SCCM Resource Library-14-Rapid Implementation of Remote Ventilator Monitoring and Control During the COVID-19 Pandemic

Video Transcription

Hello, I'm Dr. Charles Bruin. I'm a cardiac and medical intensivist and emergency room physician at Regents Hospital in Minnesota, United States. I'll be presenting abstract  14 today to you, our rapid implementation of remote control ventilator monitoring during the COVID-19 pandemic. I have no disclosures. During the initial COVID-19 surge, there was a  severe shortage of PPE, staffing, respiratory equipment, but this was especially evident in shortage of intensivists and respiratory therapists. Other institutions had reported  taking the video and display control head from the ventilators and placing it outside the room  by a long connection cable. We felt this method had severe drawbacks and undertook a rapid deployment of a more robust system that would allow complete in-room and remote ventilator  monitoring and operation. Our institution is an urban quaternary referral care center. We have five geographically distributed ICUs, medical, cardiovascular, surgical, burn,  and neurocritical care. Ventilator management is also performed in a 55-bed emergency department.  We use primarily Medtronic Puritan Bennett 980 ventilators. The adapter module and interface  computer were procured and installed on 40 deployed ventilators. Communication was established  between the computer with our hospital-secured Wi-Fi. Medtronic OmniSense software provided the interface control and access could be established to any ventilator from any Windows  computer with secure on-campus access to the hospital network. From initial concept to implementation was approximately 10 days and this was accomplished in late March 2020.  Approval and budgetary appropriation by hospital administration was rapid given the pressing nature of the COVID-19 pandemic. The approximate cost was $1,200 per ventilator.  Close collaboration with Medtronic facilitated the hardware modification and software installation.  In these two photos you can see our standard setup. The photo on the right shows one of our  standard Puritan Bennett 980 ventilators. At the lower part of the ventilator near the support  feed you can see the adapter interface and control computer firmly attached. It would be logged on  to the hospital network by Wi-Fi. On the left you can see our respiratory therapist using a laptop computer logged into the in-room ventilator making adjustment changes.  This is a screen that would be displayed to any logged in user. On the left is an identical version  of the Puritan Bennett 980 display screen showing waveform tracings and appropriate ventilator settings. On the right is a control pad which the user would use to control the  ventilator by mouse input or selection of the scroll wheel or individual buttons.  From this screen the user can perform any action that can be performed on the in-room  ventilator screen such as alarm changes, ventilator setting changes such as respiratory rate, tidal volumes, oxygenation, PEEP, alarm settings, and review of histories.  Several benefits were realized. In-room visits by respiratory therapists and physicians were  reduced approximately 50 percent. That's four to five less visits per patient per day and a reduction of about 50 percent. There was a reduction in the consumption of PPE resources  that would go along with each of those visits. There were fewer staff exposures and this was used mostly during FIO2 and PEEP titrations, spontaneous breathing trials,  addressing ventilator patient dyssynchrony, and alarm management.  Additional benefits were the remote operation allowed collaboration between the intensivist and respiratory therapist on geographically distributed patients. In other words, we were  able to round on patients that were in multiple units at once making ventilator changes. This was  an unanticipated large improvement in efficiency. The savings avoided donning and doffing PPE and  this was especially seen during off hours when there were fewer staff and respiratory therapists  available. No complications or patient adverse events were experienced as a result of this  remote operation. In conclusion, implementation of a remote ventilator operation is feasible,  cost effective, and provides significant benefits including facilitating communication, serving PPE resources, minimizing staff exposures, and maximizing staff efficiency.  Thank you for allowing me to present this. It is an honor. Thank you for all the work you do. Please enjoy the rest of the conference.

Video Summary

Dr. Charles Bruin presented on the rapid implementation of remote control ventilator monitoring during the COVID-19 pandemic. Due to shortages of PPE and staff, their institution deployed a system that allowed for complete in-room and remote monitoring and operation of ventilators. The system used Medtronic Puritan Bennett 980 ventilators with an adapter module and interface computer. It cost approximately $1,200 per ventilator and was installed in 10 days. Benefits included reduced in-room visits, decreased PPE consumption, fewer staff exposures, and improved efficiency. Remote operation allowed for collaboration between intensivists and respiratory therapists. No complications or adverse events were reported. This implementation is feasible, cost-effective, and provides significant benefits.

Asset Subtitle

Crisis Management, Pulmonary, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Charles A. Bruen, MD

Introduction/Hypothesis: During the upsurge of patient admissions o with COVID-19 pneumonia and ARDS requiring mechanical ventilation, both staffing and supply resources were severely limited. Other institutions reported adapting their ventilator systems by removing the head/video display and placing it outside the room connected by an extension cable. We felt this method had several drawbacks, and undertook a rapid deployment of a more robust system which would allow complete in-room and remote ventilator monitoring and operation.

Methods: At our urban tertiary care hospital, ventilator respiratory support is deployed in five geographically separated ICUs (medical, cardiovascular, surgical, neurocritical, burn) and a 55-bed emergency department with the Puritan Bennett 980 Ventilator (Medtronic, Minneapolis, MN). An adaptor module and interface computer were procured and installed on 40 deployed ventilators. Communication was established by hospital secured Wi-Fi. Medtronic OmniSense software provided the interface control. Access could be established to any ventilator from any Microsoft Windows computer with secure access to the hospital network.

Results: From initial concept to implementation was 10 days. Approval and budgetary appropriation (approx. US$1200 per ventilator) by hospital administration was rapid given the pressing nature of the COVID-19 pandemic. Close collaboration with Medtronic facilitated the hardware modification and software installation. Several benefits were found. In-room visits by respiratory therapists and physicians were reduced by 4-5/day/pt., a reduction of about 50%, preventing the consumption of the corresponding amount of PPE resources and staff exposures. The most significant benefits were seen during PEEP titrations, spontaneous breath trials, patient-ventilator dyssynchrony, and allowing collaboration between the intensivist/respiratory therapist on geographically distributed patients. An unanticipated benefit was the time savings avoiding donning/doffing of PPE. No complications or patient adverse events were experienced during or as a result of remote operation.

Conclusions: Implementation of remote ventilator operation is feasible and provides significant benefits, including facilitating communication, saving PPE resources, minimizing exposures, and maximizing staff efficiency.

Meta Tag

Content Type Presentation

Knowledge Area Crisis Management

Knowledge Area Pulmonary

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag COVID-19

Tag Resource Allocation

Tag Ventilation

Year 2021

Keywords

remote control ventilator monitoring

COVID-19 pandemic

PPE shortages

Medtronic Puritan Bennett 980 ventilators

adapter module and interface computer

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