Assessment of artificial ventilation in Salvadorian public hospitals

Introduction

Artificial ventilation (AV) is an essential resource that is not always available at Salvadorian public hospitals. Approximately 40% of hospital-related deaths may have required AV [1]. The main indication for AV is respiratory insufficiency requiring support for these patients. Variations in ventilation modality and time among others can affect patient health [2]. The aim of this study was to clarify the AV situation in national hospitals of El Salvador's public health system.

Methods

This study is transversal descriptive. A representative sample (n = 5) of public national hospitals was selected. These included four second-level hospitals and one third-level hospital. Two hospitals were from the central metropolitan region, one from the par central, west and east region; representing 36.1% of available hospital beds nationwide. To complete AV data of the totality of public hospitals, a telephone survey was used. All data about patients, AV type, costs, maintenance and operative personnel, among others, were collected.

Results

Only 18% of all public hospitals around the country have mechanical AV. The majority of mechanical AV on the public health network is focused on Rosales National Hospital (HNR), with 61.9% of mechanical ventilators nationwide. Mechanical AV is operated by respiratory therapy personnel at HNR and Zacamil National Hospital; however, in another two hospitals from the east and west region, mechanical AV is operated by residents; and manual AV is provided by self-inflating resuscitator bag operated by interns only. The main causes of AV are nonsurgical; representing 88.9% of the reasons to employ mechanical AV, and 100% for manual AV. The mean patient ventilation time for mechanical AV was >48 hours, and for manual AV was >24 hours. No patient with manual AV had normal pO₂. The maintenance cost for all mechanical AV was less than $100 per month per ventilator and only 68% of mechanical ventilators were functional, the most frequent model being Servo900.

Conclusions

The actual mechanical AV existence is very limited, since only four out of 14 departments have this resource, representing 18% of public health centers nationwide, centralized in the department of San Salvador, leaving 82% of these centers with no mechanical ventilation at all, being probably supplanted by manual AV. Results show the necessity for cheaper, efficient and easy-to-use AV systems.