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1.
Rev. bioét. derecho ; (50): 99-112, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-FGT-4637

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
3.
S Afr Med J ; 110(5): 355-359, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32657716

RESUMO

Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.


Assuntos
Infecções por Coronavirus , Cuidados Críticos , Serviço Hospitalar de Emergência/organização & administração , Alocação de Recursos para a Atenção à Saúde/tendências , Pandemias , Pneumonia Viral , Alocação de Recursos , Triagem , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/ética , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Emergências/epidemiologia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/organização & administração , África do Sul/epidemiologia , Triagem/ética , Triagem/organização & administração , Ventiladores Mecânicos/provisão & distribução
4.
Nat Commun ; 11(1): 3280, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32612128

RESUMO

The atmospheric pressure that decreases with altitude affects lung physiology. However, these changes in physiology are not usually considered in ventilator design and testing. We argue that high altitude human populations require special attention to access the international supply of ventilators.


Assuntos
Altitude , Infecções por Coronavirus/terapia , Desenho de Equipamento , Pneumonia Viral/terapia , Ventiladores Mecânicos/provisão & distribução , Pressão Atmosférica , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Humanos , Pulmão/fisiologia , Pandemias , Pneumonia Viral/fisiopatologia
6.
J Intensive Care Med ; 35(9): 927-932, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32677498

RESUMO

The coronavirus disease 2019 pandemic resulted in unprecedented numbers of patients with respiratory failure requiring ventilatory support. The number of patients who required critical care quickly outpaced the availability of intensive care unit (ICU) beds. Consequently, health care systems had to creatively expand critical care services into alternative hospital locations with repurposed staff and equipment. Deploying anesthesia workstations to the ICU to serve as mechanical ventilators requires equipment preparation, multidisciplinary planning, and targeted education. We aim to contextualize this process, highlighting major differences between anesthesia workstations and ICU ventilators, and to share the insights gained from our experiences creating an anesthesia provider-based ventilator management team.


Assuntos
Anestesia Geral/instrumentação , Infecções por Coronavirus/terapia , Unidades de Terapia Intensiva/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Ventiladores Mecânicos/provisão & distribução , Betacoronavirus , Humanos , Pandemias
7.
Respir Care ; 65(8): 1094-1103, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32712582

RESUMO

BACKGROUND: The COVID-19 pandemic is creating ventilator shortages in many countries that is sparking a conversation about placing multiple patients on a single ventilator. However, on March 26, 2020, six leading medical organizations released a joint statement warning clinicians that attempting this technique could lead to poor outcomes and high mortality. Nevertheless, hospitals around the United States and abroad are considering this technique out of desperation (eg, New York), but there is little data to guide their approach. The overall objective of this study is to utilize a computational model of mechanically ventilated lungs to assess how patient-specific lung mechanics and ventilator settings impact lung tidal volume (VT). METHODS: We developed a lumped-parameter computational model of multiple patients connected to a shared ventilator and validated it against a similar experimental study. We used this model to evaluate how patient-specific lung compliance and resistance would impact VT under 4 ventilator settings of pressure control level, PEEP, breathing frequency, and inspiratory:expiratory ratio. RESULTS: Our computational model predicts VT within 10% of experimental measurements. Using this model to perform a parametric study, we provide proof-of-concept for an algorithm to better match patients in different hypothetical scenarios of a single ventilator shared by > 1 patient. CONCLUSIONS: Assigning patients to preset ventilators based on their required level of support on the lower PEEP/higher [Formula: see text] scale of the National Institute of Health's National Heart, Lung, and Blood Institute ARDS Clinical Network (ARDSNet), secondary to lung mechanics, could be used to overcome some of the legitimate concerns of placing multiple patients on a single ventilator. We emphasize that our results are currently based on a computational model that has not been validated against any preclinical or clinical data. Therefore, clinicians considering this approach should not look to our study as an exact estimate of predicted patient VT values.


Assuntos
Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Respiração com Pressão Positiva/instrumentação , Ventiladores Mecânicos/provisão & distribução , Algoritmos , Betacoronavirus , Simulação por Computador , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Estudo de Prova de Conceito , Mecânica Respiratória
8.
PLoS One ; 15(7): e0236308, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687538

RESUMO

INTRODUCTION: The COVID-19 pandemic will test the capacity of health systems worldwide and especially so in low- and middle-income countries. The objective of this study was to assess the surge capacity of the Kenyan of the Kenyan health system in terms of general hospital and ICU beds in the face of the COVID-19 pandemic. METHODS: We assumed that 2% of the Kenyan population get symptomatic infection by SARS-Cov-2 based on modelled estimates for Kenya and determined the health system surge capacity for COVID-19 under three transmission curve scenarios, 6, 12, and 18 months. We estimated four measures of hospital surge capacity namely: 1) hospital bed surge capacity 2) ICU bed surge capacity 3) Hospital bed tipping point, and 5) ICU bed tipping point. We computed this nationally and for all the 47 county governments. RESULTS: The capacity of Kenyan hospitals to absorb increases in caseload due to COVID-19 is constrained by the availability of oxygen, with only 58% of hospital beds in hospitals with oxygen supply. There is substantial variation in hospital bed surge capacity across counties. For example, under the 6 months transmission scenario, the percentage of available general hospital beds that would be taken up by COVID-19 cases varied from 12% Tharaka Nithi county, to 145% in Trans Nzoia county. Kenya faces substantial gaps in ICU beds and ventilator capacity. Only 22 out of the 47 counties have at least 1 ICU unit. Kenya will need an additional 1,511 ICU beds and 1,609 ventilators (6 months transmission curve) to 374 ICU beds and 472 ventilators (18 months transmission curve) to absorb caseloads due to COVID-19. CONCLUSION: Significant gaps exist in Kenya's capacity for hospitals to accommodate a potential surge in caseload due to COVID-19. Alongside efforts to slow and supress the transmission of the infection, the Kenyan government will need to implement adaptive measures and additional investments to expand the hospital surge capacity for COVID-19. Additional investments will however need to be strategically prioritized to focus on strengthening essential services first, such as oxygen availability before higher cost investments such as ICU beds and ventilators.


Assuntos
Infecções por Coronavirus/epidemiologia , Número de Leitos em Hospital , Pneumonia Viral/epidemiologia , Capacidade de Resposta ante Emergências , Ventiladores Mecânicos/provisão & distribução , Betacoronavirus , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Quênia/epidemiologia , Pandemias
10.
MEDICC Rev ; 22(2): 69-71, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32478713

RESUMO

Speaking remotely with US graduates of Havana's Latin American School of Medicine (ELAM), I found them at work on hospital floors, in ICUs and health centers across the United States, putting their professional and personal commitment to the test against COVID-19. Nowhere was that more evident than in New York City, the disease's epicenter, where one grad told me virtually every hospital has at least one MD from the Cuban school, which has provided free 6-year medical training for some 30,000 doctors since the school's founding in 1999. The student body comes primarily from low- and middle-income countries worldwide, but Cuba also provided 200 US students with scholarships. One of them is Dr Joaquín Morante (ELAM Class of 2012), who did his medical residency in internal medicine, followed by fellowships in pulmonary disease and critical care medicine. Triple-licensed in internal medicine, pulmonary and critical care medicine, he is now an attending physician on staff at Jacobi Medical Center in The Bronx, one of New York City's public hospitals, and considered a 'hot spot' due to its COVID-19 caseload. I spoke with him during a break at home in mid-April.Dr Joaquín Morante, ELAM Class of 2012: Pulmonologist, critical care attending physician at Jacobi Medical Center, New York City.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Médicos , Pneumonia Viral/epidemiologia , Cuba , Administração Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Cidade de Nova Iorque/epidemiologia , Pandemias , Roupa de Proteção/provisão & distribução , Ventiladores Mecânicos/provisão & distribução
12.
Cad Saude Publica ; 36(6): e00115320, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32578805

RESUMO

This study aims to analyze the pressure on the Brazilian health system from the additional demand created by COVID-19. The authors performed a series of simulations to estimate the demand for hospital beds (health micro-regions) as well as to ICU beds, and mechanical ventilators (health macro-regions) under different scenarios of intensity (infection rates equivalent to 0.01, 0.1, and 1 case por 100 inhabitants) and time horizons (1, 3, and 6 months). The results reveal a critical situation in the system for meeting this potential demand, with numerous health micro-regions and macro-regions operating beyond their capacity, compromising the care for patients, especially those with more severe symptoms. The study presents three relevant messages. First, it is necessary to slow the spread of COVID-19 in the Brazilian population, allowing more time for the reorganization of the supply and relieve the pressure on the health system. Second, the expansion of the number of available beds will be the key. Even if the private sector helps offset the deficit, the combined supply from the two sectors (public and private) would be insufficient in various macro-regions. The construction of field hospitals is important, both in places with a history of "hospital deserts" and in those already pressured by demand. The third message involves the regionalized organization of health services, whose design may be adequate in situations of routine demand, but which suffer additional challenges during pandemics, especially if patients have to travel long distances to receive care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Pneumonia Viral/epidemiologia , Ventiladores Mecânicos/provisão & distribução , Brasil/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
15.
Farm Hosp ; 44(7): 21-23, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533664

RESUMO

Medical devices have become essential to the prevention and control of the  COVID-19 pandemic, being crucial for health professionals and patients in  particular, and the population in general. It is important to be aware of the laws  that regulate the management, distribution, and control of medical devices.  Article 82 of the Spanish Law 29/2006 on Guarantees and Rational Use of  Medicines and Medical Devices establishes that it is the responsibility of Hospital  Pharmacy Services "to participate in and coordinate the purchase of medicines and medical devices in the hospital to ensure an efficient acquisition  and rational use of medical devices". For this reason, working groups of the Spanish Society of Hospital Pharmacy and other scientific societies have issued technical guidelines and consensus statements to provide technical support and updated information on the use of masks, individual  protection equipments and other medical devices. In addition, the shortage of  medical devices caused by the high demand has resulted in the uncontrolled  production and distribution of medical devices. This phenomenon, added to the  fraudulent selling of medical devices, highlights the need for a closer surveillance of the market to guarantee the efficacy and safety of available medical devices. A rational use of medical devices is necessary to ensure the availability and safety of these products, which requires the involvement of  different stakeholders, including hospital pharmacists. Thus, it is essential that  hospital pharmacists receive specific training in technical aspects concerning the possession and use of medical devices. This will help guarantee an effective and safe use of medical products. The acquisition and use of medical  devices requires a keen understanding of the technical and legal aspects  concerning these products, which makes hospital pharmacists essential for the  integral management of medical devices.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Equipamentos e Provisões , Pandemias , Serviço de Farmácia Hospitalar , Pneumonia Viral , Equipamentos de Proteção , Certificação , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Aprovação de Equipamentos , Equipamentos e Provisões/normas , Equipamentos e Provisões/provisão & distribução , Previsões , Fraude , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pandemias/prevenção & controle , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Equipamentos de Proteção/provisão & distribução , Ventiladores Mecânicos/provisão & distribução
16.
Gac Med Mex ; 156(3): 249-252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32539019

RESUMO

Introduction: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. Objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. Results: No statistically significant differences were observed between programmed, recorded and measured positive end-expiratory pressure, mean airway pressure and peak pressure, except when simultaneously ventilating four lung simulators. Conclusions: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Ventiladores Mecânicos/provisão & distribução , Infecções por Coronavirus/fisiopatologia , Desenho de Equipamento , Humanos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/fisiopatologia , Respiração com Pressão Positiva , Respiração Artificial/instrumentação , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia
17.
A A Pract ; 14(8): e01253, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32496430

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed health care system inadequacies. Hospital ventilator shortages in Italy compelled US physicians to consider creative solutions, such as using Y-pieces or T-pieces, to preclude the need to make decisions of life or death based on medical equipment availability. We add to current knowledge and testing capacity for ventilator splitters by reporting the ability to examine the functionality of ventilator splitters by using 2 high-fidelity lung simulators. Data obtained by the high-fidelity lung simulators included: tidal volume, respiratory rate, minute ventilation, peak inspiratory pressure, peak plateau pressure, and positive end-expiratory pressure.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Ventiladores Mecânicos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Desenho de Equipamento , Humanos , Manequins , Pandemias , Pneumonia Viral/epidemiologia , Respiração com Pressão Positiva , Taxa Respiratória/fisiologia , Volume de Ventilação Pulmonar
18.
A A Pract ; 14(7): e01243, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32539282

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic created an unprecedented need for mechanical ventilation in critically ill patients. To meet this increased demand, some facilities were forced to use anesthesia gas machines (AGMs) as intensive care unit (ICU) ventilators. While an off-label use, AGM manufacturers, the Anesthesia Patient Safety Foundation, and the American Society of Anesthesiologists have guidelines for AGM use in the ICU, however, there is scant literature describing their use. This article describes our experiences at New York University Langone Medical Center using AGMs in the ICU for ventilating critically ill COVID-19 patients.


Assuntos
Anestesiologia/instrumentação , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Ventiladores Mecânicos/provisão & distribução , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva , Cidade de Nova Iorque/epidemiologia , Enfermeiras Anestesistas , Uso Off-Label , Pandemias , Pneumonia Viral/epidemiologia , Recursos Humanos
19.
Intern Med J ; 50(6): 761-763, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32537930

RESUMO

Mechanical ventilation as a resource is limited and may lead to poor outcomes in at-risk populations. Critical care supports may not be preferred by those at risk of deterioration in the COVID-19 setting. Patient-centred communication and shared decision-making should continue to remain central to clinical practice.


Assuntos
Comunicação , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Tomada de Decisão Compartilhada , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Ventiladores Mecânicos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Educação de Pacientes como Assunto , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto
20.
IEEE Pulse ; 11(3): 31-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584770

RESUMO

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 & distribução , Engenharia Biomédica , 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 , Estados Unidos/epidemiologia , United States Food and Drug Administration , Ventiladores Mecânicos/economia
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