Healthcare Management: News. Views. Education

2 . 2020

Respiratory disasters: technological paradigm of mechanical ventilation as a threat to national security

Andrey V. Ragozin

Abstract

The coronavirus pandemic has shown the critical vulnerability of national health systems to the risk of sudden mass appearance of patients with respiratory failure and the need for mechanical ventilation (IMV). The author sees the reason for this vulnerability in the historically established technological paradigm of IMV, which provides no alternative to conventional positive pressure ventilation (PPV) and its use for all types of patients (both surgical and therapeutic), including in situations of respiratory disasters. However, PPV proved to be ineffective for ventilating COVID-19 patients and has many medical, economic, mass-acqusition, and ethical disadvantages that make this method ineffective in cases of respiratory disasters. On the contrary, negative pressure ventilation (NPV, Iron Lung), which has been superseded from medical practice, is close to the ideal for respiratory therapy in the case of mass admission of patients with a therapeutic profile with respiratory failure due to infectious, chemical or radiation lesions. At the same time, available data on the use of NPV suggest the possibility of improving the results of COVID-19 treatment. As a solution, the author suggests a new technological paradigm of IMV, in which PPV and NPV are not alternative, but complementary methods of a single technological chain of respiratory therapy. It is concluded that the rejection of the view of NPV as an anachronism and the "catch-up" development of this technology will increase the effectiveness of the fight against the COVID-19 pandemic and/or create reserves for the healthcare system in the event of respiratory disasters in the future.

Keywords:COVID-19 pandemic, respiratory disaster, mechanical ventilation, positive pressure ventilation, negative pressure ventilation, acute respiratory distress syndrome

Funding. The study had no sponsor support.

Conflict of interests. The author declare no conflict of interests.

For citation: Ragozin A.V. Respiratory disasters: technological paradigm of mechanical ventilation as a threat to national security. Vestnik VSHOUZ [HEALTHCARE MANAGEMENT: News, Views, Education. Bulletin of VSHOUZ]. 2020; 6 (2): 67-84. DOI: 10.24411/2411-8621-2020-12004 (in Russian)

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