Johns Hopkins addresses COVID-19-related oxygen shortages

On Jan. 26, Johns Hopkins Center for Health Security issued a white paper on potential solutions to the COVID-19 oxygen crisis. While there have definitely been shortages of oxygen reported by news outlets, there are a few things that can be done to help avoid this issue from occurring. Of course, to be able to truly understand the importance of the solutions it helps to understand what is driving this issue in the first place.

Last month Johns Hopkins held discussions with frontline clinicians and public health officials in California, Minnesota and New York to determine the causes of oxygen supply shortages. The white paper “Potential Solutions to the COVID-19 Oxygen Crisis in the United States” documents many of those findings and reports the following:

“Oxygen shortages are occurring because a large number of patients require oxygen therapy… [and] medical providers have seen the survival benefits of providing high flow nasal oxygen, rather than mechanical ventilation, to many COVID-19 patients…. high flow oxygen therapy uses roughly five to 10 times the amount of oxygen as a mechanical ventilator. The resulting high flow of oxygen through hospital oxygen systems is causing liquid oxygen vaporizers to freeze over.

“Additionally,… [more] portable oxygen is being used, especially in alternate treatment sites;… the increased use of portable oxygen is contributing to a shortage of oxygen cylinders of all sizes. Timely oxygen delivery to hospitals has also been a problem, and oxygen flow regulators, which are needed for both wall oxygen and portable oxygen tanks, are in critically short supply.”

In order to address these issues facilities can follow these best practices and lessons learned from other hospitals:

1. Meet with and stress the importance of the relationship with the medical gas distributor that delivers this vital pharmaceutical to your facility. A mutual understanding of what the facility needs are and what the distributor can do by all parties will help to assure that these needs are met. Also, if there are potential gaps, plans can be established prior to an emergency arising.
2. Make monitoring and managing the bulk liquid oxygen system a priority. Tracking the daily use of liquid oxygen will help in assuring ample supply is always on hand. Routine inspection of the system will allow staff to properly address potential freezing of the vaporizers, eliminating this issue from hindering the flow of oxygen.
3. Make monitoring and managing the facility’s oxygen cylinders a priority. Again, thoroughly tracking the use of these cylinders will help assure that they are quickly refilled and ready for use instead of being stored as empty cylinders.
4. Use of oxygen concentrators instead of medical oxygen when possible will help to reduce the demand on the system.
5. Instruct clinical staff on how to use a lower saturation threshold when appropriate to help conserve oxygen.
6. If the demand does exceed the capability of the bulk oxygen system, facilities could consider adding secondary oxygen supply lines that bypass the existing oxygen delivery systems, allowing more oxygen to flow without freezing the vaporizers. These secondary systems can connect directly to trucks or tanks carrying bulk liquid oxygen.
7. For alternate care sites that are within the facility — such as the conversion of conference rooms into intensive care unit space — the use of temporary manifold systems instead of connecting the system to the existing bulk oxygen system can divert this load off the system.

Regarding any of these options ASHE recommends first discussing these with a multidisciplinary team to assure that all perspectives are considered. It is also imperative that local authorities having jurisdiction are consulted and included in the discussions.

For additional information, read the John’s Hopkins white paper “Potential Solutions to the COVID-19 Oxygen Crisis in the United States.”