National Estimates of Increase in US Mechanical Ventilator Supply During the COVID-19 Pandemic | Critical Care Medicine | JAMA Network Open | JAMA Network
[Skip to Navigation]
Sign In
Figure.  Total Adult Mechanical Ventilators in US Acute Care Hospitals per 100 000 Residents
Total Adult Mechanical Ventilators in US Acute Care Hospitals per 100 000 Residents

Data are from 2020.

Table.  National Estimates of Increase in Adult Mechanical Ventilators in the US by Hospital Characteristics During the COVID-19 Pandemic, 2020a
National Estimates of Increase in Adult Mechanical Ventilators in the US by Hospital Characteristics During the COVID-19 Pandemic, 2020a
1.
Rubinson  L, Vaughn  F, Nelson  S,  et al.  Mechanical ventilators in US acute care hospitals.   Disaster Med Public Health Prep. 2010;4(3):199-206. doi:10.1001/dmp.2010.18 PubMedGoogle ScholarCrossref
2.
Branson  R, Dichter  JR, Feldman  H,  et al.  The US Strategic National Stockpile ventilators in coronavirus disease 2019: a comparison of functionality and analysis regarding the emergency purchase of 200 000 devices.   Chest. 2021;159(2):634-652. doi:10.1016/j.chest.2020.09.085 PubMedGoogle ScholarCrossref
3.
HealthData.gov. COVID-19 reported patient impact and hospital capacity by state. Updated June 27, 2022. Accessed January 19, 2022. https://healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh
4.
US Census Bureau. Historical population density data (1910-2020). Updated October 8, 2021. Accessed December 23, 2021. https://www.census.gov/data/tables/time-series/dec/density-data-text.html
5.
Keohane  LM.  Expanding ventilator capacity—the need for state and regional planning.   JAMA Health Forum. 2020;1(4):e200391. doi:10.1001/jamahealthforum.2020.0391Google ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Views 1,227
    Citations 0
    Research Letter
    Critical Care Medicine
    August 2, 2022

    National Estimates of Increase in US Mechanical Ventilator Supply During the COVID-19 Pandemic

    Author Affiliations
    • 1Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
    • 2Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
    • 3Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
    • 4Brown University School of Public Health, Providence, Rhode Island
    JAMA Netw Open. 2022;5(8):e2224853. doi:10.1001/jamanetworkopen.2022.24853
    Introduction

    Despite the unprecedented demand for mechanical ventilators in the US during the COVID-19 pandemic, the last survey of US hospitals occurred in 2010 and estimated approximately 62 000 full-featured ventilators.1 To meet the demand for mechanical ventilation, the federal government invoked the Defense Production Act to partner with manufacturers to purchase as many as 200 000 ventilators of varying functionality across production phases for the US Strategic National Stockpile.2 Many hospitals also purchased additional full-featured ventilators during the pandemic. Therefore, we performed an updated assessment of current ventilators in use at US hospitals to aid with current and future pandemic preparedness and to determine whether any change was correlated with COVID-19 burden.

    Methods

    In this cross-sectional study, we used new survey data from the 2020 American Hospital Association (AHA) Annual Survey to estimate the increase in mechanical ventilator supply. The ventilator questions were developed in response to the COVID-19 pandemic and were fielded for the first time in 2020. Data from the AHA were merged with US Census data and COVID-19 burden data from the Department of Health and Human Services for 2020 to correspond with the AHA survey year.3 We assessed whether the increase in adult and pediatric and neonatal mechanical ventilators in US hospitals varied across hospital structural features, region, and safety-net status using a multivariable regression model weighted by likelihood of survey response to create national-level estimates. We then created a map of current adult mechanical ventilators per 100 000 residents using the state-level population estimates from the 2020 US Census.4 A state-level analysis used Pearson statistics to assess the correlation between increase in ventilators per capita and COVID-19 intensive care unit (ICU) admissions per capita. Analyses were performed with SAS, version 9.4M7 (SAS Institute Inc). Two-sided P < .05 indicated statistical significance. This study was deemed exempt from review by the institutional review board of the Harvard T. H. Chan School of Public Health owing to the use of deidentified hospital-level data. We followed the STROBE reporting guideline.

    Results

    In total, 2712 of 4609 US adult acute care hospitals responded to the survey (response rate, 58.8%). Responding hospitals were more likely to be large (367 [13.5%] vs 111 [5.9%]; P < .001), major teaching hospitals (207 [7.6%] vs 44 [2.3%]; P < .001), and not for profit (1887 [69.6%] vs 979 [51.6%]; P < .001). Of hospitals providing pediatric care, 1103 of 1397 responded (response rate, 79.0%). The multivariate adjusted relative increase in adult mechanical ventilators during the public health emergency in 2020 was 31.5% (95% CI, 22.4%-41.3%; P < .001) (Table). The statistically significant increase in adult mechanical ventilators during the COVID-19 pandemic did not vary across hospital characteristics (Table). The increase in pediatric and neonatal mechanical ventilators was 15.6% (95% CI, 1.6%-31.5%; P = .03).

    South Carolina, Alaska, Nevada, Idaho, and Mississippi had the lowest per capita supply of adult mechanical ventilators, whereas New York, Louisiana, Arkansas, North Dakota, and Washington, DC, had the highest per capita supply (Figure). The state-level increase in ventilators during the pandemic was not correlated with the state-level ICU burden (r = 0.13; P = .37).

    Discussion

    This cross-sectional study found a substantial increase in adult and pediatric mechanical ventilators reported by acute care hospitals in 2020 compared with 2019. Study limitations include possible response bias. The AHA Annual Survey did not differentiate between ventilator functionality, changes in numbers of anesthesia ventilators, or transport, backup, or rental ventilators, nor did it account for temporary ventilator allocation coordinated through state public health departments or the Dynamic Ventilator Reserve.5 The increase in ventilators that were deployed in hospitals was not correlated with the state’s COVID-19 ICU burden, but this finding may not account for more dynamic shifts in ventilator stock across hospitals during waves of the pandemic. For both the current COVID-19 pandemic as well as future pandemic preparedness, these findings may help guide policy makers in deploying ventilators to states with the most urgent need of ventilators.

    Back to top
    Article Information

    Accepted for Publication: June 5, 2022.

    Published: August 2, 2022. doi:10.1001/jamanetworkopen.2022.24853

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Tsai TC et al. JAMA Network Open.

    Corresponding Author: Thomas C. Tsai, MD, MPH, Department of Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (ttsai@bwh.harvard.edu).

    Author Contributions: Dr Tsai had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Tsai, Jha, Figueroa.

    Acquisition, analysis, or interpretation of data: Tsai, Orav, Figueroa.

    Drafting of the manuscript: Tsai.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Tsai, Orav.

    Obtained funding: Tsai.

    Administrative, technical, or material support: Figueroa.

    Supervision: Jha, Figueroa.

    Conflict of Interest Disclosures: Dr Tsai reported receiving grants from the Massachusetts Life Sciences Center and Massachusetts Consortium on Pathogen Readiness during the conduct of the study and grants from the Commonwealth Fund and Arnold Ventures outside the submitted work. Dr Figueroa reported receiving grants from the Massachusetts Consortium on Pathogen Readiness during the conduct of the study and grants from the Commonwealth Fund, the Robert Wood Johnson Foundation, the National Institute of Aging, the Episcopal Health Foundation, and Arnold Ventures outside the submitted work. No other disclosures were reported.

    Funding/Support: This study was supported by a grant from the Massachusetts Consortium on Pathogen Readiness underwritten by the Massachusetts Life Sciences Center.

    Role of the Funder/Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Disclaimer: This manuscript was written and submitted for publication prior to the authors' government service. Any views or opinions expressed are those of those authors and are not made on behalf of the federal government.

    References
    1.
    Rubinson  L, Vaughn  F, Nelson  S,  et al.  Mechanical ventilators in US acute care hospitals.   Disaster Med Public Health Prep. 2010;4(3):199-206. doi:10.1001/dmp.2010.18 PubMedGoogle ScholarCrossref
    2.
    Branson  R, Dichter  JR, Feldman  H,  et al.  The US Strategic National Stockpile ventilators in coronavirus disease 2019: a comparison of functionality and analysis regarding the emergency purchase of 200 000 devices.   Chest. 2021;159(2):634-652. doi:10.1016/j.chest.2020.09.085 PubMedGoogle ScholarCrossref
    3.
    HealthData.gov. COVID-19 reported patient impact and hospital capacity by state. Updated June 27, 2022. Accessed January 19, 2022. https://healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh
    4.
    US Census Bureau. Historical population density data (1910-2020). Updated October 8, 2021. Accessed December 23, 2021. https://www.census.gov/data/tables/time-series/dec/density-data-text.html
    5.
    Keohane  LM.  Expanding ventilator capacity—the need for state and regional planning.   JAMA Health Forum. 2020;1(4):e200391. doi:10.1001/jamahealthforum.2020.0391Google ScholarCrossref
    ×