Non-Invasive Ventilators Offer Life-Saving Treatment for Less Severe COVID-19 Patients

New clinical evidence produced in recent weeks has shown the benefits of non-invasive ventilators for use in less severe cases of COVID-19-related respiratory problems, which constitute the majority of cases nationwide. In a series of white papers, published evidence, and case studies from both China and Italy, experts say many coronavirus patients with less-severe respiratory distress could benefit from non-invasive ventilation therapy, thus freeing more invasive ventilation devices for the most critically ill patients nationwide. 
 
“This could be a game changer in the race to get as many ventilators in the hospitals as we possibly can,” said Scott Whitaker, President and CEO of AdvaMed. “A large majority of COVID patients could benefit from these respiratory devices, easing pressure on our critical care system in hospitals and offering another lifesaving option for tens of thousands of people suffering from respiratory problems.”
 
According to the Centers for Disease Control and Prevention (CDC), patients with mild symptoms of COVID-19 may not initially require hospitalization; however, their symptoms could worsen and require oxygen supplementation, which can be delivered through non-invasive ventilation (NIV). NIV is a form of mechanical ventilation where air is delivered to the patient through a mask or mouthpiece. Invasive ventilation is used when sufficient ventilation cannot be achieved using non-invasive methods, so oxygen is delivered through a tube inserted into the trachea either through intubation or tracheotomy. As governments and health administrations around the world respond to the global demand spike for ventilators, many have now issued guidance documents on the use of bilevel or BiPAP devices that deliver NIV in patients with confirmed or suspected COVID-19.
 
“There is an increasing amount of clinical guidance coming out of China, Europe, and the U.S. that positions non-invasive ventilation and invasive ventilation as appropriate, along the spectrum of patient presentation and care,” said ResMed Chief Medical Officer Carlos M. Nunez, M.D. ResMed is one of seven AdvaMed member respiratory manufacturers. “These limited numbers of invasive ventilators can be reserved for the most severe cases by using non-invasive devices to care for those with less acute respiratory symptoms and findings.” 
 
“With the extraordinary demand for ventilators, both for immediate needs and for future pandemic planning, our industry’s increased production and delivery of non-invasive ventilators is already helping to match available supply with the clinical needs of patients,” said Hillrom President and CEO John Groetelaars, another AdvaMed member company. “This form of respiratory therapy is ideal for treating patients with mild to moderate respiratory distress across various acute care settings, including the emergency department, med-surg and post-ventilator weaning support.”
 
Wherever hospitals’ capacity and available equipment is insufficient to meet demand, it’s important to support as many patients as are clinically appropriate on NIV devices. The U.S National Academy of Medicine indicated that the use of NIV therapy could be a way to forestall the need for intubation and reduce days on a ventilator. As it is with all clinical decisions, providers considering NIV therapy for COVID-19 patients must ensure that the appropriate design mitigations are in place to minimize spread of the disease. Recommendations from the WHO and the CDC include using negative-pressure isolation rooms for patients, and gloves, gowns and masks for caregivers.
 
A survey of AdvaMed ventilator manufacturers recently found the member companies combined could produce, on average, 60,000 NIV devices per week by the middle of the second quarter. This estimate represents an increase from approximately 14,000 per week manufactured presently, due in large part to the less complex design of the non-invasive construct.