COVID-19 patients on ventilators need sedatives. Hospitals fear they’re running out
As U.S. hospitals continue to see droves of coronavirus patients, a ventilator shortage isn’t the only problem they’re facing.
Hospital workers fear they’ll soon run out of the sedatives and other key drugs needed to use the life-saving machines, as hundreds of patients now depend on them.
A report released by health care services company Vizient last week showed a surge in demand not just for sedatives, but pain medications and paralytic agents as well. All three are essential to treating COVID-19 patients on ventilators, but health care experts warn that demand for the drugs could soon outpace the supply.
Daniel Kistner, a manager for the pharmacy program at Vizient, told NPR it’s like nothing he’s ever seen before.
“We have seen an increase in demand on pharmaceuticals that’s unprecedented,” he added. “We’re not at a rate yet where there’s just no drug, but we are quickly approaching it.”
Kistner noted there’s no overnight fix for the supply problem, considering injectible drugs can take up to three weeks to make. That leaves hospitals little time to prepare as projections show the COVID-19 outbreak is expected to peak in the U.S. in just eight days on April 15, according to University of Washington researchers.
San Francisco General Hospital is one of dozens of medical centers across the country that are running low on key drugs used to treat ailing coronavirus patients. As of April 3, the hospital had 12 patients in the intensive care unit and another nine on ventilators, KNTV reports.
With the growing need for the machines comes an increased demand for the pharmaceuticals required to use them.
“All those medicines, we need more than we’ve ever needed before … we need a huge surge of these,” Erin Fox, a University of Utah adjunct professor who monitors nationwide drug supplies, told the TV station. “So just like — you actually can’t make a ventilator work for a patient unless you have the sedatives and the paralytic agents that you need.”
Why do COVID-19 patients need sedatives?
So why are sedatives and other drugs so necessary?
COVID-19, the disease caused by the coronavirus, can cause severe respiratory illness that causes a patient’s lungs to fill with liquid, making it difficult to breathe. In severe cases, the disease can be life-threatening and ventilators are used to keep patients alive. Through a process called intubation, doctors insert a large tube down into the lungs to help deliver more oxygen to the patient from the ventilator.
“You can imagine if I tried to shove a plastic tube down your throat, it’s a very human reflex not to let someone do that,” Esther Choo, an associate professor of emergency medicine at Oregon Health & Science University, explained in a recent interview with Vox. “So we place people in deep sedation.”
Once the tube is inserted in the trachea, it’s imperative that patients stay sedated. Coronavirus patients can remain on ventilators for weeks at a time, however, making the need for the right medications much more dire.
Paralytic drugs, which help immobilize the body’s skeletal system in patients suffering from acute respiratory distress syndrome, or ARDS, are in short supply. John Balmes, a pulmonologist at the University of California, San Francisco, told KNTV the drugs help ARDS patients “efficiently use the flow of oxygen while ventilators are keeping them alive.”
Phoebe Putney Memorial Hospital in Albany, Georgia, a hot spot for COVID-19, is also facing a shortage of the essential drugs — fentanyl, specifically. Doctors there said they typically see a caseload of 12 to 15 patients needing ventilators; that number has since surged to as many as 46 at a time, according to NPR.
“At present we’re running through anywhere up to 134 bags of fentanyl,” Dr. Shanti Akers, a critical care physician at Phoebe Putney, told NPR. “Pre-COVID that would have lasted us two to three weeks. And now we’re running through that quantity in simply a day.”
The drug shortage remains a looming and unresolved issue, and medical staff are bracing for the worst. Last month, President Donald Trump invoked the wartime Defense Production Act to produce an additional 40,000 ventilators. But Kistner argued that situation isn’t ideal and likened it to “having a car without gas.”
“If you say we need ventilators and not, and the drugs to make them go, we’re going to have a ton of ventilators sitting around not being used,” he warned in an interview with Vox.