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Journal Article Review Ppublish 38 citations

PubMed: 32805237 DOI: 10.1016/j.chest.2020.08.015

It Takes a Village…: Contending With Drug Shortages During Disasters.

Chest 158(6):2414-2424

Authors: Lisa D Burry, Jeffrey F Barletta, David Williamson, Salmaan Kanji, Ryan C Maves, Jeffrey Dichter, Michael D Christian, James Geiling, Brian L Erstad

Affiliations

  • Department of Pharmacy and Medicine, Sinai Health System, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
  • College of Pharmacy, Midwestern University, Glendale, AZ.
  • Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal-Hôpital du Sacré-Cœur de Montréal, Faculté de pharmacie, Université de Montréal, Montréal, QC, Canada.
  • The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Department of Medicine, Naval Medical Center, San Diego, CA; Department of Medicine, Uniformed Services University, Bethesda, MD.
  • Pulmonary, Allergy, Critical Care, and Sleep Medicine Division, University of Minnesota, Minneapolis, MN.
  • London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, London, England.
  • Geisel School of Medicine at Dartmouth, Hanover, NH.
  • The University of Arizona College of Pharmacy, Tucson, AZ.

Abstract

Critical drug shortages have been widely documented during the coronavirus disease 2019 (COVID-19) pandemic, particularly for IV sedatives used to facilitate mechanical ventilation. Surges in volume of patients requiring mechanical ventilation coupled with prolonged ventilator days and the high sedative dosing requirements observed quickly led to the depletion of "just-in-time" inventories typically maintained by institutions. This manuscript describes drug shortages in the context of global, manufacturing, regional and institutional perspectives in times of a worldwide crisis such as a pandemic. We describe etiologic factors that lead to drug shortages including issues related to supply (eg, manufacturing difficulties, supply chain breakdowns) and variables that influence demand (eg, volatile prescribing practices, anecdotal or low-level data, hoarding). In addition, we describe methods to mitigate drug shortages as well as conservation strategies for sedatives, analgesics and neuromuscular blockers that could readily be applied at the bedside. The COVID-19 pandemic has accentuated the need for a coordinated, multi-pronged approach to optimize medication availability as individual or unilateral efforts are unlikely to be successful.

MeSH

Ventilation, Thoracic Diseases, Critical Care, Pharmaceutical Preparations, Disasters, Pandemics, Covid-19

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