Estimates of the Demand for Mechanical Ventilation in the United States During an Influenza Pandemic
Identifieur interne : 000389 ( Pmc/Checkpoint ); précédent : 000388; suivant : 000390Estimates of the Demand for Mechanical Ventilation in the United States During an Influenza Pandemic
Auteurs : Martin I. Meltzer ; Anita Patel ; Adebola Ajao ; Scott V. Nystrom ; Lisa M. Koonin [Géorgie (pays)]Source :
- Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America [ 1058-4838 ] ; 2015.
Abstract
An outbreak in China in April 2013 of human illnesses due to avian influenza A(H7N9) virus provided reason for US public health officials to revisit existing national pandemic response plans. We built a spreadsheet model to examine the potential demand for invasive mechanical ventilation (excluding “rescue therapy” ventilation). We considered scenarios of either 20% or 30% gross influenza clinical attack rate (CAR), with a “low severity” scenario with case fatality rates (CFR) of 0.05%–0.1%, or a “high severity” scenario (CFR: 0.25%–0.5%). We used rates-of-influenza-related illness to calculate the numbers of potential clinical cases, hospitalizations, admissions to intensive care units, and need for mechanical ventilation. We assumed 10 days ventilator use per ventilated patient, 13% of total ventilator demand will occur at peak, and a 33.7% weighted average mortality risk while on a ventilator. At peak, for a 20% CAR, low severity scenario, an additional 7000 to 11 000 ventilators will be needed, averting a pandemic total of 35 000 to 55 000 deaths. A 30% CAR, high severity scenario, will need approximately 35 000 to 60 500 additional ventilators, averting a pandemic total 178 000 to 308 000 deaths. Estimates of deaths averted may not be realized because successful ventilation also depends on sufficient numbers of suitably trained staff, needed supplies (eg, drugs, reliable oxygen sources, suction apparatus, circuits, and monitoring equipment) and timely ability to match access to ventilators with critically ill cases. There is a clear challenge to plan and prepare to meet demands for mechanical ventilators for a future severe pandemic.
Url:
DOI: 10.1093/cid/civ089
PubMed: 25878301
PubMed Central: 4603361
Affiliations:
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<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<p>An outbreak in China in April 2013 of human illnesses due to avian influenza A(H7N9)
virus provided reason for US public health officials to revisit existing national pandemic
response plans. We built a spreadsheet model to examine the potential demand for invasive
mechanical ventilation (excluding “rescue therapy” ventilation). We considered scenarios
of either 20% or 30% gross influenza clinical attack rate (CAR), with a “low severity”
scenario with case fatality rates (CFR) of 0.05%–0.1%, or a “high severity” scenario (CFR:
0.25%–0.5%). We used rates-of-influenza-related illness to calculate the numbers of
potential clinical cases, hospitalizations, admissions to intensive care units, and need
for mechanical ventilation. We assumed 10 days ventilator use per ventilated patient, 13%
of total ventilator demand will occur at peak, and a 33.7% weighted average mortality risk
while on a ventilator. At peak, for a 20% CAR, low severity scenario, an additional 7000
to 11 000 ventilators will be needed, averting a pandemic total of 35 000 to 55 000
deaths. A 30% CAR, high severity scenario, will need approximately 35 000 to 60 500
additional ventilators, averting a pandemic total 178 000 to 308 000 deaths. Estimates of
deaths averted may not be realized because successful ventilation also depends on
sufficient numbers of suitably trained staff, needed supplies (eg, drugs, reliable oxygen
sources, suction apparatus, circuits, and monitoring equipment) and timely ability to
match access to ventilators with critically ill cases. There is a clear challenge to plan
and prepare to meet demands for mechanical ventilators for a future severe pandemic.</p>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">Clin. Infect. Dis</journal-id>
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<article-id pub-id-type="doi">10.1093/cid/civ089</article-id>
<article-id pub-id-type="publisher-id">civ089</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Cdc Modeling Efforts in Response to a Potential Public Health Emergency: Influenza A (H7N9) as an Example</subject>
</subj-group>
</article-categories>
<title-group><article-title>Estimates of the Demand for Mechanical Ventilation in the United States
During an Influenza Pandemic</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Meltzer</surname>
<given-names>Martin I.</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<pmc-comment>qzm4@cdc.gov </pmc-comment>
<xref ref-type="corresp" rid="d721550e150"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Patel</surname>
<given-names>Anita</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ajao</surname>
<given-names>Adebola</given-names>
</name>
<xref ref-type="aff" rid="af3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nystrom</surname>
<given-names>Scott V.</given-names>
</name>
<xref ref-type="aff" rid="af4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Koonin</surname>
<given-names>Lisa M.</given-names>
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<xref ref-type="aff" rid="af5">5</xref>
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<aff id="af1"><label>1</label>
<addr-line>Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases</addr-line>
</aff>
<aff id="af2"><label>2</label>
<addr-line>Division of Strategic National Stockpile, Office of Public Health Preparedness and Response</addr-line>
,<institution>Centers for Disease Control and Prevention, Atlanta, Georgia</institution>
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<aff id="af3"><label>3</label>
<addr-line>Formerly, GAP Solutions Incorporated, Contracted to the Office of the Assistant Secretary for Preparedness and Response</addr-line>
</aff>
<aff id="af4"><label>4</label>
<addr-line>Division of Medical Countermeasure Strategy and Requirements, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, D.C.</addr-line>
</aff>
<aff id="af5"><label>5</label>
<addr-line>Influenza Coordination Unit, Office of Infectious Diseases</addr-line>
,<institution>Centers for Disease Control and Prevention</institution>
,<addr-line>Atlanta, Georgia</addr-line>
</aff>
<author-notes><corresp id="d721550e150">Correspondence: Martin I. Meltzer, PhD, MS C-18, Centers for
Disease Control and Prevention (CDC), 1600 Clifton Rd, Atlanta, GA 30333 (<email>qzm4@cdc.gov</email>
).</corresp>
</author-notes>
<pub-date pub-type="ppub"><day>01</day>
<month>5</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub" iso-8601-date="2015-04-10"><day>10</day>
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<volume>60</volume>
<issue>Suppl 1</issue>
<issue-title>CDC Modeling Efforts in Response to a Potential Public Health Emergency:
Influenza A(H7N9) as an Example</issue-title>
<fpage>S52</fpage>
<lpage>S57</lpage>
<permissions><copyright-statement>Published by Oxford University Press on behalf of the Infectious
Diseases Society of America 2015. This work is written by (a) US Government employee(s)
and is in the public domain in the US</copyright-statement>
<copyright-year>2015</copyright-year>
</permissions>
<self-uri xlink:href="civ089.pdf"></self-uri>
<abstract><title>Abstract</title>
<p>An outbreak in China in April 2013 of human illnesses due to avian influenza A(H7N9)
virus provided reason for US public health officials to revisit existing national pandemic
response plans. We built a spreadsheet model to examine the potential demand for invasive
mechanical ventilation (excluding “rescue therapy” ventilation). We considered scenarios
of either 20% or 30% gross influenza clinical attack rate (CAR), with a “low severity”
scenario with case fatality rates (CFR) of 0.05%–0.1%, or a “high severity” scenario (CFR:
0.25%–0.5%). We used rates-of-influenza-related illness to calculate the numbers of
potential clinical cases, hospitalizations, admissions to intensive care units, and need
for mechanical ventilation. We assumed 10 days ventilator use per ventilated patient, 13%
of total ventilator demand will occur at peak, and a 33.7% weighted average mortality risk
while on a ventilator. At peak, for a 20% CAR, low severity scenario, an additional 7000
to 11 000 ventilators will be needed, averting a pandemic total of 35 000 to 55 000
deaths. A 30% CAR, high severity scenario, will need approximately 35 000 to 60 500
additional ventilators, averting a pandemic total 178 000 to 308 000 deaths. Estimates of
deaths averted may not be realized because successful ventilation also depends on
sufficient numbers of suitably trained staff, needed supplies (eg, drugs, reliable oxygen
sources, suction apparatus, circuits, and monitoring equipment) and timely ability to
match access to ventilators with critically ill cases. There is a clear challenge to plan
and prepare to meet demands for mechanical ventilators for a future severe pandemic.</p>
</abstract>
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<affiliations><list><country><li>Géorgie (pays)</li>
</country>
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<tree><noCountry><name sortKey="Ajao, Adebola" sort="Ajao, Adebola" uniqKey="Ajao A" first="Adebola" last="Ajao">Adebola Ajao</name>
<name sortKey="Meltzer, Martin I" sort="Meltzer, Martin I" uniqKey="Meltzer M" first="Martin I." last="Meltzer">Martin I. Meltzer</name>
<name sortKey="Nystrom, Scott V" sort="Nystrom, Scott V" uniqKey="Nystrom S" first="Scott V." last="Nystrom">Scott V. Nystrom</name>
<name sortKey="Patel, Anita" sort="Patel, Anita" uniqKey="Patel A" first="Anita" last="Patel">Anita Patel</name>
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<country name="Géorgie (pays)"><noRegion><name sortKey="Koonin, Lisa M" sort="Koonin, Lisa M" uniqKey="Koonin L" first="Lisa M." last="Koonin">Lisa M. Koonin</name>
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