.

I've read a lot of doctor/anaesthetic reports on twitter, general rule is not to use NIV like cpap because of the aerosol effect back into the room. Also apparently co2 clearance isn't a massive issue, its oxygenation and pulmonary oedema alongside the pneumonia.
I presume the government are speaking to actual ventilation manufacturers like GE and drager?
Numbers wise isn't just how many you can manage, its the space. You could have 4 if they were stable but I presume they're not, seen lots of adults are nursed prone, plus available floorspace would be key

The man power involved in proning too.
Gas machines breaking down, poc staff too busy processing samples to come and carry our repairs...

Consumables availability/delivery.

Do we face mass litigation when this settles for pressure sores, withdrawal of treatment, missed/ late drugs etc???

I worry about surviving this, working beyond normal limits and being faced with the hell described by Italy, to face legal proceedings due to skin damage, and harm inflicted due to extraordinary circumstances.

From JAMA

Random factories can't just start 'making ventilators'. You have to have a fully set up, audited quality management system in place and jump through quite a few regulatory hoops to make such critical medical equipment

All that needs to be said.