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Found 68 results
  1. Content Article
    Studies from medical and surgical intensive care units (ICU) suggest that long-term outcomes are poor for patients who have spent significant time in an ICU. This study in the American Journal of Surgery aimed to identify determinants of post-intensive care physical and mental health outcomes 6–12 months after injury. The authors found that: Delirium during an intensive care unit (ICU) stay is linked with long-term physical impairment in injury survivors who spent three or more days in the ICU. The use of ventilators in the ICU is another factor associated with long-term physical impairment and mental health symptoms in these patients. Delirium and ventilator use are potentially modifiable, suggesting opportunities for improving patient outcomes. They suggest that that this knowledge can inform the development of interventions that specifically target delirium and ventilator use to mitigate long-term impairments.
  2. Content Article
    Between 2009 and 2010, 48 year-old David Richards was admitted to intensive care during the ‘swine flu pandemic’. He spent six weeks in an intensive care unit (ICU), first on mechanical ventilation and later receiving extra-corporeal membrane oxygenation (ECMO) treatment. He recovered and became a survivor of severe acute respiratory distress syndrome (ARDS). During his 50 days in intensive care, David's former partner Rose kept an ‘ICU diary’. Rose recorded clinical updates as well as conversations with relatives and staff who were by David's bedside. In this article, David describes how important this diary has been to him understanding and processing his experience. It forms a record not just of procedures, treatments and clinical signs but of how he reacted, how he appeared to feel and how he tried to communicate during a time that were permeated by delirium.
  3. News Article
    Remdesivir has no significant effect on patients with Covid-19 who are already being ventilated but has a small effect against death or progression to ventilation among other patients admitted to hospital, the World Health Organization’s Solidarity trial has found. This appears to be a change from findings reported in February 2021, when preliminary trial data suggested that remdesivir “had little or no effect on patients admitted to hospital with Covid-19.” The updated results, published in the Lancet, reported that overall 14.5% of patients assigned to remdesivir died compared with 15.6% assigned to the control group. The release of these results has prompted questions about why it has taken so long to publish these data, especially considering WHO’s recommendation against the use of remdesivir in patients with Covid-19. Read full story Source: BMJ, 4 May 2022
  4. News Article
    Two thousand ventilators being used in UK hospitals are at risk of suddenly shutting down due to electrical faults that have led to a global safety alert. Hospitals have been ordered to source replacement ventilators after Philips Respironics said its breathing support devices could suddenly stop working, in some cases without activating a warning alarm. The Medicines and Healthcare products Regulatory Agency (MHRA) said the problem related to “a number of electrical faults in the devices, which can result in an unexpected shutdown, leading to loss of ventilation”. It said there had been five reported cases of shutdowns in the UK so far, none of which involved patient harm. Globally, there have been 389 reports of failures, including one where the patient died and four where they were seriously injured. In six of the total cases, the warning alarm didn’t sound. Philips Respironics is one of several manufacturers that increased production of ventilators during the pandemic. The MHRA brought in a fast approval process for ventilators and other medical devices in response to Covid-19. The MHRA said the root cause of the problem was not yet known and remained under investigation, but that Philips Respironics currently had “no permanent solution” to correct it. Helen Hughes, chief executive of Patient Safety Learning, said there was a “significant patient safety concern” that some Philips devices could remain in use until replacements were sourced. Read full story Source: The Guardian, 9 April 2022 National Patient Safety Alert: Philips Health SystemsV60, V60 Plus and V680 ventilators – potential unexpected shutdown leading to complete loss of ventilation
  5. News Article
    Two-thirds of defective breathing machines distributed by the health service have not been repaired or replaced in the 12 months since they were subject to a worldwide recall over safety concerns. Philips Respironics last year issued a field safety notice for a series of ventilation devices because the polyester-based foam used to dampen the noise of the machines can break down. The foam particles or potentially toxic chemicals may be inhaled or ingested by patients. Almost 8,000 of the affected machines have been contracted by the Health Safety Executive (HSE) for use in hospitals and private homes, including 6,394 continuous positive airway pressure (CPAP) devices, 1,348 bilevel positive airway pressure (BPAP) devices, and 147 mechanical ventilators. However, the HSE told The Times that only 2,723 devices had been repaired or replaced a year after the recall was announced. A spokesman did not respond when asked if the HSE was concerned about patient safety, given that more than 5,000 devices have not been attended to. Read full story (paywalled) Source: The Times, 8 July 2022
  6. News Article
    A trust was supplied with ventilators that were not ‘fit for NHS purposes’ by two suppliers at the height of the first Covid wave, HSJ has revealed. Guy’s and St Thomas’ Foundation Trust has now received a refund for both contracts, which were signed in March 2020 just as the pandemic began to hit the NHS. The service rushed to secure the equipment in response to fears that existing ventilator capacity would be inadequate to deal with the rising number of seriously ill Covid patients. At the time, the use of ventilators was the only effective therapy for the sickest Covid patients. Minutes published by the trust at its most recent board meeting revealed the issue. GSTT then told HSJ in a statement: “Two contracts for ventilators were in dispute. In one case, the trust has already received a refund. In the other, which involved equipment we do not assess as fit for NHS purposes, the trust was reimbursed by central funding.” The trust would not confirm the number of ventilators involved, the cost or the issue that meant they were not “fit for NHS purposes”. Read full story (paywalled) Source: HSJ, 23 June 2022
  7. News Article
    The lungs and hearts of patients damaged by the coronavirus improve over time, a study has shown. Researchers in Austria recruited coronavirus patients who had been admitted to hospital. The patients were scheduled to return for evaluation 6, 12 and 24 weeks after being discharged, in what is said to be the first prospective follow-up of people infected with COVID-19, which will be presented at today's European Respiratory Society International Congress. Clinical examinations, laboratory tests, analysis of the amounts of oxygen and carbon dioxide in arterial blood, and lung function tests were carried out during these visits. At the time of their first visit, more than half of the patients had at least one persistent symptom, predominantly breathlessness and coughing, and CT scans still showed lung damage in 88% of patients. But by the time of their next visit, 12 weeks after discharge, the symptoms had improved, and lung damage was reduced to 56%. Dr Sabina Sahanic, a clinical PhD student at the University Clinic in Innsbruck and part of the team that carried out the study, said: "The bad news is that people show lung impairment from COVID-19 weeks after discharge; the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves." A separate presentation to the congress said that the sooner COVID-19 patients started a pulmonary rehabilitation programme after coming off ventilators, the better and faster their recovery. Yara Al Chikhanie, a PhD student at the Dieulefit Sante clinic for pulmonary rehabilitation and the Hp2 Lab at the Grenoble Alps University in France, used a walking test to evaluate the weekly progress of 19 patients who had spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to a clinic for pulmonary rehabilitation. She said: "The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive. The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients' walking and breathing capacities and muscle gain." Read full story Source: The Independent, 7 September 2020
  8. News Article
    Death rates among seriously ill COVID-19 patients dropped sharply as doctors rejected the use of mechanical ventilators, analysis has found. The chances of dying in an intensive care unit (ICU) went from 43% before the pandemic peaked to 34% in the period after. In a report, the Intensive Care National Audit & Research Centre said that no new drugs nor changes to clinical guidelines were introduced in that period that could account for the improvement. However, the use of mechanical ventilators fell dramatically. Before the peak in admissions on 1 April, 75.9% of COVID-19 patients were intubated within 24 hours of getting to an ICU, a proportion which fell to 44.1% after the peak. Meanwhile, the proportion of ICU patients put on a ventilator at any point dropped 22 percentage points to 61% either side of the peak. Researchers suggested this could have been a result of “informal learning” among networks of doctors that patients on ventilators were faring worse than expected. Read full story Source: The Telegraph, 3 September 2020
  9. News Article
    NASA scientists as well as other innovators are busy developing alternatives to the traditional ventilator being used worldwide to treat severe cases of COVID-19. The movement is in response to growing evidence that in some cases ventilators can cause more harm than good in some patients with low oxygen levels. Statistics tell the story: 80% of patients with the coronavirus die on such machines. Its VITAL machine is tailored for COVID-19 patients and is focused on providing air delicately to stiff lungs — a hallmark symptom of the virus. Eight U.S. manufacturers have been selected to make the ventilator that was made in 37 days by engineers at NASA’s Jet Propulsion Laboratory. Read full story Source: CNBC, 30 May 2020 Read f
  10. News Article
    Hundreds of ventilators the UK government bought from China to relieve a major shortage are the wrong type and could kill patients, senior doctors have warned in a newly uncovered letter. The medical staff behind the letter say the devices were designed for use in ambulances rather than hospitals, had an "unreliable" oxygen supply and were of "basic" quality. Seen by Sky News' partner organisation NBC, the document also claims the ventilators cannot be cleaned properly, are an unfamiliar design and come with a confusing instruction manual. Cabinet Office minister Michael Gove triumphantly announced the arrival of "300 ventilators from China" to help treat COVID-19 patients on 4 April. But the letter of warning from doctors was issued just nine days later. "We believe that if used, significant patient harm, including death, is likely," it says. Read full story Source: Sky News, 30 April 2020
  11. News Article
    The availability of dialysis equipment used to treat more than a quarter of ventilated COVID-19 patients has reached “critical” levels, HSJ has learned. Concerns are growing over an “exceptional shortage” of specialist dialysis machines used to treat intensive care patients with acute kidney failure. Although hospitals are able to deploy alternative machines which are not typically used in intensive care, this is logistically challenging and can carry increased risks for patients. Read full story Source: HSJ, 22 April 2020
  12. News Article
    More than a quarter of patients with COVID-19 on ventilators also need renal support in the form of dialysis, raising concerns that there could be significant supply problems as countries attempt to stock up on the required fluid and plastic consumables. Nephrology consultant Graham Lipkin told The BMJ, “This is an under-recognised challenge. While the original focus has been on whether we have enough ventilators and intensive care beds, it has become apparent that there is a high incidence of acute kidney injury (AKI) requiring some form of renal replacement therapy (RRT) through dialysis. With the volume of people coming into intensive care, there are increasing challenges to capacity across the system.” Lipkin, who is president of the Renal Association, has been working with NHS England to develop new clinical guidelines for the prevention and optimal management of AKI in hospital. The guidance aims to reduce the incidence of AKI and therefore the demand for dialysis. Read full story Source: BMJ, 21 April 2020
  13. News Article
    According to an Allego press release, several of the world’s ventilator manufacturers have formed a Ventilator Training Alliance (VTA) and partnered with Allego to create a mobile app that front-line medical providers can use to access a centralised repository of ventilator training resources. Dräger, GE Healthcare, Getinge, Hamilton Medical, Medtronic, Nihon Kohden, and Philips have joined this humanitarian training coalition. The VTA app – powered by learning and readiness platform provider Allego – connects respiratory therapists, nurses and other medical professionals with ventilator training resources from alliance member companies, including instructional how-to videos, manuals, troubleshooting guides, and other ventilator-operation expertise critical to helping responders treat patients suffering from COVID-19-related respiratory distress. Read full story Source: American Association for Respiratory Care, 16 April 2020
  14. News Article
    Having access to a ventilator can mean the difference between life and death for patients who are seriously ill with COVID-19, but sometimes even these breathing machines cannot save someone's life. Juanita Nittla is a chief nurse in the intensive care unit (ICU) at London's Royal Free Hospital, and has been working for the NHS as an intensive care specialist nurse for the past 16 years. Switching off ventilators is part of Juanita's job. The work is traumatic and painful, the 42-year-old says. "Sometimes I feel like I am somewhat responsible for someone's death." Medical teams face tough decisions about when to stop treatment for patients who aren't getting better. The decision is made after careful consideration, analysing factors such as the age of the patient, underlying health conditions, their response to the virus and likelihood of recovery. Read full story Source: BBC News, 20 April 2020
  15. News Article
    None of the new life-saving mechanical ventilators ordered last month to cope with the increase in coronavirus patients has so far been awarded safety approval. Models by manufacturers such as Dyson have yet to get the green light from the Medicines and Healthcare products Regulatory Agency, the Financial Times reported. It comes a month after the Government issued a rallying cry to put non-medical manufacturers such as Dyson on a "war footing" to make additional machines. The lag is thought to be due in part to changing clinical understanding of how best to manage the virus. Read full story (paywalled) Source: The Times, 14 April 2020
  16. News Article
    Eight in ten coronavirus patients placed on ventilators in New York City have died, according to officials. New York state has recorded more cases than any country other than America itself. The tally rose by 10,000 in 24 hours to 159,937, ahead of Spain and Italy, which at different times have reported the most infections in the world. The US, which now holds the position, had 463,433 confirmed cases yesterday and the national death toll was 16,504. Read full story Source: The Times. 10 April 2020
  17. News Article
    Doctors seeing patients with blood oxygen levels so low they are surprised they are conscious – yet they are sitting up and talking. British and American intensive care doctors at the front line of the coronavirus crisis are starting to question the aggressive use of ventilators for the treatment of patients. In many cases, they say the machines – which are highly invasive and require the patient to be rendered unconscious – are being used too early and may cause more harm than good. Instead they are finding that less invasive forms of oxygen treatment through face masks or nasal cannulas work better for patients, even those with very low blood oxygen readings. Dr Ron Daniels, a consultant in critical care at University Hospitals Birmingham NHS Foundation Trust, on Thursday confirmed reports from US medics that he and other NHS doctors were revising their view of when ventilators should be used. Read full story Source: The Telegraph, 9 April 2020
  18. News Article
    Shortages are dogging the fight against the coronavirus. At Bradford Royal Infirmary (BRI) it's still only possible to test six staff for the virus per day, consultants have been making their own personal protective equipment, and there's an urgent need to save oxygen. Searching for ways round the problem, Dr Tom has been working with Leeds University on a 3D-printed valve that could be attached to the hospital's ventilators to reduce the amount of oxygen they use. But he also began looking at CPAP machines used to treat sleep apnoea at home. These maintain air at a continuous pressure, inside a mask, to keep the user's airways open - they have to be repurposed to provide oxygen for use in the hospital, but they use much less of it than standard hospital ventilators. They said, 'Yes we've got 2,000, how many do you want?''' he says. "And so our plan is to start with 100 and to see whether, if we use these early enough during a patient's stay, we can prevent people deteriorating and needing to go on to the more complex ventilators, and needing to come to the intensive care unit." We've been testing them over the weekend, and there's evidence from China and from the US that they seem effective. They just help inflate your lungs and that seems to be beneficial. They are also very simple, which means that there's no need for a huge amount of training. Read full story Source: BBC News, 7 April 2020
  19. News Article
    The designs of a new breathing aid developed by engineers at the Mercedes F1 team, University College London (UCL), and clinicians at UCL Hospital have been made freely available to support the global response to COVID-19. It's the latest development in Formula 1’s Project Pitlane effort to help fight coronavirus. The Continuous Positive Airway Pressure (CPAP) devices, which help coronavirus patients with lung infections to breathe more easily, were developed by engineers at the Mercedes team and University College London (UCL), and clinicians at UCL Hospital after a round-the-clock effort to reverse engineer a device that could be manufactured rapidly by the thousands. After patient evaluations at UCLH and across sister hospitals in the London area, the device received regulatory approval last week. An order for up to 10,000 has now been placed by the British National Health Service, and the Mercedes AMG High Performance Powertrains technology centre in Brixworth – the facility where the F1 team’s highly successful power units are developed and built – is now building 1,000 devices per day. Read full story Source: F1, 7 April 2020
  20. News Article
    Stable coronavirus patients could be taken off ventilators in favour of those more likely to survive, it emerged on Wednesday, as another sharp rise in deaths left the UK braced for the outbreak to reach up to 1,000 deaths a day by the end of the week. In a stark new document issued by the British Medical Association (BMA), doctors set out guidelines to ration care if the NHS becomes overwhelmed with new cases as the outbreak moves towards its peak. Under the proposals, designed to provide doctors with ethical guidance on how to decide who should get life-saving care when resources are overstretched, hospitals would have to impose severe limits on who is put on a ventilator. Large numbers of patients could be denied care, with those facing a poor prognosis losing the potentially life-saving equipment even if their condition is improving. The BMA suggested that younger, healthier people could be given priority over older people and that those with an underlying illness may not get treatment that could save them, with healthier patients given priority instead. Read full story Source: The Guardian, 1 April 2020
  21. News Article
    National and regional NHS chiefs will seek to share out scarce ventilators to ”areas with the most immediate need, on a fair share basis relative to patient ventilation need," they have told hospital chiefs, who are increasingly concerned about what they will receive and when. Many are expecting demand for ventilated beds to outstrip what they have as the number of patients seriously ill with covid-19 ramps up. Trust leaders yesterday told HSJ they were growing increasingly worried about the lack of information over when the machines would be sent to their trusts. Some are worried London, and other regions which see their demand spike first, will get more supply. A letter from NHS England and Improvement to trust chiefs late on Wednesday told them that as “extra ventilators become available we will coordinate distribution via regional teams who will work with local health systems”. Read full story (paywalled) Source: HSJ, 27 March 2020
  22. News Article
    The government says a communications mix-up meant it missed the deadline to join an EU scheme to get extra ventilators for the coronavirus crisis. Ministers were earlier accused of putting Brexit before public health when Downing Street said the UK had decided to pursue its own scheme. But No 10 now says officials did not get emails inviting the UK to join and it could join future schemes. The party's shadow Health Secretary Jonathan Ashworth said: "Given the huge need for PPE, testing capacity and crucial medical equipment including ventilators, people will want to know why on Monday ministers were saying they had 'chosen other routes' over the joint EU procurement initiatives but now they are claiming that they missed the relevant emails. "We need an urgent explanation from ministers about how they will get crucial supplies to the frontline as a matter of urgency." Read full story Source: BBC News, 27 March 2020
  23. Content Article
    V60 and V60 Plus devices are designed for in-hospital use. They can be used to provide average volume assured pressure support (AVAPS), pressure-controlled ventilation (PCV), continuous positive airway pressure (CPAP), and positive pressure ventilation (PPV) treatment to patients in critical care and high dependency unit (HDU) settings. The safety concern identified relates to a number of electrical faults in the devices, which can result in an unexpected shutdown, leading to loss of ventilation. There are two ways in which this shutdown can occur: The first will sound a warning to alert the user that the machine is shutting down. This will let the user know they need to switch to an alternative source of ventilation. There is a risk that the patient will be unventilated while this second source of ventilation is prepared. The second failure mode will cause the device to shut down with no warning alarm. If a ventilator fails in use and does not alarm, the patient will be unventilated until the clinician becomes aware and responds. If unnoticed by healthcare professionals, ventilation failure can have a severe health impact on patients. This can include hypoxia, which can result in long-term cognitive impairment to the patient. There is also a risk of death if a patient is without ventilation for a sustained period of time Philips has no permanent solution to correct this issue and as such we are issuing this alert to help hospitals manage the risk.
  24. Content Article
    Mary Land was a patient on an Acute Respiratory care unit 'surge' ward at Pinderfield Hospital, being treated for COVID pneumonia against a backdrop of comorbidities. On 5 February 2021 she was discovered in an unresponsive condition, with the tube connecting her facemask to a BIPAP ventilator detached at the connection point to the mask. In his report, the Coroner raised patient safety concerns relating to how the tubes of her Philips Respironics AF 541 mask became detached from the ventilator.
  25. Content Article
    The coronavirus has a high incidence of patients with severe acute respiratory syndrome (SARS). Many patients infected with COVID-19 need to be admitted to the ICU for invasive ventilation. They are also at a high risk of developing secondary, ventilator-associated pneumonia (VAP).
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