Page 624 - Clinical Application of Mechanical Ventilation

590 Chapter 18

estimated more than 215,000 were killed and 300,000 injured as a result of the
Victims of primary blast
injury to the lungs often earthquake (Ryan, 2010). Casualties caused by man are common in prolonged
require mechanical ventila- and large-scale wars throughout history. In World War II, estimates of total deaths
tion, fluid management, and
supportive care. range from 50 million to 70 million. Estimated civilian casualties range from 40 to
52 million, including 13 to 20 million from war-related disease and famine. Total
military casualties ranged from 22 to 25 million, including deaths in captivity of
about 5 million prisoners of war (Roberts, 2011; Wikipedia, 2011). On a smaller
scale but with equal devastation, the simultaneous bombing of four commuter trains
in Madrid is an example of a man-made mass casualty incident. The bombings on
March 11, 2004, killed 177 people and injured more than 2,000. Many of these
victims suffered primary (and compressive) blast injury to the lungs and required
mechanical ventilation, fluid management, and supportive care (Hunt, 2010).
Nerve agents used in
the war or terrorism acts are National and international events increase the utilization of health care for those
acetylcholinesterase inhibitors who have been exposed to chemical agents such as nerve agents, blood agents, chok-
that lead to accumulation of
acetylcholine at the musca- ing agents, riot-control, and paralyzing agents (e.g., Moscow hostage crisis, October
rinic and nicotinic receptors 28, 2002). Among these agents, nerve agents often require mechanical ventilation.
throughout the body. A
sudden surge of acetylcholine Nerve agents are acetylcholinesterase inhibitors that lead to an accumulation of ace-
may quickly induce loss of
consciousness, seizures, flac- tylcholine at the muscarinic and nicotinic receptors throughout the body. Exposure
cid paralysis, and apnea. to large amounts of nerve agents (a sudden surge of acetylcholine) may quickly in-
duce loss of consciousness, seizures, flaccid paralysis, and apnea (McCafferty, 2002).
Pandemics. A pandemic is the occurrence of infectious disease that is spreading
pandemic: An occurrence of
infectious disease that is spreading through human populations across a large region, continent, or the world. Infec-
through human populations across tious diseases have been the primary cause of mass casualty incidents throughout
a large region, continent, or world.
history. Some notable ones are the Black Death and Spanish Flu. The Black Death
pandemic (bacterium Yersinia pestis) killed between 75 and 100 million people
around the world in 1400 (Wikipedia, 2010). From March 1918 to June 1920,
the Spanish Flu pandemic (influenza A/H1N1) caused 50 to 100 million deaths
Among those patients worldwide (Johnson, 2002). Recent H1N1 outbreaks in 2009 showed a much lower
with confirmed cases of H1N1,
many developed acute lung mortality rate due to a better knowledge base of the disease and quick implemen-
injury or acute respiratory dis- tation of isolation procedures. Among those patients with confirmed cases, many
tress syndrome and required
mechanical ventilation. developed acute lung injury or acute respiratory distress syndrome and required
mechanical ventilation (Rello et al., 2009; Venkata et al., 2010). Management
modalities for some of these patients included inhaled nitric oxide, high frequency
oscillatory ventilation, extracorporeal membrane oxygenation, and prone position-
ing (Kumar et al., 2009; MMWR, 2009).
Mass Casualty and Mechanical Ventilation

In 2005, the U.S. Department of Health and Human Services estimated the num-
ber of health care utilization and deaths associated with moderate and severe pan-
demic influenza scenarios (Table 18-3). The number of mechanical ventilators that
would be required for a 1958/68-like outbreak is estimated to be 64,875. For an
influenza outbreak on the scale of 1918, an estimated 742,500 ventilators would be
needed (HHS, 2005). Based on a study in 2006, there were 105,000 ICU ventila-
tors available in the U.S. Among these ventilators, about 100,000 would be in use

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