Assuntos
Necessidades e Demandas de Serviços de Saúde , Serviços de Assistência Domiciliar , Respiração Artificial , Ventiladores Mecânicos , Necessidades e Demandas de Serviços de Saúde/economia , Serviços de Assistência Domiciliar/economia , Humanos , Respiração Artificial/economia , Ventiladores Mecânicos/economiaRESUMO
The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.
Assuntos
COVID-19/terapia , Complicações do Diabetes/terapia , Diabetes Mellitus/terapia , Alocação de Recursos , COVID-19/complicações , COVID-19/epidemiologia , Complicações do Diabetes/economia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/ética , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Pandemias , Racismo/ética , Racismo/estatística & dados numéricos , Alocação de Recursos/economia , Alocação de Recursos/ética , Alocação de Recursos/organização & administração , Alocação de Recursos/estatística & dados numéricos , Triagem/economia , Triagem/ética , Estados Unidos/epidemiologia , Ventiladores Mecânicos/economia , Ventiladores Mecânicos/estatística & dados numéricos , Ventiladores Mecânicos/provisão & distribuiçãoAssuntos
COVID-19/terapia , Atenção à Saúde/economia , Saúde Global/economia , Pandemias/prevenção & controle , Ventiladores Mecânicos/economia , COVID-19/epidemiologia , Saúde Global/legislação & jurisprudência , Humanos , Cooperação Internacional , Indústria Manufatureira/economia , Indústria Manufatureira/legislação & jurisprudência , Políticas , Respiração Artificial/instrumentaçãoRESUMO
Although the cure for the SARS-CoV-2 virus (COVID-19) will come in the form of pharmaceutical solutions and/or a vaccine, one of the only ways to face it at present is to guarantee the best quality of health for patients, so that they can overcome the disease on their own. Therefore, and considering that COVID-19 generally causes damage to the respiratory system (in the form of lung infection), it is essential to ensure the best pulmonary ventilation for the patient. However, depending on the severity of the disease and the health condition of the patient, the situation can become critical when the patient has respiratory distress or becomes unable to breathe on his/her own. In that case, the ventilator becomes the lifeline of the patient. This device must keep patients stable until, on their own or with the help of medications, they manage to overcome the lung infection. However, with thousands or hundreds of thousands of infected patients, no country has enough ventilators. If this situation has become critical in the Global North, it has turned disastrous in developing countries, where ventilators are even more scarce. This article shows the race against time of a multidisciplinary research team at the University of Huelva, UHU, southwest of Spain, to develop an inexpensive, multifunctional, and easy-to-manufacture ventilator, which has been named ResUHUrge. The device meets all medical requirements and is developed with open-source hardware and software.
Assuntos
COVID-19/terapia , Pandemias , SARS-CoV-2 , Ventiladores Mecânicos , Engenharia Biomédica , Custos e Análise de Custo , Desenho de Equipamento , Humanos , Ventilação com Pressão Positiva Intermitente/economia , Ventilação com Pressão Positiva Intermitente/instrumentação , Ventilação com Pressão Positiva Intermitente/estatística & dados numéricos , Respiração com Pressão Positiva/economia , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/estatística & dados numéricos , Espanha , Interface Usuário-Computador , Ventiladores Mecânicos/economiaRESUMO
Desde inicios del 2020, el mundo se ha visto afectado por la COVID-19 causada por el SARS-CoV-2, que en agosto lo padecen más de 31 millones de pacientes, algunos de los cuales presentan el síndrome de distrés respiratorio, que requiere de ventilación mecánica. Por el alto número de contagios, la disponibilidad de ventiladores para el tratamiento es escasa. Se presenta la descripción de un prototipo de un dispositivo de asistencia ventilatoria temporal de lazo cerrado de bajo costo; el AR_CODEX, basado en una bolsa válvula-mascarilla (BVM), que contribuye al mantenimiento ventilatorio mínimo del paciente durante un tiempo corto en casos donde no hay disponibilidad de ventiladores mecánicos. Para esto, se diseñó y construyó un sistema mecánico ajustable que compresiona la bolsa de ventilación, el cual cuenta con sensores de flujo y presión. Además, se elaboró una interfaz gráfica para un adecuado monitoreo del paciente y un sistema de control para variables como volumen, presión máxima, frecuencia respiratoria y relación inspiración: espiración. Por otro lado, existe un problema de sensibilidad en el sensor de flujo debido a varios factores, como la variación del voltaje en los motores. Adicionalmente, la implementación de un lazo cerrado es importante para compensar variaciones aleatorias en el funcionamiento del dispositivo. Es necesario realizar pruebas en animales para evaluar el correcto funcionamiento de AR_CODEX en seres vivos.
In early 2020, the world has been affected from Covid-19 caused by SARS-CoV-2. By August there were more than 31 million patients, some of them suffering from respiratory distress that requires mechanical ventilation. Due to the rise of infection rates there is no ventilator availability for the treatment. In this work we describe a reduced cost closed loop temporal assisted ventilation device prototype, AR_CODEX. It is based on mask valve bag (BVM from its Spanish initials), contributing to the minimum ventilation maintenance for the patient du-ring a short period of time when there is no mechanical ventilation availability. For this purpose an adjustable mechanical system was designed and built to pressurize the ventilation bag that is equipped with flux and pres-sure sensors. Additionally a graphical interface was developed to include adequate monitoring and controlling system for volume, maximum pressure, respiratory frequency and inhalation/exhalation rate. In addition there is a sensibility issue on the flux sensor due to engine voltage variation. A closed loop implementation is important to overcome aleatory variations during the device operation. It is needed to run AR_CODEX device performance test on animals to evaluate prior to use it directly on human patients.
Assuntos
Humanos , Respiração Artificial/instrumentação , Ventiladores Mecânicos/economia , Taxa Respiratória , Máscaras , Tecnologia de Baixo Custo , Equipamentos e Provisões , Estudo de Prova de Conceito , COVID-19RESUMO
OBJECTIVE: The advent of new technologies has made it possible to explore alternative ventilator manufacturing to meet the worldwide shortfall for mechanical ventilators especially in pandemics. We describe a method using rapid prototyping technologies to create an electro-mechanical ventilator in a cost effective, timely manner and provide results of testing using an in vitro-in vivo testing model. RESULTS: Rapid prototyping technologies (3D printing and 2D cutting) were used to create a modular ventilator. The artificial manual breathing unit (AMBU) bag connected to wall oxygen source using a flow meter was used as air reservoir. Controlled variables include respiratory rate, tidal volume and inspiratory: expiratory (I:E) ratio. In vitro testing and In vivo testing in the pig model demonstrated comparable mechanical efficiency of the test ventilator to that of standard ventilator but showed the material limits of 3D printed gears. Improved gear design resulted in better ventilator durability whilst reducing manufacturing time (< 2-h). The entire cost of manufacture of ventilator was estimated at 300 Australian dollars. A cost-effective novel rapid prototyped ventilator for use in patients with respiratory failure was developed in < 2-h and was effective in anesthetized, healthy pig model.
Assuntos
Desenho de Equipamento/métodos , Respiração Artificial/instrumentação , Ventiladores Mecânicos/provisão & distribuição , Anestesia Geral/métodos , Animais , COVID-19 , Infecções por Coronavirus/terapia , Volume de Reserva Expiratória/fisiologia , Feminino , Humanos , Volume de Reserva Inspiratória/fisiologia , Modelos Biológicos , Pandemias , Pneumonia Viral/terapia , Impressão Tridimensional/instrumentação , Respiração Artificial/economia , Respiração Artificial/métodos , Taxa Respiratória/fisiologia , Suínos , Volume de Ventilação Pulmonar/fisiologia , Ventiladores Mecânicos/economiaAssuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração com Pressão Positiva/economia , Respiração com Pressão Positiva/instrumentação , Ventiladores Mecânicos/economia , COVID-19 , Humanos , Pandemias , Respiração com Pressão Positiva/métodos , SARS-CoV-2RESUMO
COVID-19 is devastating health systems globally and causing severe ventilator shortages. Since the beginning of the outbreak, the provision and use of ventilators has been a key focus of public discourse. Scientists and engineers from leading universities and companies have rushed to develop low-cost ventilators in hopes of supporting critically ill patients in developing countries. Philanthropists have invested millions in shipping ventilators to low-resource settings, and agencies such as the World Health Organization and the World Bank are prioritizing the purchase of ventilators. While we recognize the humanitarian nature of these efforts, merely shipping ventilators to low-resource environments may not improve outcomes of patients and could potentially cause harm. An ecosystem of considerable technological and human resources is required to support the usage of ventilators within intensive care settings. Medical-grade oxygen supplies, reliable electricity, bioengineering support, and consumables are all needed for ventilators to save lives. However, most ICUs in resource-poor settings do not have access to these resources. Patients on ventilators require continuous monitoring from physicians, nurses, and respiratory therapists skilled in critical care. Health care workers in many low-resource settings are already exceedingly overburdened, and pulling these essential human resources away from other critical patient needs could reduce the overall quality of patient care. When deploying medical devices, it is vital to align the technological intervention with the clinical reality. Low-income settings often will not benefit from resource-intensive equipment, but rather from contextually appropriate devices that meet the unique needs of their health systems.
Assuntos
Infecções por Coronavirus/epidemiologia , Disparidades em Assistência à Saúde/economia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pobreza/estatística & dados numéricos , Ventiladores Mecânicos/estatística & dados numéricos , COVID-19 , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Países em Desenvolvimento , Feminino , Recursos em Saúde/economia , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Nigéria , Pneumonia Viral/terapia , Nações Unidas , Ventiladores Mecânicos/economia , Organização Mundial da SaúdeRESUMO
We present a low-cost clinically viable ventilator design, AmbuBox, using a controllable pneumatic enclosure and standard manual resuscitators that are readily available (AmbuBag), which can be rapidly deployed during pandemic and mass-casualty events with a minimal set of components to manufacture and assemble. The AmbuBox is designed to address the existing challenges presented in the existing low-cost ventilator designs by offering an easy-to-install and simple-to-operate apparatus while maintaining a long lifespan with high-precision flow control. As an outcome, a mass-producible prototype of the AmbuBox has been devised, characterized, and validated in a bench test setup using a lung simulator. This prototype will be further investigated through clinical testing. Given the potentially urgent need for inexpensive and rapidly deployable ventilators globally, the overall design, operational principle, and device characterization of the AmbuBox system have been described in detail with open access online. Moreover, the fabrication and assembly methods have been incorporated to enable short-term producibility by a generic local manufacturing facility. In addition, a full list of all components used in the AmbuBox has been included to reflect its low-cost nature.
Assuntos
COVID-19/terapia , Serviços Médicos de Emergência/métodos , Respiração Artificial/métodos , SARS-CoV-2/fisiologia , Ventiladores Mecânicos/economia , Custos e Análise de Custo , Desenho de Equipamento , Humanos , Instalações Industriais e de Manufatura , PandemiasAssuntos
Betacoronavirus , Viés , Dissonância Cognitiva , Infecções por Coronavirus/epidemiologia , Princípio do Duplo Efeito , Política de Saúde , Pneumonia Viral/epidemiologia , COVID-19 , Comunicação , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Formulação de Políticas , Anos de Vida Ajustados por Qualidade de Vida , SARS-CoV-2 , Ventiladores Mecânicos/economia , Ventiladores Mecânicos/provisão & distribuiçãoRESUMO
As the number of coronavirus 2019 disease (COVID-19) cases in the United States began mounting in the early weeks of March, health care workers raised the alarm about a looming shortage of ventilators to treat patients. On March 30, 2020, Ford Motor Company announced plans to produce 50,000 ventilators in 100 days [1], and General Motors followed suit on April 8, stating that it would deliver out 6,000 ventilators by the end of May and another 24,000 by August [2].
Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Ventiladores Mecânicos/provisão & distribuição , Engenharia Biomédica , COVID-19 , Pressão Positiva Contínua nas Vias Aéreas/economia , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Infecções por Coronavirus/epidemiologia , Custos e Análise de Custo , Desenho de Equipamento/economia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Impressão Tridimensional/economia , SARS-CoV-2 , Estados Unidos/epidemiologia , United States Food and Drug Administration , Ventiladores Mecânicos/economiaAssuntos
Infecções por Coronavirus/terapia , Recursos em Saúde , Oxigênio , Pneumonia Viral/terapia , Ventiladores Mecânicos , África Subsaariana , Betacoronavirus , COVID-19 , Recursos em Saúde/economia , Recursos em Saúde/provisão & distribuição , Humanos , Oxigênio/economia , Oxigênio/provisão & distribuição , Oxigênio/uso terapêutico , Oxigenoterapia/economia , Pandemias , SARS-CoV-2 , Ventiladores Mecânicos/economia , Ventiladores Mecânicos/provisão & distribuiçãoRESUMO
Manual ventilation by compressing self-inflating bags is a life-saving option for respiratory support in many resource-limited settings. Previous efforts to automate manual ventilation using mechatronic systems were unsuccessful. The Covid-19 pandemic stimulated re-exploration of automating manual ventilation as an economically viable alternative to address the anticipated shortage of mechanical ventilators. Many devices have been developed and displayed in the lay press and social media platforms. However, most are unsuitable for clinical use for a variety of reasons. These include failure to understand the clinical needs, complex ventilatory requirements in Covid-19 patients, lack of technical specifications to guide innovators, technical challenges in delivering ventilation parameters in a physiological manner, absence of guidelines for bench testing of innovative devices and lack of clinical validation in patients. The insights gained during the design, development, laboratory testing and clinical validation of a novel device designated the 'Artificial Breathing Capability Device' are shared here to assist innovators in developing clinically usable devices. A detailed set of clinical requirements from such devices, technical specifications to meet these requirements and framework for bench testing are presented. In addition, regulatory and certification issues, as well as concerns related to the protection of intellectual property, are highlighted. These insights are designed to foster an innovation ecosystem whereby clinically useful automated manual ventilation devices can be developed and deployed to meet the needs associated with the Covid-19 pandemic and beyond.
Assuntos
COVID-19/terapia , Desenho de Equipamento , Invenções , Respiração Artificial/instrumentação , Ventiladores Mecânicos , COVID-19/epidemiologia , Humanos , Pandemias/economia , Pandemias/prevenção & controle , Respiração Artificial/economia , Ventiladores Mecânicos/economiaRESUMO
Modern mechanical ventilator technologies broadly consist of digitally-controlled electronic devices and analogue systems driven by compressed gas sources. Drawbacks such as high cost, complex maintenance and the need for cumbersome sources of compressed driving gas hinder adoption in pre-hospital and low-resource environments. We describe the evaluation and testing of a simple, low-cost alternative ventilator that uses a novel pressure-sensing approach and control algorithm. This is designed to provide portable positive-pressure mechanical ventilation at a reduced cost, while autonomously monitoring patient condition and important safety parameters. A prototype ventilator was constructed and evaluated using an anaesthetic test-lung as a patient surrogate. Using a modifiable test-lung and digital pressure sensor, we investigated ventilation pressure waveform circuit leak detection, and compliance and resistance change detection. During intermittent positive-pressure ventilation to the test-lung, the prototype system showed acceptable pressure waveform parameters: all simulated circuit leaks ≥ 6 mm2 in size were detected; compliance changes were detected between 10 ml.cmH2 O-1 , 20 ml.cmH2 O-1 and 50 ml.cmH2 O-1 ; and resistance changes were detected across the available simulated range. These results show this prototype technology has the potential to provide safe emergency ventilation without the use of any complex digital sensors or software while its construction and design enables significant reductions in cost and complexity. The study suggests further work is now justified in progressing the technology to clinical trials.
Assuntos
Desenho de Equipamento/métodos , Respiração Artificial/instrumentação , Ventiladores Mecânicos/economia , Desenho de Equipamento/economia , Desenho de Equipamento/normas , Humanos , Respiração Artificial/economia , Ventiladores Mecânicos/normasRESUMO
BACKGROUND: There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China. METHODS: We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008-09 and 2009-10 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs. RESULTS: The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490-$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness. CONCLUSIONS: The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.
Assuntos
Influenza Humana/prevenção & controle , Máscaras/economia , Dispositivos de Proteção Respiratória/economia , Infecções Respiratórias/prevenção & controle , Ventiladores Mecânicos/economia , China , Análise Custo-Benefício , Pessoal de Saúde , Humanos , Influenza Humana/economia , Máscaras/estatística & dados numéricos , Modelos Econômicos , Pandemias , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Respiratórias/economia , Ventiladores Mecânicos/estatística & dados numéricosRESUMO
BACKGROUND: The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa. METHODS: A cross-sectional survey was conducted at 5 main referral hospitals in East Africa: Uganda, Kenya, Tanzania, Rwanda, and Burundi. Using a questionnaire based on the World Federation of the Societies of Anesthesiologists (WFSA) international guidelines for safe anesthesia, we interviewed anesthetists in these hospitals, key informants from the Ministry of Health and National Anesthesia Society of each country (Supplemental Digital Content, http://links.lww.com/AA/B561). RESULTS: Using the WFSA checklist as a guide, none of respondents had all the necessary requirements available to provide safe obstetric anesthesia, and only 7% reported adequate anesthesia staffing. Availability of monitors was limited, and those that were available were often nonfunctional. The paucity of local protocols, and lack of intensive care unit services, also contributed significantly to poor maternal outcomes. For a population of 142.9 million in the East African community, there were only 237 anesthesiologists, with a workforce density of 0.08 in Uganda, 0.39 in Kenya, 0.05 in Tanzania, 0.13 in Rwanda, and 0.02 anesthesiologists in Burundi per 100,000 population in each country. CONCLUSIONS: We identified significant shortages of both the personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anesthetists, to improve the training of nonphysician anesthesia providers, and to develop management protocols for obstetric patients requiring anesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.
Assuntos
Anestesia Obstétrica/economia , Atenção à Saúde/economia , Países em Desenvolvimento/economia , Custos de Cuidados de Saúde , Padrões de Prática Médica/economia , Adulto , África Oriental , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/mortalidade , Anestesia Obstétrica/normas , Anestesiologistas/economia , Anestesiologistas/educação , Anestésicos/economia , Anestésicos/provisão & distribuição , Lista de Checagem , Estudos Transversais , Atenção à Saúde/normas , Feminino , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Humanos , Mortalidade Materna , Pessoa de Meia-Idade , Avaliação das Necessidades/economia , Admissão e Escalonamento de Pessoal/economia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Gravidez , Respiração Artificial/economia , Medição de Risco , Fatores de Risco , Ventiladores Mecânicos/economia , Ventiladores Mecânicos/provisão & distribuiçãoRESUMO
BACKGROUND: There has been increasing debate surrounding mask and respirator interventions to control respiratory infection transmission in both healthcare and community settings. As decision makers are considering the recommendations they should evaluate how to provide the most efficient protection strategies with minimum costs. The aim of this review is to identify and evaluate the existing economic evaluation literature in this area and to offer advice on how future evaluations on this topic should be conducted. METHODS: We searched the Scopus database for all literature on economic evaluation of mask or respirator use to control respiratory infection transmission. Reference lists from the identified studies were also manually searched. Seven studies met our inclusion criteria from the initial 806 studies identified by the search strategy and our manual search. RESULTS: Five studies considered interventions for seasonal and/or pandemic influenza, with one also considering SARS (Severe Acute Respiratory Syndrome). The other two studies focussed on tuberculosis transmission control interventions. The settings and methodologies of the studies varied greatly. No low-middle income settings were identified. Only one of the reviewed studies cited clinical evidence to inform their mask/respirator intervention effectiveness parameters. Mask and respirator interventions were generally reported by the study authors to be cost saving or cost-effective when compared to no intervention or other control measures, however the evaluations had important limitations. CONCLUSIONS: Given the large cost differential between masks and respirators, there is a need for more comprehensive economic evaluations to compare the relative costs and benefits of these interventions in situations and settings where alternative options are potentially applicable. There are at present insufficient well conducted cost-effectiveness studies to inform decision-makers on the value for money of alternative mask/respirator options.
Assuntos
Influenza Humana/transmissão , Máscaras/economia , Síndrome Respiratória Aguda Grave/transmissão , Tuberculose/transmissão , Ventiladores Mecânicos/economia , Análise Custo-Benefício , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Máscaras/estatística & dados numéricos , Pandemias , Síndrome Respiratória Aguda Grave/prevenção & controle , Tuberculose/prevenção & controle , Ventiladores Mecânicos/estatística & dados numéricosRESUMO
PURPOSE: Skilled nursing facility ventilator units (SNF) are a recent attempt to reduce the costs of an increasing number of patients who are in acute intensive care units and are not able to be liberated from ventilators. Transfers of such patients from long-term care chronic vent units (LTCVs) to SNFs in Maryland began in 2006. The safety of these transfers needs to be assessed. METHODS: We retrospectively followed up all patients designated as eligible by their insurance for transfer from our LTCV units to SNF from July 1, 2008 through June 30, 2010 looking only at survival. Those patients who refused transfer and appealed and remained in our LTCV were compared to those who were transferred to SNF ventilator units. The analysis was by Kaplan-Meier statistics. RESULTS: There was an increased mortality (P=.025) of those transferred to SNF ventilator facilities as compared to those remaining in the LTCV. CONCLUSION: We recognize that bias may occur in patients choosing to remain in our LTCV compared to those accepting transfers, the magnitude of the difference in mortality indicates the need for more comprehensive well designed analysis investigating the outcome of all transfers occurring to and from LTCVs.
Assuntos
Transferência de Pacientes , Respiração Artificial/economia , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Ventiladores Mecânicos/economia , Idoso , Idoso de 80 Anos ou mais , Continuidade da Assistência ao Paciente , Custos e Análise de Custo , Estado Terminal/economia , Estado Terminal/mortalidade , Coleta de Dados , Feminino , Custos de Cuidados de Saúde , Humanos , Estimativa de Kaplan-Meier , Masculino , Maryland , Pessoa de Meia-Idade , Respiração Artificial/métodos , Estudos Retrospectivos , Medição de Risco , Instituições de Cuidados Especializados de Enfermagem/economiaRESUMO
Because anesthetic machines have become more complex and more expensive, they have become less suitable for use in the many isolated hospitals in the poorest countries in the world. In these situations, they are frequently unable to function at all because of interruptions in the supply of oxygen or electricity and the absence of skilled technicians for maintenance and servicing. Despite these disadvantages, these machines are still delivered in large numbers, thereby expending precious resources without any benefit to patients. The Glostavent was introduced primarily to enable an anesthetic service to be delivered in these difficult circumstances. It is smaller and less complex than standard anesthetic machines and much less expensive to produce. It combines a drawover anesthetic system with an oxygen concentrator and a gas-driven ventilator. It greatly reduces the need for the purchase and transport of cylinders of compressed gases, reduces the impact on the environment, and enables considerable savings. Cylinder oxygen is expensive to produce and difficult to transport over long distances on poor roads. Consequently, the supply may run out. However, when using the Glostavent, oxygen is normally produced at a fraction of the cost of cylinders by the oxygen concentrator, which is an integral part of the Glostavent. This enables great savings in the purchase and transport cost of oxygen cylinders. If the electricity fails and the oxygen concentrator ceases to function, oxygen from a reserve cylinder automatically provides the pressure to drive the ventilator and oxygen for the breathing circuit. Consequently, economy is achieved because the ventilator has been designed to minimize the amount of driving gas required to one-seventh of the patient's tidal volume. Additional economies are achieved by completely eliminating spillage of oxygen from the breathing system and by recycling the driving gas into the breathing system to increase the Fraction of Inspired Oxygen (FIO2) at no extra cost. Savings also are accrued when using the drawover breathing system as the need for nitrous oxide, compressed air, and soda lime are eliminated. The Glostavent enables the administration of safe anesthesia to be continued when standard machines are unable to function and can do so with minimal harm to the environment.