Page 78 - JSOM Winter 2021

filters that do not have heat-and-moisture-exchange properties 6. GE Healthcare Life Care Solutions Datex-Ohmeda. Topic:
are available and may be a useful alternative. These types of COVID-19 – Requests for information regarding the off-label
viral filters are commonly used on the exhaust port of ICU use of GE Healthcare anesthesia devices for ICU ventilation. 23
ventilators and may be available, although they do add nota- March 2020. https://www.gehealthcare.com/-/jssmedia/3c655c83
bd6b427e9824994c12be0da5.pdf?la=en-us.
ble dead space and may not have a sampling port for gas anal- 7. Asrat S. Mechanical Ventilation Wave Forms. Slide presentation.
ysis. Note that Draeger, Medtronic, Pall, and others produce https://www.slideshare.net/sintubeyene/mechanical-ventilation
5
quality viral filters with sampling ports for gas analysis. If the -wave-forms.
anesthesia machine has a heated breathing system, some an- 8. Drägerwerk AG. COVID-19: Usage of Dräger anesthesia devices
esthesia machine manufacturers recommend that the heating for long-term ventilation. Letter to customers and healthcare
remain active for long-term therapy. 6–11 professionals. 19 May 2020. https://www.draeger.com/Library
/Content/Draeger-Customer-Letter-Covid19-Usage-Anaesthesia
-devices-for-long-term-ventilation.pdf.
Inhalation Therapy Management 9. Mindray North America. Mindray A-Series Anesthesia Delivery
System Consideration for use as a Ventilator. Letter to custom-
Nebulization of drugs and aerosol therapy are not approved ers. 23 March 2020. https://www.mindraynorthamerica.com/wp
with most anesthesia machines. 6–11 If aerosol or other drugs -content/uploads/2020/03/1658B-Considerations-for-MR
are given to the airways, malfunctions can occur. Without a -Anes-Sys-used-for-Ventilators-during-COVID-19-1.pdf.
mechanical filter between the connection port of the nebulizer 10. Getinge. COVID-19 Pandemic: Ventilating ICU patients using
Flow-I, Flow-c and Flow-e anesthesia machines. Customer no-
and the anesthesia machine, malfunctions are likely to occur tification letter. 10 April 2020. https://www.getinge.com/dam
(e.g., incorrect measurement of the gas analyzer; erroneous /hospital/documents/english/mcv00103387_reva_covid-19_
measurement of expiratory flows, tidal and minute volumes). customer_letter_long_term_ventilation_with_flow-en-us.pdf.
If no mechanical filter is used on the Y-piece, disconnect the 11. Mindray North America. Mindray A-Series Anesthesia Delivery
sampling gas line during nebulization and aerosol therapy. System: Consideration for use as a Ventilator. Addendum – Proce-
dures for Converting Drive Gas from Oxygen to Air. 30 March 2020.
https://www.mindraynorthamerica.com/wp-content/uploads
Conclusion /2020/03/1659B-Considerations-for-MR-Anes-Sys-used-for
-Vent-during-COVID-19-Air-Drive-Gas-Addendum.pdf.
This article is not intended to provide clinical guidance; we 12. Azami T, Preiss D, Somogyi R, et al. Calculations of O consump-
2
recognize that others have produced recommendations on the tion during low-flow anesthesia from tidal gas concentrations,
clinical management of SARS-Cov-2 virus. 13-15 Further, the in- flowmeter, and minute ventilation. J Clin Monit Comput. 2004;
tent is not to duplicate high-quality existing advice regarding 18(5–6):325–332.
mass critical care or crisis surge response. 16–19 We recommend 13. Aziz S, Arabi YM, Alhazzani W, et al. Managing ICU surge during
the COVID-19 crisis: rapid guidelines. Intensive Care Med. 2020;
that important considerations be reviewed prior to using an 46(7):1303–1325.
anesthesia machine for long-term ventilation in a critical care 14. World Health Organization. Clinical management of severe acute
setting. There are significant differences with modes of venti- respiratory infection (SARI) when COVID-19 disease is sus-
lation, fresh gas and flow capabilities, inhalation and carbon pected: interim guidance. 13 March 2020. https://www.who.int
dioxide management, alarm notifications and settings, as well /docs/default-source/coronaviruse/clinical-management-of-novel
as suction and filter requirements. -cov.pdf?sfvrsn=bc7da517_2. Accessed 4 May 2021.
15. Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis
Campaign: guidelines on the management of critically ill adults
Disclosure with coronavirus disease 2019 (COVID-19). Intensive Care Med.
The authors have nothing to disclose. 2020;46(5):854–887.
16. Christian MD, Devereaux AV, Dichter JR, et al; Task Force for
Mass Critical Care. Introduction and executive summary: care
References
1. US Food and Drug Administration. Ventilator Supply Mitiga- of the critically ill and injured during pandemics and disasters:
tion Strategies: Letter to Health Care Providers. 22 March 2020. CHEST consensus statement. Chest. 2014;146(4 Suppl):8S–34S.
https://www.fda.gov/medical-devices/letters-health-care-providers 17. Devereaux A, Christian MD, Dichter JR, et al; Task Force for
/ventilator-supply-mitigation-strategies-letter-health-care Mass Critical Care. Summary of suggestions from the Task Force
-providers. for Mass Critical Care summit, January 26–27, 2007. Chest.
2. American Society of Anesthesiologists, Anesthesia Patient Safety 2008;133(5 Suppl):1S–7S.
Foundation. APSF/ASA Guidance on Purposing Anesthesia Ma- 18. Hick JL, Hanfling D, Wynia MK, Pavia AT. Duty to plan: health
chines as ICU Ventilators. https://www.asahq.org/in-the-spotlight care, crisis standards of care, and novel coronavirus SARS-CoV-2.
/coronavirus-covid-19-information/purposing-anesthesia- March 5, 2020. Discussion paper. https://nam.edu/duty-to-plan
machines-for-ventilators. Updated 7 May 2020. -health-care-crisis-standards-of-care-and-novel-coronavirus-sars
3. Haina KMK Jr. Use of anesthesia machines in a critical care set- -cov-2/.
ting during the coronavirus disease 2019 pandemic. A A Pract. 19. Sprung CL, Zimmerman JL, Christian MD, et al; European So-
2020;14(7):e01234. ciety of Intensive Care Medicine Task Force for Intensive Care
4. American Society of Anesthesiologists. 2008 ASA Recommen- Unit Triage during an Influenza Epidemic or Mass Disaster. Rec-
dations for Pre Anesthesia Checkout. https://www.asahq.org ommendations for intensive care unit and hospital preparations
/standards-and-guidelines/2008-asa-recommendations-for-pre for an influenza epidemic or mass disaster: summary report of
-anesthesia-checkout. the European Society of Intensive Care Medicine’s Task Force for
5. Anesthesia Patient Safety Foundation. FAQ on Anesthesia Machine intensive care unit triage during an influenza epidemic or mass
Use, Protection, and Decontamination During the COVID-19 disaster. Intensive Care Med. 2010;36(3):428–443.
Pandemic. Updated 19 February 2021. https://www.apsf.org/faq
-on-anesthesia-machine-use-protection-and-decontamination
-during-the-covid-19-pandemic/.

76 | JSOM Volume 21, Edition 4 / Winter 2021