The Aisys control screen was dark, the AC power indicator light was off, but the physiologic monitor was on and functioning. The care team donned PPE, entered the patient’s room and observed that mechanical ventilation had ceased, the extractor fan was off, and the room was very warm. On hospital day 10, an audible alarm sounded at the central station and the SpO 2 was noted to be 45%.
Monitoring was via a central station telemetry network (GE CARESCAPE, GE Healthcare, Waukesha, WI) to which the workstation physiologic monitor had been connected, with high volume audio alarms for abnormal rhythms and bradycardia/tachycardia, and the default low volume audio alarm for low SpO 2. The rooms had no interior or door windows, but indirect viewing was provided via a remote visual patient monitoring system (AvaSys Telesitter, Belmont, MI). Anesthesia workstations (Aisys Carestation CS 2, GE Healthcare, Waukesha, WI) were being used as ventilators in this temporary ICU, managed 24/7 by a group of anesthesiologists. Temporary negative pressure rooms had been created by replacing the exterior window of each room with a hardboard panel that contained a cutout for a HEPA filter/extractor fan exhaust duct (Air Shield 550 HEPA Air Scrubber, AER Industries, Irwindale, CA). Report of the CaseĪ 66-year-old man with a history of noninsulin-dependent diabetes was admitted to a temporary COVID-19 ICU for acute respiratory failure requiring tracheal intubation and mechanical ventilation. This case highlights that novel use of standard equipment is subject to unforeseen problems. We report the case of an anesthesia machine ventilator failure in a COVID-19 patient who was being managed in a windowless negative pressure room in a telemetry unit that had been converted to a temporary COVID-19 ICU.
1 The APSF/ASA document “Guidance on Purposing Anesthesia Machines as ICU Ventilators” includes “Key Points to Consider in Preparing to Use Anesthesia Machines as ICU Ventilators,” which notes that any location with high pressure air and oxygen might be acceptable. With the need for intensive care unit (ICU) beds and ventilators exceeding supply, anesthesia machines were used as ventilators in non-OR locations, an off-label use. The COVID-19 pandemic in New York City during spring 2020 resulted in an unprecedented number of patients requiring mechanical ventilation.
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