Abstract
Background:
Efforts to address the shortage of mechanical ventilators during the 2020 COVID-19 pandemic are well known. However, little is known of the behind the scenes efforts to provide the supplies, without which these devices would have been inoperable. In the final analysis, availability of these supplies was subject to the fundamental, economic forces of supply and demand. A sluggish production system coupled with an exponential increase in the number of severely ill patients resulted in an imbalance between ventilator related supplies and the unprecedented demand for them. As manufacturers struggled to fill orders many went partially or even completely unfilled. Simultaneously, the federal government replenished its ventilator reserve including circuits further increasing the demand. In addition to the increased volume of patients, demand was influenced by the rapid influx of additional ventilators, the need to filter inspired and expired gasses, and the use of transport ventilators in the ICU. Furthermore, use of transport ventilators in the ICUs necessitated manual ventilation of patients during transport increasing the demand for bag-valve resuscitators and PEEP valves. MGH utilizes 1 primary vendor to order supplies from a variety of manufacturers. We describe a pro-active, multifaceted plan to maintain a constant supply of ventilator-associated consumables for the Respiratory Care Department at the Massachusetts General Hospital for the period March 23 – May 11, 2020.
Methods:
Access strategic reserve to provide an early buffer for diminished receipt of supplies. Alternate use of heated humidifiers, HEPA filters, standard HMEs, and combination HEPA filter/HME without ventilator filters. Identify additional supply chains including acceptable alternative devices, normal third-party supplier and order directly from some manufacturers to promote a steady inflow of supplies.
Results:
We placed 93 orders with 10 vendors for 600 PEEP valves, 1,850 ICU ventilator circuits, 855 transport ventilator circuits, 4,450 HEPA filters, 1,120 HMEs, and 2,800 HEPA/HMEs, to equip 248 ventilators. Frequently we placed 2 orders to the same manufacturer simultaneously utilizing our primary distributer and ordering directly from the manufacturer.
Conclusions:
By employing several humidification and filtering techniques and creative purchasing procedures we maintained enough supplies to ventilate 394 patients utilizing 248 ventilators.
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