The OstreaVent story
by Enrique M. Ostrea, Jr., M.D.About 15 years ago, I was asked to make rounds in a nursery of a government hospital in Tagbilaran, Bohol. In the course of my rounds, I noticed a 12 year old girl manually ventilating a premature infant with an inflatable bag. I asked the neonatologist who accompanied me on rounds what the child was doing and she replied, “Sir, that is our ventilator!” I quickly asked, “What if the child gets tired or falls asleep?” She sadly replied, “Then, the baby dies, Sir”! That experience never left my mind, eversince. I eventually found out that it was common practice in many neonatal intensive care units in the Philippines to manually ventilate an infant for lack of ventilators. My most horrifying experience was when I saw 4 intubated, premature infants connected through a common tubing and ventilated with one inflatable bag by one person. I was therefore determined that this practice should end. The ventilator is not a complicated machine and can be produced easily. It was the high cost of commercial ventilator that was the major deterrent towards acquiring sufficient number of ventilators in hospitals.
Pedro is a farmer and grows rice in the paddies of their small farm for their livelihood. He and his young wife, Maria are expecting their first child. Maria has had very little prenatal care and is unaware that her blood pressure has started to rise, a condition known as pregnancy-induced hypertension. She started experiencing some swelling of her feet and occasional dizziness and headache which she just attributed as part of her pregnancy. At about the 28th week of her pregnancy, she started to experience abdominal cramps and then, without warning, her bag of water broke and she went into spontaneous labor. Pedro rushed his wife to the nearby hospital where she delivered a 28 week old premature, male infant with a birth weight of 1000 grams.
Within a few minutes after birth, the baby started to develop respiratory distress and needed oxygen. The respiratory distress worsened and a chest X-ray was taken which showed hyaline membrane disease (Figure A), a disease common to premature infants due to a deficiency in their lungs of a substance called surfactant. The infant needed further support from a ventilator to survive and so the infant was transferred to the provincial government hospital for further care. Unfortunately, the hospital only had a few ventilators available and all were in use. Pedro was therefore asked to rent a ventilator which would cost him 2000 pesos for the first day and 1000 pesos for each subsequent day. The poor couple did not have enough money to rent a ventilator and so the infant was intubated and just ventilated manually, using an inflatable bag, by the medical and nursing staff and even some members of Pedro’s family. On the second day of life, the infant’s condition suddenly deteriorated. A repeat chest Xray was taken which showed bilateral pneumothorax (Figure B). The infant continued to deteriorate and subsequently died.