Access Now: AORN COVID-19 Clinical Support

Archive June 2020 XXI, No. 6

Anesthesia Alert

Anesthesia Machines Provide Life-Saving Support

Michael McLaughlin

Michael McLaughlin, DNP, CRNA/APN

BIO

DESPERATE MEASURE
Michael McLaughlin, DNP, CRNA/APN
DESPERATE MEASURE Michael McLaughlin, DNP, CRNA/APN, removes a vaporizer from an anesthesia machine that will be used to ventilate patients with the coronavirus.

I've been working near the epicenter of the COVID-19 pandemic in New York City, intubating patients on a special team formulated specifically to manage the airways of COVID-19-infected patients. I know all too well the urgent need for ventilators and have heard of hospitals hooking up six patients to a single ventilator. With the COVID-19 pandemic essentially bringing elective surgeries to a temporary halt, thousands of operating rooms across the US are vacant. The anesthesia machines housed inside these operating rooms can quickly be converted into ventilators, offering lifesaving support as the virus peaks across the country.

The situation here in the tri-state area is grave enough that many hospitals have already performed these conversions in their dormant ORs. The conversion, which is simple for any anesthesia professional to perform, involves removing the anesthetic gas vaporizers and adding a humidity-heat-viral exchange filter to the breathing circuit. That's it.

Why it works

A ventilator is just one of the many components that makes up an anesthesia machine. When a patient is unconscious, anesthetic medications we use cause the patient to stop breathing; the built-in ventilator takes over that function for the patient by means of mechanical ventilation. If you simply place the patient on an anesthesia machine and do not turn on the anesthetic gases, it's essentially a ventilator.

An anesthesia machine's vaporizers house anesthetic gases, which you won't need when using the machine as a ventilator. It's important to remove them so someone doesn't inadvertently turn on anesthesia while a patient is being ventilated. The heat and humidity exchange filters add humidity to the breathing circuit, ensuring the airway stays warm and moist. The exchange devices also filter bacteria and viruses, helping to keep the anesthesia machines clean and safe to use.

Anesthesia professionals need to always be present to operate the anesthesia machine and manage its use as a ventilator. Ideally, an anesthesia provider can oversee three or four of these machines at once. If an alarm goes off on the machine, an anesthesia provider would need to be ready to tend to that alarm, which is only heard in the patient's immediate area. They cannot be tied to a central monitoring system as you would typically find in a traditional ICU. The close monitoring of patients is imperative.

FRESH AIR
Michael McLaughlin, DNP, CRNA/APN
FRESH AIR Heat and humidity exchange filters create a moist breathing environment for the patient and keep the circuit free of contaminants.

Anesthesia machines do not have the same specialized functionality of typical standalone ventilators, which may offer additional breathing support modes. For example, if the patient has a certain type of lung pathology, you can tailor and fine tune a traditional ventilator to better treat the disease. The ventilator function on many anesthesia machines offers basic functions for life support. As far as a life-saving measures, a patient can be sustained on an anesthesia machine in a pandemic situation where equipment shortages exist. Anesthesia machines are bulky — much larger than a typical ventilator that can easily be wheeled around — so the idea of a freestanding surgery center donating or loaning one to an area hospital by shipping it to them isn't feasible. However, the conversion provides the possibility that outpatient ORs can host COVID-19 patients in need of mechanical ventilation.

Patients requiring mechanical ventilation must first be intubated with an endotracheal tube. It is important to keep in mind that everyone in the immediate area is in danger during intubation because of the insidious communicability of COVID-19. Opening the patient's airway to insert a breathing tube could aerosolize the virus, which is spread through droplets in the air. The result of intubation is much like someone constantly sneezing or coughing into the air around you. Right now, when intubating COVID-19 patients, it is recommended anesthesia providers wear a powered air-purifying respirator (PAPR), a suit that filters the air. Intubation should be done in a room with negative pressure when possible.

Last resort

The FDA has approved repurposing anesthesia machines for use as ventilators in an emergency-use authorization, intended to increase access to life-saving treatments for COVID-19 patients. Anesthesia machines in use as ventilators require special supervision by properly trained anesthesia professionals in order to ensure patient safety. In the current situation, we are doing things that wouldn't typically be done. Using anesthesia machines as ventilators is one way we are responding during this desperate time to save lives. OSM

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