Potential Intensive Care unit Ventilator Demand/Capacity Mismatch due to Novel Swine-Origin H1N1 in Canada

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Abstract
PURPOSE: To investigate the ability of Canadian intensive care units (ICUs) and ventilators to handle widespread re-emergence of the swine-origin H1N1 virus in the context of an aggressive strategy of vaccination.METHOD: Data collected during the first wave in Winnipeg, Manitoba, were applied to a variety of second wave pandemic models to determine potential ICU and ventilator demand.RESULTS: For attack rates greater than 20% to 25%, significant shortages in ventilators may be expected across Canada regardless of the duration of the pandemic if vaccination is not considered. The shortfall arises largely due to the extended durations that patients must remain on ventilation. From the Winnipeg study, 50% of patients required ventilation for more than two weeks. For larger attack rates of 35%, ventilator demand may exceed capacity for over five weeks, with a peak shortfall of 700 ventilators. Vaccination can significantly reduce the attack rates, and is expected to reduce ventilator demand to manageable levelsCONCLUSION: Canada’s health care system must be prepared for the possibility of a significant influx of ICU patients during the second wave of swine-origin H1N1. Efficient vaccination and other disease prevention measures can reduce the attack rate to manageable levels.