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1.
Isr Med Assoc J ; 23(5): 274-278, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34024042

RESUMO

BACKGROUND: This focus article is a theoretical reflection on the ethics of allocating respirators to patients in circumstances of shortage, especially during the coronavirus disease-2019 (COVID-19) outbreak in Israel. In this article, respirators are placeholders for similar life-saving modalities in short supply, such as extracorporeal membrane oxygenation machines and intensive care unit beds. In the article, I propose a system of triage for circumstances of scarcity of respirators. The system separates the hopeless from the curable, granting every treatable person a real chance of cure. The scarcity situation eliminates excesses of medicine, and then allocates respirators by a single scale, combining an evidence-based scoring system with risk-proportionate lottery. The triage proposed embodies continuity and consistency with the healthcare practices in ordinary times. Yet, I suggest two regulatory modifications: one in relation to expediting review of novel and makeshift solutions and the second in relation to mandatory retrospective research on all relevant medical data and standard (as opposed to experimental) interventions that are influenced by the triage.


Assuntos
/terapia , Alocação de Recursos/ética , Triagem/métodos , Ventiladores Mecânicos/provisão & distribução , /epidemiologia , Surtos de Doenças , Análise Ética , Oxigenação por Membrana Extracorpórea/instrumentação , Humanos , Unidades de Terapia Intensiva/ética , Unidades de Terapia Intensiva/provisão & distribução , Israel , Triagem/ética , Ventiladores Mecânicos/ética
4.
A A Pract ; 15(3): e01392, 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687347

RESUMO

Ventilator shortages occurred due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This in vitro study evaluated the effectiveness of 3-dimensional (3D)-printed splitters and 3D-printed air flow limiters (AFL) in delivering appropriate tidal volumes (TV) to lungs with different compliances. Groups were divided according to the size of the AFL: AFL-4 was a 4-mm device, AFL-5 a 5-mm device, AFL-6 a 6-mm device, and no limiter (control). A ventilator was split to supply TV to 2 artificial lungs with different compliances. The AFL improved TV distribution.


Assuntos
/epidemiologia , Serviços Médicos de Emergência/métodos , Complacência Pulmonar/fisiologia , Impressão Tridimensional , Ventiladores Mecânicos/provisão & distribução , Humanos , Pulmão/fisiologia , Masculino , Volume de Ventilação Pulmonar/fisiologia
6.
BMJ Open ; 11(1): e042945, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500288

RESUMO

OBJECTIVE: In this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic. DESIGN: Descriptive survey. SETTING: All non-specialist secondary care providers in England from 27 March27to 5 June 2020. PARTICIPANTS: Acute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195). MAIN OUTCOME MEASURES: Two thresholds for 'safe occupancy' were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement. RESULTS: At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1-17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds. CONCLUSIONS: Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above 'safe-occupancy' thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.


Assuntos
/epidemiologia , Número de Leitos em Hospital , Hospitais/provisão & distribução , Capacidade de Resposta ante Emergências , Ventiladores Mecânicos/provisão & distribução , Ocupação de Leitos/estatística & dados numéricos , Inglaterra/epidemiologia , Pessoal de Saúde , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Medicina Estatal
7.
World Neurosurg ; 148: e172-e181, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33385598

RESUMO

BACKGROUND: The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. METHODS: We conducted a de-identified retrospective review of all operative cases and procedures performed by the Department of Neurosurgery from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved 2-sample z tests assessing daily case totals over the 113-day periods before and after implementation of the OR triage plan on March 16, 2020. RESULTS: The neurosurgical service performed 1429 surgical and interventional radiologic procedures over the study period. There was no statistically significant difference in mean number of daily total cases in the pre-versus post-OR triage plan periods (6.9 vs. 5.8 mean daily cases; 1-tail P = 0.050, 2-tail P = 0.101), a trend reflected by nearly every category of neurosurgical cases. CONCLUSIONS: During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.


Assuntos
/epidemiologia , Hospitais Universitários/organização & administração , Neurocirurgia/organização & administração , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Neoplasias Encefálicas/cirurgia , California/epidemiologia , Derivações do Líquido Cefalorraquidiano/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Procedimentos Endovasculares/estatística & dados numéricos , Número de Leitos em Hospital , Departamentos Hospitalares/organização & administração , Humanos , Controle de Infecções , Disseminação de Informação/métodos , Unidades de Terapia Intensiva , Laboratórios Hospitalares , Sistemas Multi-Institucionais , Salas Cirúrgicas , Política Organizacional , Equipamento de Proteção Individual/provisão & distribução , Estudos Retrospectivos , Medição de Risco , Capacidade de Resposta ante Emergências , Triagem , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Ventiladores Mecânicos/provisão & distribução , Ferimentos e Lesões/cirurgia
8.
Rev. esp. anestesiol. reanim ; 68(1): 21-27, ene. 2021. graf
Artigo em Espanhol | IBECS | ID: ibc-196761

RESUMO

INTRODUCCIÓN: Uno de los principales retos en el manejo de la COVID-19 es el aumento súbito de la demanda de camas de cuidados intensivos. En este artículo se describen las estrategias de gestión hospitalaria durante la escalada y desescalada de la respuesta a la epidemia de COVID-19 en un hospital terciario de Madrid. MATERIALES Y MÉTODOS: Los datos derivan del sistema informático del hospital y del plan de contingencia del mismo. RESULTADOS: La epidemia de COVID-19 produjo un rápido aumento de los pacientes con necesidad de cuidados intensivos, lo que saturó las camas de UVI disponibles en pocos días. El hospital tuvo que aumentar su capacidad abriendo cuatro UVI adicionales para proporcionar los cuidados necesarios a todos los pacientes. Los retos principales fueron relativos a la infraestructura hospitalaria, los materiales y el personal. Gracias a las estrategias de gestión utilizadas, el hospital fue capaz de aumentar su capacidad de camas de UVI en un 340%, proporcionar cuidados a todos los pacientes con necesidad y mantener una mínima actividad quirúrgica programada. CONCLUSIONES: La capacidad de un hospital de aumentar su capacidad para enfrentarse a eventos excepcionales es difícil de cuantificar y se enfrenta a limitaciones físicas (materiales, personal, espacios). Con una gestión flexible y adaptable durante eventos excepcionales se pueden alargar significativamente estos límites


BACKGROUND: A major challenge during the COVID-19 outbreak is the sudden increase in ICU bed occupancy rate. In this article we reviewed the strategies of escalation and de-escalation put in place at a large university hospital in Madrid during the COVID-19 outbreak, in order to meet the growing demand of ICU beds. MATERIALS AND METHODS: The data displayed originated from the hospital information system and the hospital contingency plan. RESULTS: The COVID-19 outbreak produced a surge of ICU patients which saturated the available ICU capacity within a few days. A total of four new ICUs had to be opened in order to accommodate all necessary new ICU admissions. Management challenges included infrastructure, material allocation and ICU staffing. Through the strategies put in place the hospital was able to generate a surge capacity of ICU beds of 340%, meet all requirements and also maintain minimal surgical activity. CONCLUSIONS: Hospital surge capacity is to date hardly quantifiable and often has to face physical limitations (material, personnel, spaces). However an extremely flexible and adaptable management strategy can help to overcome some of these limitations and stretch the system capacities during times of extreme need


Assuntos
Humanos , Planos de Contingência , Unidades de Terapia Intensiva/organização & administração , Ocupação de Leitos , Número de Leitos em Hospital , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Ventiladores Mecânicos/provisão & distribução , Necessidades e Demandas de Serviços de Saúde
9.
Bioethics ; 35(2): 125-134, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33325536

RESUMO

In March 2020, the rapid increase in severe COVID-19 cases overwhelmed the healthcare systems in several European countries. The capacities for artificial ventilation in intensive care units were too scarce to care for patients with acute respiratory disorder connected to the disease. Several professional associations published COVID-19 triage recommendations in an extremely short time: in 21 days between March 6 and March 27. In this article, we compare recommendations from five European countries, which combine medical and ethical reflections on this situation in some detail. Our aim is to provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. In more general terms we want to identify shortcomings in regard to a common European response to the current situation.


Assuntos
/terapia , Alocação de Recursos para a Atenção à Saúde , Padrão de Cuidado/ética , Triagem/ética , Fatores Etários , Europa (Continente)/epidemiologia , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Prioridades em Saúde , Hospitalização , Direitos Humanos , Humanos , Unidades de Terapia Intensiva/ética , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Ventiladores Mecânicos/provisão & distribução , Suspensão de Tratamento/ética
10.
Front Public Health ; 8: 587423, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33363084

RESUMO

COVID-19 has overwhelmed healthcare systems across the globe with an unprecedented surge in the demand for hospitalizations. Consequently, many hospitals are facing precarious conditions due to limited capacity, especially in the provision of ventilators. The governing ethical principles of medical practice delineated in (1) favor prioritizing younger patients, largely because of their relatively higher expected life years. We conduct a survey of the general public in the United States to elicit their preferences for the allocation of a limited number of ventilators. The results show that the general public views align with the established ethical principles, which favor younger patients. JEL Classification: C91.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Hospitalização , Prognóstico , Alocação de Recursos , Triagem/ética , Adulto , Feminino , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos , Ventiladores Mecânicos/provisão & distribução
11.
Rev. bioét. derecho ; (50): 99-112, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191348

RESUMO

En el marco de una pandemia a escala mundial como la que representa el COVID-19 uno de los mayores dilemas bioéticos que se plantean es el de la gestión de determinados medios asistenciales escasos, tales como los respiradores (ventilación mecánica asistida), pues del acceso a los mismos dependen las posibilidades de supervivencia de numerosos pacientes en estado crítico. El presente trabajo trata de determinar los criterios para la gestión de dichos soportes vitales en un contexto de escasez extrema de los mismos para hacer frente a las necesidades de la totalidad de los pacientes que los requieren, analizando la literatura comparada sobre el particular, así como diferentes informes institucionales y de organismos en la esfera de la bioética


In the context of a worldwide pandemic such as COVID-19, one of the greatest bioethical dilemmas that arise is the management of certain scarce medical devices, such as ventilators (mechanical ventilation), since the survival of many critically ill patients depends on the access to these ventilators. The present paper tries to determine the criteria applicable for the management of these medical devices in a context of extreme scarcity to face the needs of all the patients who require them. To this end, the comparative literature on the subject as well as different institutional and academic reports in the field of bioethics are analysed


En el marc d'una pandèmia a escala mundial com la que representa la COVID-19 un dels majors dilemes bioètics que es plantegen és el de la gestió de determinats mitjans assistencials escassos, com ara els respiradors (ventilació mecànica assistida), ja que de l'accés als mateixos depenen les possibilitats de supervivència de nombrosos pacients en estat crític. El present treball pretén determinar els criteris per a la gestió d'aquests suports vitals en un context d'escassetat extrema dels mateixos per fer front a les necessitats de la totalitat dels pacients que els requereixen, analitzant la literatura comparada sobre el particular, així com diferents informes institucionals I d'organismes en l'esfera de la bioètica


Assuntos
Humanos , Sistemas de Manutenção da Vida/estatística & dados numéricos , Administração dos Cuidados ao Paciente , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Pandemias , Triagem , Respiração Artificial , Ventiladores Mecânicos/provisão & distribução , Unidades de Terapia Intensiva/provisão & distribução
13.
Biomed Eng Online ; 19(1): 75, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008462

RESUMO

BACKGROUND: The world is facing an unprecedented outbreak affecting all aspects of human lives which is caused by the COVID-19 pandemic. Due to the virus novelty, healthcare systems are challenged by a high rate of patients and the shortage of medical products. To address an increased need for essential medical products, national authorities, worldwide, made various legislative concessions. This has led to essential medical products being produced by automotive, textile and other companies from various industries and approved under the emergency use authorizations or legal concessions of national regulatory bodies. This paper presents a narrative commentary of the available documentation on emergency use authorizations and legal concessions for medical products during COVID-19 pandemic. METHODOLOGY: The basis for narrative commentary includes scientific articles published in Web of Science, Scopus, PubMed and Embase databases, official publications of international organizations: Food and Drug Agency (FDA), World Health Organisation (WHO), World Bank and United Nations (UN), and national regulatory agency reports in native languages (English, German, Bosnian, and Croatian) published from November 1, 2019 to May 1, 2020. This paper focuses on three types of essential medical products: mechanical ventilators, personal protective equipment (PPE) and diagnostic tests. Evidence-informed commentary of available data and potential identified risks of emergency use authorizations and legal concessions is presented. DISCUSSION: It is recognized that now more than ever, raising global awareness and knowledge about the importance of respecting the essential requirements is needed to guarantee the appropriate quality, performance and safety of medical products, especially during outbreak situation, such as the COVID-19 pandemic. Emergency use authorizations for production, import and approval of medical products should be strictly specified and clearly targeted from case to case and should not be general or universal for all medical products, because all of them are associated with different risk level. CONCLUSION: Presented considerations and experiences should be taken as a guide for all possible future outbreak situations to prevent improvised reactions of national regulatory bodies.


Assuntos
Betacoronavirus , Comércio/legislação & jurisprudência , Infecções por Coronavirus , Licenciamento/legislação & jurisprudência , Indústria Manufatureira/legislação & jurisprudência , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral , Kit de Reagentes para Diagnóstico/provisão & distribução , Ventiladores Mecânicos/provisão & distribução , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Falha de Equipamento , União Europeia , Saúde Global , Humanos , Equipamento de Proteção Individual/normas , Kit de Reagentes para Diagnóstico/normas , Medição de Risco , Estados Unidos , United States Food and Drug Administration , Ventiladores Mecânicos/normas
14.
Elife ; 92020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33044170

RESUMO

This study examined records of 2566 consecutive COVID-19 patients at five Massachusetts hospitals and sought to predict level-of-care requirements based on clinical and laboratory data. Several classification methods were applied and compared against standard pneumonia severity scores. The need for hospitalization, ICU care, and mechanical ventilation were predicted with a validation accuracy of 88%, 87%, and 86%, respectively. Pneumonia severity scores achieve respective accuracies of 73% and 74% for ICU care and ventilation. When predictions are limited to patients with more complex disease, the accuracy of the ICU and ventilation prediction models achieved accuracy of 83% and 82%, respectively. Vital signs, age, BMI, dyspnea, and comorbidities were the most important predictors of hospitalization. Opacities on chest imaging, age, admission vital signs and symptoms, male gender, admission laboratory results, and diabetes were the most important risk factors for ICU admission and mechanical ventilation. The factors identified collectively form a signature of the novel COVID-19 disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde , Pandemias , Pneumonia Viral/terapia , Adulto , Idoso , Área Sob a Curva , Índice de Massa Corporal , Comorbidade , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Dinâmica não Linear , Pneumonia Viral/epidemiologia , Utilização de Procedimentos e Técnicas , Curva ROC , Respiração Artificial/estatística & dados numéricos , Fatores de Risco , Ventiladores Mecânicos/provisão & distribução
15.
Anesth Analg ; 131(5): 1337-1341, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079852

RESUMO

BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.


Assuntos
Agendamento de Consultas , Infecções por Coronavirus/terapia , Cuidados Críticos , Prestação Integrada de Cuidados de Saúde , Procedimentos Cirúrgicos Eletivos , Unidades de Terapia Intensiva/provisão & distribução , Admissão do Paciente , Pneumonia Viral/terapia , Capacidade de Resposta ante Emergências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Bases de Dados Factuais , Necessidades e Demandas de Serviços de Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde , New York/epidemiologia , Sistemas de Informação em Salas Cirúrgicas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Respiração Artificial , Fatores de Tempo , Ventiladores Mecânicos/provisão & distribução
16.
PLoS One ; 15(10): e0241027, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33085729

RESUMO

As the number of cases of COVID-19 continues to grow, local health services are at risk of being overwhelmed with patients requiring intensive care. We develop and implement an algorithm to provide optimal re-routing strategies to either transfer patients requiring Intensive Care Units (ICU) or ventilators, constrained by feasibility of transfer. We validate our approach with realistic data from the United Kingdom and Spain. In the UK, we consider the National Health Service at the level of trusts and define a 4-regular geometric graph which indicates the four nearest neighbours of any given trust. In Spain we coarse-grain the healthcare system at the level of autonomous communities, and extract similar contact networks. Through random search optimisation we identify the best load sharing strategy, where the cost function to minimise is based on the total number of ICU units above capacity. Our framework is general and flexible allowing for additional criteria, alternative cost functions, and can be extended to other resources beyond ICU units or ventilators. Assuming a uniform ICU demand, we show that it is possible to enable access to ICU for up to 1000 additional cases in the UK in a single step of the algorithm. Under a more realistic and heterogeneous demand, our method is able to balance about 600 beds per step in the Spanish system only using local sharing, and over 1300 using countrywide sharing, potentially saving a large percentage of these lives that would otherwise not have access to ICU.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Recursos em Saúde/provisão & distribução , Modelos Teóricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Algoritmos , Infecções por Coronavirus/virologia , Cuidados Críticos , Número de Leitos em Hospital , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Pandemias , Transferência de Pacientes , Pneumonia Viral/virologia , Espanha/epidemiologia , Reino Unido/epidemiologia , Ventiladores Mecânicos/provisão & distribução
18.
BMC Res Notes ; 13(1): 421, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894167

RESUMO

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 & distribução , Anestesia Geral/métodos , Animais , 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/economia
20.
Int J Health Geogr ; 19(1): 36, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928236

RESUMO

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD: The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS: The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION: Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.


Assuntos
Área Programática de Saúde/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Betacoronavirus , Acesso aos Serviços de Saúde/organização & administração , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Illinois , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Fatores Socioeconômicos , Análise Espacial , Ventiladores Mecânicos/provisão & distribução
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