Does Having More Ventilators Even Help?

[Randomkindness]

This is a genuine question because I might not be seeing the full picture. I keep seeing reports of buying additional ventilators for different areas. But if there is a limited number of ICU nurses and respiratory therapists will that even help? Thanks.

[MunoRN, RN]

I think more importantly there is the question how many patients can be saved with a ventilator. The number of patients who need a ventilator and the number who would benefit from a ventilator are two very different things. As the criteria that predicts mortality is becoming more clear, I don't think the answer is more ventilators, it's more palliative care consults.

[CampyCamp, RN]

These are both questions I've asked. I'm taking advantage of the opportunity to educate the public (on social media, of course) that nurses have highly complex educations but we also have specialties that we acclimate to after months of specialized education.

A vent does not control itself

A vent can cause injury or worsening of medical conditions if not managed correctly

A patient is very vulnerable on a vent and needs close care for safety and comfort

An acute ventilated patient almost always needs other forms of life support- vasopressors, renal therapy, or others

It takes months to be independent in ICU

I'll be absolutely flustered the first time (if/when) I have to care for a pt on an anesthesia vent. I think respiratory will too at first but will acclimate faster. I hope the crnas and mdas will be very hands on.

[Rose_Queen, BSN, MSN, RN]

We will be using CRNAs and PACU nurses to assist with vents. The PACU nurses are all required to maintain vent competency as there are times patients come out of the OR with a “wake up” vent. CRNAs are familiar with vents due to ICU experience and use of the anesthesia machines. We are planning to use the anesthesia machines as back up when we run out of vents. That may help with the running and care; however, from what I’m reading once a patient gets to the point of needing a vent, it’s not likely they’ll make it off the vent.

[subee, MSN, CRNA]

CMS has lifted supervision requirements for CRNA (which was a billing issue, not a practice issue) and my state along with others have lifted restriction on APRN's and allowed them to practice independently. This will allow anesthesiologists be freed up to help ICU nurses learn more independent ventilator management skills. Patients can and do get off the vent. We are early enough in the epidemic that lots of people are being denied a vent because their chances of survival are nil. When the going gets rougher, I think we will see more patients surviving vent support because the cut off ages will become younger.

[HiddenAngels]

1 hour ago, MunoRN said:

I think more importantly there is the question how many patients can be saved with a ventilator. The number of patients who need a ventilator and the number who would benefit from a ventilator are two very different things. As the criteria that predicts mortality is becoming more clear, I don't think the answer is more ventilators, it's more palliative care consults.

Aaaaahhh Does having more vents even help.. I'm going to go out on a limb here and say yes. It helps preserve life in a way that gives people time to weigh critical decisions. The outcome of having someone recover after having been on a vent is like the previous post above me is saying, often slim, however, it does and can happen..

[subee, MSN, CRNA]

1 minute ago, HiddenAngels said:

Aaaaahhh Does having more vents even help.. I'm going to go out on a limb here and say yes. It helps preserve life in a way that gives people time to weigh critical decisions. The outcome of having someone recover after having been on a vent is like the previous post above me is saying, often slim, however, it does and can happen..

I made an error on my posting. It should have said a lot of people are NOT denied a vent even though prognosis is nil. When these people never even go on a vent, I think the post-vent survival rates will start to rise.

[SansNom]

If this situation gets as bad as many predict, ALL of us will have to be rapidly adapting to new situations, and no doubt stepping outside of our comfort zones and areas of expertise.

If in fact med/surg nurses are in a situation where they have to manage a vented patient, it is easy to learn to do mouth care and suctioning and basic vent maintenance. An RT or MD or RN does not need to be at the bedside of vented patients constantly, which is why one RT is usually assigned to multiple patients in an ICU. It's even easy to actually change settings and operate the machines, assuming you have a MD or someone knowledgeable to tell you what to set them to.

I'd imagine in that kind of situation a small handful of doctors, CRNAs, and RTs could be on hand calling the shots on settings and higher level maintenance while any nurse could quickly learn to do basic things.

So back to the original question, yes, it will be beneficial to have the vents even without everyone trained because we could delegate maintenance of them based on knowledge and capability.

It's not an ideal situation, of course, but what aspect of this crisis is ideal anyway? We all should just be ready to adapt quickly as is necessary.

[MunoRN, RN]

2 hours ago, HiddenAngels said:

Aaaaahhh Does having more vents even help.. I'm going to go out on a limb here and say yes. It helps preserve life in a way that gives people time to weigh critical decisions. The outcome of having someone recover after having been on a vent is like the previous post above me is saying, often slim, however, it does and can happen..

There is certainly a subset of patients who may benefit from being on a vent, but no, not all patients who require a vent will benefit from one and we have enough data at this point to know who those patients are. And no, prolonging a non-survivable dying process is not a benefit of putting someone on a vent.

[herring_RN, ASN, BSN]

On 3/31/2020 at 5:51 PM, MunoRN said:

There is certainly a subset of patients who may benefit from being on a vent, but no, not all patients who require a vent will benefit from one and we have enough data at this point to know who those patients are. And no, prolonging a non-survivable dying process is not a benefit of putting someone on a vent.

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