For researchers used to working in a laboratory, finding ways to continue their research from home has created unexpected innovations. This is the story of how a newly developed creative solution to allow the Medtronic ventilator team to continue their research from home became the answer to an urgent clinical need. Working together with clinicians against the backdrop of the public health emergency declared by HHS as a result of the COVID-19 pandemic, their solution went from the laboratory to clinical implementation in less than two weeks. As a result, clinicians could access Puritan Bennett™ 980 ventilators from outside the patient room — effectively reducing clinician exposure to the coronavirus and dramatically changing care during the pandemic.
When we think back to the beginning of the pandemic, it can be hard to remember how little we knew and how ill-prepared we all were. The sudden influx of patients. The lack of personal protective equipment (PPE). The need to effectively treat a new, highly infectious disease without known protocols. All of this led to an intense fear for healthcare workers on the front line.
Until many of these unknowns could be figured out, one thing was clear — clinicians needed to reduce their exposure to the coronavirus. It was crucially important that they could continue to treat patients without becoming patients themselves. But treating patients on ventilators created a hazard.
Airborne pathogens are inevitably released when patients exhale, even when some filtration methods are present. Putting on proper PPE could easily take over ten minutes per patient, with another ten minutes to remove PPE and perform hand hygiene/infection prevention. And when PPE was in short supply and more and more patients were being admitted, it’s easy to see how this wasn’t going to be sustainable.
For these infectious patients, the sensible way to reduce exposure was to limit the number of times clinicians entered the room. But how could they do this when coronavirus patients need constant surveillance and could not go unattended for any extended period of time? That’s where the idea of remote access came in.
Experiencing this dilemma, several hospitals with Puritan Bennett™ 980 ventilators reached out to Medtronic, wondering if there was a way to access and control their Puritan Bennett™ 980 ventilators remotely.
Concurrently, the Medtronic offices had shut down, and all employees were required to work from home. In order to continue their research, the Puritan Bennett™ 980 ventilator R&D team had been working on a way to access the ventilators in their laboratory remotely. Their side project quickly became an urgent priority.
In just 10 days of around-the-clock work, the Medtronic R&D team created a solution: Puritan Bennett™ remote control. This new additive software feature enables clinicians to remotely view and adjust Puritan Bennett™ 980 ventilator settings outside of a patient’s room using a connected device.
In order to get this feature into the hands of clinicians, it needed to be tested through a pilot program. Participating hospitals in Minnesota, Illinois, Massachusetts, Alabama, and Tennessee worked with Medtronic to test its clinical efficiency.
Each facility had Puritan Bennett™ remote control for several weeks. Multiple benefits were found that not only helped with exposure issues, but greatly improved workflow challenges. In-room visits by respiratory therapists and physicians were reduced by 4-5 visits per day per patient at Regions Hospital.†,1 “For one COVID-19 patient on a ventilator for two weeks, it eliminates about 65 in-room visits,” Kelly Sullivan, supervisor of respiratory care services at Regions Hospital said. “It's reduced the number of times they're going in and out of rooms by nearly 50%.” This significantly reduced PPE requirements and staff exposure.
This solution allowed for remote collaboration opportunities between intensivists and respiratory therapists, as well as helped with PEEP titrations, spontaneous breath trials, and patient-ventilator dyssynchrony issues.1 “It's also a big advantage to our patients where we can closely monitor the ventilators [from outside their room] and make very quick changes without having to take the additional time to gown up and go in and out of the patients' rooms," Sullivan said. Patients may be able to get more rest without as many check-ins, and alarm management can be dealt with remotely.
The anxiety around exposure can create a lot of hesitancy, but this solution gives clinicians more freedom to focus on patient care. No complications or patient adverse events were experienced during or as a result of remote operation during this pilot program.1
Puritan Bennett™ remote control was made available in May 2020, under Enforcement Discretion from the FDA during the Public Health Emergency announced by HHS in response to the COVID-19 pandemic. It has been deployed in the United States to Puritan Bennett™ 980 ventilator customers.
To install Puritan Bennett™ remote control, there is a software component and a hardware component. The software can be downloaded onto the ventilator’s interface with an encryption code obtained from Medtronic. The hardware component is a connectivity box that is hardwired to the ventilator with an HDMI and ethernet cable. This connectivity box enables secure access to a Wi-Fi-enabled PC or tablet via the hospital’s wireless network.
To download Puritan Bennett™ remote control for your ventilators, contact your Medtronic rep who can help you through the process.
† These results were isolated experiences. Other hospitals may not experience the same results, depending on their patient base and specific protocols.
1. Bruen C, Valdivia D, Nahum A, Sullivan K. Rapid Implementation of Remote Ventilator Monitoring and Control During the COVID-19 Pandemic. Critical Care Medicine. 2021;49(1):7. doi: 10.1097/01.ccm.0000726084.72737.a2
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