Should Transport Ventilators Be Used in Times of Crisis? The Use of Emergency Authorized Nonconventional Ventilators Is Associated With Mortality Among Patients With COVID-19 Acute Respiratory Distress Syndrome

Vikram B Gondhalekar; Amir Gandomi; Sarah L Gilman; Negin Hajizadeh; Zubair M Hasan; Matthew A Bank; Daniel M Rolston; Allison Cohen; Timmy Li; Mitsuaki Nishikimi; Mangala Narasimhan; Lance Becker; Daniel Jafari

doi:10.1097/CCM.0000000000006252

Should Transport Ventilators Be Used in Times of Crisis? The Use of Emergency Authorized Nonconventional Ventilators Is Associated With Mortality Among Patients With COVID-19 Acute Respiratory Distress Syndrome

Crit Care Med. 2024 Apr 2. doi: 10.1097/CCM.0000000000006252. Online ahead of print.

Authors

Vikram B Gondhalekar¹, Amir Gandomi^{2

3}, Sarah L Gilman¹, Negin Hajizadeh⁴, Zubair M Hasan⁴, Matthew A Bank⁵, Daniel M Rolston¹, Allison Cohen¹, Timmy Li¹, Mitsuaki Nishikimi^{6

7}, Mangala Narasimhan⁴, Lance Becker^{1

7}, Daniel Jafari^{1

8}

Affiliations

¹ Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY.
² Department of Information Systems and Business Analytics, Frank G. Zarb School of Business, Hofstra University, Manhasset, NY.
³ Institute of Health System Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY.
⁴ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY.
⁵ Division of Acute Care Surgery, Department of Surgery, South Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Bayshore, NY.
⁶ Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁷ Laboratory of Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY.
⁸ Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY.

PMID: 38563609
DOI: 10.1097/CCM.0000000000006252

Abstract

Objectives: Nonconventional ventilators (NCVs), defined here as transport ventilators and certain noninvasive positive pressure devices, were used extensively as crisis-time ventilators for intubated patients with COVID-19. We assessed whether there was an association between the use of NCV and higher mortality, independent of other factors.

Design: This is a multicenter retrospective observational study.

Setting: The sample was recruited from a single healthcare system in New York. The recruitment period spanned from March 1, 2020, to April 30, 2020.

Patients: The sample includes patients who were intubated for COVID-19 acute respiratory distress syndrome (ARDS).

Interventions: None.

Measurements and main results: The primary outcome was 28-day in-hospital mortality. Multivariable logistic regression was used to derive the odds of mortality among patients managed exclusively with NCV throughout their ventilation period compared with the remainder of the sample while adjusting for other factors. A secondary analysis was also done, in which the mortality of a subset of the sample exclusively ventilated with NCV was compared with that of a propensity score-matched subset of the control group. Exclusive use of NCV was associated with a higher 28-day in-hospital mortality while adjusting for confounders in the regression analysis (odds ratio, 1.41; 95% CI [1.07-1.86]). In the propensity score matching analysis, the mortality of patients exclusively ventilated with NCV was 68.9%, and that of the control was 60.7% (p = 0.02).

Conclusions: Use of NCV was associated with increased mortality among patients with COVID-19 ARDS. More lives may be saved during future ventilator shortages if more full-feature ICU ventilators, rather than NCVs, are reserved in national and local stockpiles.