Estimates of the demand for mechanical ventilation in the United States during an influenza pandemic.
Identifieur interne : 000673 ( PubMed/Corpus ); précédent : 000672; suivant : 000674Estimates 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. KooninSource :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [ 1537-6591 ] ; 2015.
English descriptors
- KwdEn :
- Disaster Planning (methods), Humans, Influenza A Virus, H7N9 Subtype (pathogenicity), Influenza, Human (epidemiology), Influenza, Human (mortality), Influenza, Human (therapy), Intensive Care Units (supply & distribution), Models, Theoretical, Pandemics, Public Health (methods), Respiration, Artificial (instrumentation), United States (epidemiology), Ventilators, Mechanical (supply & distribution).
- MESH :
- geographic , epidemiology : United States.
- epidemiology : Influenza, Human.
- instrumentation : Respiration, Artificial.
- methods : Disaster Planning, Public Health.
- mortality : Influenza, Human.
- pathogenicity : Influenza A Virus, H7N9 Subtype.
- supply & distribution : Intensive Care Units, Ventilators, Mechanical.
- therapy : Influenza, Human.
- Humans, Models, Theoretical, Pandemics.
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.
DOI: 10.1093/cid/civ089
PubMed: 25878301
Links to Exploration step
pubmed:25878301Le document en format XML
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Meltzer</name><affiliation><nlm:affiliation>Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases.</nlm:affiliation></affiliation></author><author><name sortKey="Patel, Anita" sort="Patel, Anita" uniqKey="Patel A" first="Anita" last="Patel">Anita Patel</name><affiliation><nlm:affiliation>Division of Strategic National Stockpile, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Ajao, Adebola" sort="Ajao, Adebola" uniqKey="Ajao A" first="Adebola" last="Ajao">Adebola Ajao</name><affiliation><nlm:affiliation>Formerly, GAP Solutions Incorporated, Contracted to the Office of the Assistant Secretary for Preparedness and Response.</nlm:affiliation></affiliation></author><author><name sortKey="Nystrom, Scott V" sort="Nystrom, Scott V" uniqKey="Nystrom S" first="Scott V" last="Nystrom">Scott V. Nystrom</name><affiliation><nlm:affiliation>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.</nlm:affiliation></affiliation></author><author><name sortKey="Koonin, Lisa M" sort="Koonin, Lisa M" uniqKey="Koonin L" first="Lisa M" last="Koonin">Lisa M. 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Meltzer</name><affiliation><nlm:affiliation>Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases.</nlm:affiliation></affiliation></author><author><name sortKey="Patel, Anita" sort="Patel, Anita" uniqKey="Patel A" first="Anita" last="Patel">Anita Patel</name><affiliation><nlm:affiliation>Division of Strategic National Stockpile, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Ajao, Adebola" sort="Ajao, Adebola" uniqKey="Ajao A" first="Adebola" last="Ajao">Adebola Ajao</name><affiliation><nlm:affiliation>Formerly, GAP Solutions Incorporated, Contracted to the Office of the Assistant Secretary for Preparedness and Response.</nlm:affiliation></affiliation></author><author><name sortKey="Nystrom, Scott V" sort="Nystrom, Scott V" uniqKey="Nystrom S" first="Scott V" last="Nystrom">Scott V. Nystrom</name><affiliation><nlm:affiliation>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.</nlm:affiliation></affiliation></author><author><name sortKey="Koonin, Lisa M" sort="Koonin, Lisa M" uniqKey="Koonin L" first="Lisa M" last="Koonin">Lisa M. Koonin</name><affiliation><nlm:affiliation>Influenza Coordination Unit, Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</title><idno type="eISSN">1537-6591</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Disaster Planning (methods)</term><term>Humans</term><term>Influenza A Virus, H7N9 Subtype (pathogenicity)</term><term>Influenza, Human (epidemiology)</term><term>Influenza, Human (mortality)</term><term>Influenza, Human (therapy)</term><term>Intensive Care Units (supply & distribution)</term><term>Models, Theoretical</term><term>Pandemics</term><term>Public Health (methods)</term><term>Respiration, Artificial (instrumentation)</term><term>United States (epidemiology)</term><term>Ventilators, Mechanical (supply & distribution)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Respiration, Artificial</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Disaster Planning</term><term>Public Health</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="pathogenicity" xml:lang="en"><term>Influenza A Virus, H7N9 Subtype</term></keywords><keywords scheme="MESH" qualifier="supply & distribution" xml:lang="en"><term>Intensive Care Units</term><term>Ventilators, Mechanical</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Models, Theoretical</term><term>Pandemics</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">25878301</PMID><DateCompleted><Year>2015</Year><Month>07</Month><Day>16</Day></DateCompleted><DateRevised><Year>2018</Year><Month>11</Month><Day>13</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1537-6591</ISSN><JournalIssue CitedMedium="Internet"><Volume>60 Suppl 1</Volume><PubDate><Year>2015</Year><Month>May</Month><Day>01</Day></PubDate></JournalIssue><Title>Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</Title><ISOAbbreviation>Clin. Infect. Dis.</ISOAbbreviation></Journal><ArticleTitle>Estimates of the demand for mechanical ventilation in the United States during an influenza pandemic.</ArticleTitle><Pagination><MedlinePgn>S52-7</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1093/cid/civ089</ELocationID><Abstract><AbstractText>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.</AbstractText><CopyrightInformation>Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. 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Response.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nystrom</LastName><ForeName>Scott V</ForeName><Initials>SV</Initials><AffiliationInfo><Affiliation>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.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Koonin</LastName><ForeName>Lisa M</ForeName><Initials>LM</Initials><AffiliationInfo><Affiliation>Influenza Coordination Unit, Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>CC999999</GrantID><Agency>Intramural CDC HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>T32 GM007752</GrantID><Acronym>GM</Acronym><Agency>NIGMS NIH HHS</Agency><Country>United 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