VENTILATORS IN COVID-19, BETWEEN SCARCITY AND ABUNDANCE MINDSET

During a pandemic similar to COVID-19, causing severe respiratory illness, many people may require mechanical ventilation. Depending on the extent of the outbreak, there may be insufficient capacity to provide ventilator support to all the rapidly rising cases in intensive care units (ICUs), worldwide. This never precedented before demand for ventilators is creating enormous pressure on governments and stretching many resources towards one end. More supply to ventilators is expected by even none specialised manufacturers and armatures due to this scarcity mindset. In this paper, we shall study the rationale behind putting on ventilators on COVID-19. An emphasis for more evidence-based strategies that pull towards an abundant mindset is discussed based on the results and studies of the ventilated COVID-19 patients. This paper reviews studies coming from the different world-leading ICUs where the majority of COVID-19 critical cases are seen, showing that we have to re-visit the pros and cons of having patients on ventilators, instead of just putting them on simple CPAP, for most of the cases. The authors question whether ICUs are applying selection criteria based on patient's immunological parameters (number of lymphocytes, IL-6 and other potential biomarkers), before applying ECMO. The paper questions whether the history of the case is considered before deciding to put or keep the patient on the ventilator. The authors agree that the length should weigh the demand for ventilators on ventilation and the inflexion point. Furthermore, there is a clear need for a new design of ventilators that does not damage the lung and be more friendly for ventilating Acute Respiratory Distress Syndrome (ARDS). Finally, there is a need for new modelling that address the demand for the ventilators, based on COVID-19 destruction of the lung and related tissues. On the other hand, the limitation here is that the mortality data about the ventilator models are scarce and/or based on small trials. This warrants further clinical studies to elucidate better the advantages and disadvantages related to invasive measures, like ventilation and ECMO. This work concludes with a proposed framework and a set of recommendations.