To all,

Here are some global numbers I was approved to share that I received a three weeks ago:

 

Be safe and healthy.

 

 

 Homecare.

•  
• o   Shortage of concentrators

• o   See a strong increase in palliative care patients

• o   Some severe patients are not treated in the hospital and they send them home to free up hospital beds. 

• o   Increase stock of disposables

• o   Italy defined protocol to avoid cross infection with devices

• o   Initially big concern with PPE. Has improved somewhat

• o   Using home ventilators in hospitals.

• o   24/7 hotline for ventilators and training videos on youtube

• o   Big demand for high flow therapy devices. Even using CPAPs

• o   Sleep business slowed down

• ·         Hospital Care

• o   Strong increase in LOX demand.

• o   Italy some hospitals up to 20 times

• o   Other countries report 30-100% increase

• o   Varies very much among countries

• o   Liter flow varies among physician

• o   Hospitals are doing stock piling of cylinders

• o   Countries installing additional LOX tanks

• o   Countries have requested extended testing period for cylinders.

• o   Countries have requested approval to use technical IG cylinders.

• o   Transforming Nitrogen trucks to O2 trucks.   Army staff is trained to drive O2 trucks

• o   In several countries they build temporary hospitals.  For example a 4000 bed hospital in London

Canada

• ·         IG fillers now fill medical

• ·         PPE ok situation

• ·         Nursing homes requires a lot of PPE

• ·         Ventilators eg Trilogies on backlog

• ·         Not seen any increase in O2 so far

• ·         Focus is to flatter the curve. Expect to peak in three weeks

USA

• ·         Contacting daily with customers.

• ·         6700 hospitals.  Nursing homes, other HC facilities and ACS

• ·         Emergency triage hospitals are being set up in NY, LA, CA, IL, MI, NV, with 1000-3000 beds each. Critical patients will be in ICU, the overflow locations should take care of the less critical patients.   Estimated 300 ACS across the US to be set up.

• ·         High requests for E & Large Cylinders, Regulators, Carts, Flowmeters,
• Hospital and ACS bottle necks: Ventilators, Patient Distribution line size, Source supply sizing (Vaporizers, Cabinets, Storage Tanks)

Mexico

• ·         Similar situation to the US

• ·         Most of the big cities setting up ACS and expanding Oxygen supplies

• ·         Decreasing or eliminating elective surgery to reserve resources

• ·         All LOX tanks have telemetry

• ·         Covid hospitals  being identified to estimate increase in volume. 

• ·         Hospitals bottle neck is the ventilators and the personnel.

• ·         Vaporizers in various places in the country to be prepared

Other North Latam

• ·         Main problem is the lack of Biomed devices (eg ventilators)

• ·         Changing service to use IG cylinders

• ·         Moving people from IG to HC

• ·          Request for medical devices increasing

• ·         Hospitals enabling and preparing additional bed

Colombia

• ·         Changing from GOX to Concentrators·        

Brazil

• ·         Hospital care.

• o   Customers have asked to put additional tanks to start with

• o   Also have the flu season coming now

• o   Expect it to get worse in 15-20 days.

• o   Hospitals asking us for ventilators.

• o   Building 22 temporary hospitals.  Average size is 500 beds.  In Sao Paulo and Rio it will be 2000 beds.

• o   Problems with contractors to have people to work and do the piping etc.

• ·         Now in preparation phase

• ·         Hospitals asking more cylinders.

• ·         Making plans for temporary locations

• ·         20-50 liter per minutes for serious patients

• ·         10-20% of the people

• ·         Non serious, started with 5 l/min and then up to 10 l/min

• ·         Pressure in pipeline dropping

Keith, China lists flow of 20 - 50 LPM for "serious patients". Would you know if this is vent inspiratory flow, which would be intermittent or is it continuous flow, such as via a flowmeter? Standard clinical flowmeters read up to 15 LPM, with an unreadable and uncalibrated flow flush setting up to 70 LPM. Fulsh flow is traditionally rarely used and then for short periods. Thanks

George:

Here is some information our Clinical & RT team sent me relating to your post:  

The basic respiratory information is correct in term of minute volume calculation based on tidal volume and respiratory rate. 

 

Two issue to be considered:

The first is that these ventilators were designed to run on an endless supply of medical air and oxygen from wall connections.  Efficiency was not a paramount concern so two models/brands of ventilators on the same settings can use very different amounts of gas to achieve the same outcome.  (I have heard certain ventilators referred to as “gas hogs”)  These ventilators have a bias flow (think of it as a background flow)  that varies greatly between ventilators based on peep and other settings.

Second a normal minute ventilation may be in the 6-12 LPM range but many COVID-19 patients have high minute volumes and high levels of peep.  Yes the peak flow of 60 LPM may only take place during inspiration but I believe, based on information we received from globally oxygen usage reviews, that the usage may be higher than we suspect.  I will continue to look for more references and any additional information forwarded to me. 

 

PS: I just heard back from the manufacturer of the XXXXX.  The 60 LPM flow rate is all they give out and that represents peak output which we could use as a ceiling.  As I suspected there are too many variables to calculate other usages.  That 60 LPM represents  total gas flow and the ratio would vary based on the prescribed FiO2.  Some units may be using onboard compressors and others may be utilizing the medical air for basic operation.

 

Something that people should be aware of if they are using anesthesia machines for ventilators. If you’re using an Ohmeda anesthesia machine it uses oxygen as a drive gas to drive the Ventilator. That can be switched very simply that they use air as there drive gas.There is no danger or harm in doing this even though Ohmeda prefers to use oxygen. If there was a leak in the Bellows the 02 analyzer would pick this up.

The savings of oxygen is astronomical.