As the COVID-19 pandemic advances, ventilators have emerged as one of the most important tools for treating patients in critical condition

As the COVID-19 pandemic advances, ventilators are one of the most important tools for treating patients with severe cases of the novel coronavirus.

In some jurisdictions worldwide, including Italy and Spain, a shortage of the potentially life-saving machines has led doctors to make horrifying decisions about which patients to place on ventilators and which to let die.

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In a move to reduce the chance of a similarly tragic scenario, Alberta last week announced plans to more than double the province’s supply of ventilators dedicated to the COVID-19 response, bringing the province’s stock from 314 to 761 by the end of April.

The province’s official modelling suggests that in the most likely scenario, 232 COVID-19 patients will need to be on ventilators concurrently at the peak of the outbreak expected in mid-May.

Many who haven’t had experiences in intensive-care units likely don’t have a full understanding of what ventilators are, says Ken Parhar, an expert on the machines from the University of Calgary. Ventilators are a form of life support that moves air in and out of patients’ lungs, Parhar said, which is why the devices are sometimes called “breathing machines.”

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“Patients who have COVID-19 disease, particularly severe COVID-19 disease, develop infections in their lungs, primarily,” said Parhar, a clinical assistant professor at the U of C’s Department of Critical Care Medicine.

“What can happen is they have trouble getting oxygen from the air that they’re breathing into their body. When that’s the case, we intubate them by putting a breathing tube through their mouth, into their trachea and hook them up to a ventilator to help assist their breathing.”

Given the uncomfortable nature of the machines, patients often have to be sedated, and doctors have to be careful not to damage patients’ lungs when using ventilators. While on the machines, some patients also experience other complications, such as muscle atrophy.

The machines don’t cure COVID-19, Parhar said, but “buy the patient time” as their body fights the virus.

Alberta is procuring its additional supply of ventilators through a variety of sources, including machines used by chartered surgical facilities and others donated by places such as the Southern Alberta Institute of Technology

But the largest source of new units will come from repurposing devices meant for transport, anaesthetic and pediatric use, with more than 300 ventilators coming from these areas.

These devices are still capable of providing oxygen and sustaining life, according to Parhar. Pediatric ventilation devices designed for use on younger patients can also be used on smaller adult patients, while anaesthetic devices typically aren’t used for long periods of time but, in theory, can be put to use for extended periods of time.

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The alternative devices may also be unfamiliar to ICU doctors, Parhar said, meaning that those treating COVID-19 patients would likely prefer to only use them if standard ventilators are unavailable.

“It’s a lot like driving a car. There’s a lot of different vehicles that all have the same basic functions, so you could basically get in any vehicle and drive, if you needed to, across the province or across the country,” he said.

“There may be some features you’re less familiar with, but the basic functions are sustained across all ventilators, so we’d really be comfortable using any of them. But our preference, obviously, is to use the ones we’re most familiar with.”

Alberta Premier Jason Kenney has also mentioned the potential of taking retired machines out of storage for use. Parhar said he expects this would only happen under “extreme circumstances,” but noted that if retired units are brought back, they would undergo testing to ensure they are fully operational.