Mechanical Ventilation Supply and Options for the COVID-19 Pandemic: Leveraging All Available Resources for a Limited Resource in a Crisis

The novel Coronavirus disease (COVID-19) has exposed critical supply shortages both in the United States and worldwide including those in ICU and hospital bed supply, hospital staff, and mechanical ventilators. Many of those critically ill have required days to weeks of supportive mechanical invasive ventilation (MV) as part of their treatment. Previous estimates set the US availability of mechanical ventilators at approximately 62,000 full-featured ventilators, with 98,000 non-full featured devices (including non-invasive devices). Given the limited availability of this resource both in US and in low- and middle-income countries, we provide a framework to approach the shortage of MV resources. Here we discuss evidence and possibilities to reduce overall MV needs, strategies to maximize the availability of MV devices designed for invasive ventilation, the literature underlying methods to create and fashion new sources of potential ventilation that are available to hospitals and front-line providers, and discuss the staffing needs necessary to support MV efforts. The pandemic has already pushed cities like New York and Boston well beyond previous ICU capacity in its first wave. As hotspots continue to develop around the country and the globe, it is evident that issues may arise ahead regarding the efficient and equitable use of resources. This unique challenge may continue to stretch resources and require care beyond previously set capacities and boundaries. The approaches presented here provide a review of the known evidence and strategies for those at the front-line facing this challenge.