Table 5 Issues encountered with the use of anesthesia machines in COVID-19 critically patients and relative proposed solutions
| Problem | Proposed solution |
|---|---|
| Audibility and correct perception of alarms potentially associated with life-threatening AM failures |
• Constant presence of anesthesia providers in the clinical team; • Maximize staff proximity to the workstation. |
|
Condensed water accumulation in the circuit causing obstruction of HMEF or filters Reduced reliability of flow sensors |
• Use of high fresh gas flow (dryer gas mixture); • HME perpendicularly positioned above the endotracheal tube to reduce the backflow of excess moisture into the circuit; • Use of heated breathing circuits, condensers and water traps to limit water accumulation. |
| Endotracheal tube obstruction | • Dedicated endotracheal tube cleaning devices. |
| Frequent disconnection due to filter change and machine self-tests | • Temporary use of a portable ventilator during disconnection to maintain protective ventilation and PEEP settings. |
| Limited functionality for the assessment of respiratory mechanics | • Prioritize the use of newer AMs in more complicated patients considering the possibility to perform measurements of respiratory mechanics (e.g. end-inspiratory and end-expiratory pauses). |