Nonconventional ventilators during the COVID-19 pandemic: Clinical efficacy, crisis research considerations, and preparedness next steps

In the chaotic early days of the COVID-19 pandemic, many potential shortages loomed large, but none seemed as terrifying and immediate as the potential shortage of mechanical ventilators, and the inability to support the lives of infected individuals who could not adequately breathe on their own. At the time of the initial pandemic surge, the United States had a finite supply of conventional full-function ventilators (i.e., those used for an intubated patient in the ICU) and basic ventilators (i.e., nonconventional ventilators [NCVs] including, portable transport ventilators and noninvasive ventilators), and an additional back-up supply in the National Strategic Stockpile. If and when there was a shortage of full-function conventional ventilators, use of basic ventilators seemed an obvious option. However NCVs, by design, do not provide all the features of full-function ventilators, and models may vary in settings and ability to provide consistent respiratory support in patients with changing pulmonary mechanics. Although initial projections of mechanical ventilator needs—and shortages—fortunately did not materialize nationally, supplies were exhausted in certain hospitals at certain times. The potential and realized ventilator shortages motivate the question: How did patients fare under this particular crisis standard of care? In addition, how does this inform our national preparedness strategy for inevitable future respiratory pandemics?

Ankita Agarwal, George L Anesi