VentilatorManagement-EID-June-2017

Commentary:  VentStockpilingCommentary-EID-June_2017

DOI: http://dx.doi.org/10.3201/eid2306.161417

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No. 6, June 2017

“Diligent preparation and effective countermeasures are critical to mitigating future influenza pandemics. The 1918 influenza pandemic, the most severe in recent history, resulted in ≈50 million deaths globally, of which nearly 675,000 occurred in the United States (1). The 1957 and 2009 pandemics were less severe, causing ≈70,000 and 9,000–18,000 US deaths, respectively (1).

US Department of Health and Human Services (HHS) estimated that 865,000 US residents would be hospitalized during a moderate pandemic (as in 1957 and 1968) and 9.9 million during a severe pandemic (as in 1918).

When severe influenza outbreaks cause high rates of hospitalization, a surge of medical resources is required, including critical care supplies, antiviral medications, and personal protection equipment. Given uncertainty in the timing and severity of the next pandemic, as well as the time required to manufacture medical countermeasures, stockpiling is central to influenza preparedness (3). However, difficulty in forecasting and limited public health budgets often constrain decisions about sizes, locations, and deployment of such stockpiles. Mechanical ventilators are essential for treating influenza patients in severe acute respiratory failure. Substantial concern exists that intensive care units (ICUs) might have insufficient resources to treat all persons requiring ventilator support. Prior studies argue that current capacities are insufficient to handle even moderately severe pandemics and that sentinel reporting and model-based decision-making are critical for managing limited resources (4–6). For this reason, the United States has stockpiled mechanical ventilators in strategically located warehouses for use in public health emergencies, such as an influenza pandemic. The Centers for Disease Control and Prevention (CDC) manages this Strategic National Stockpile (SNS) and has plans for rapid deployment to states during critical events (7).

However, SNS ventilators might not suffice to meet demand during a severe public health emergency. In 2002, the SNS included ≈4,400 ventilators (8,9), and 4,500 SNS ventilators were added during 2009 and 2010. The American Association for Respiratory Care suggested the SNS inventory should increase to at least 11,000–16,000 ventilators in preparation for a severe influenza pandemic (10). The American Association for Respiratory Care and CDC (11) provide training on 3 types of SNS ventilators—LP10 (Covidien, Boulder, CO, USA); LTV1200 (CareFusion, Yorba Linda, CA, USA); and Uni-vent Eagle 754 (Impact Instrumentation, Inc., West Caldwell, NJ, USA)—to ensure proper use nationwide. In addition to the nationally held SNS, some US states maintain their own stockpiles. Successful deployment of central ventilator stockpiles, whether federal or state, requires rapid distribution to healthcare facilities with patients in need, along with adequate bed space, requisite supplies, and trained personnel Robust methods for sizing and locating ventilator stockpiles have not yet been developed (15). Wilgis (16) discussed the relative merits of central stockpiling of ventilators to be distributed during an emergency versus distributing ventilators to hospitals a priori. Centralized stockpiles benefit from better inventory tracking, more timely repairs, and superior allocation of a limited resource, but hospital-based supplies facilitate staff training, enable immediate use, and avoid the cost and logistical challenges of central storage and deployment. …..”