Medical Gas Systems for Ventilated Patients — Planning & Response, Part One

When the novel coronavirus (COVID-19) became a reality for this country and the quarantine began, we did not know what to expect. Pandemic updates from Washington, DC by the President of the United States and his lead physicians became a daily routine. Just a few hours away, COVID-19 cases in New York City were overwhelming the hospitals. Oxygen and medical gas systems were overtaxed by patients requiring ventilators, and many existing piping infrastructures proved to be inadequately sized for such a high demand. The facilities and engineering community was scrambling to help their healthcare clients bolster their systems for the worst.

A prominent, regional hospital approached Barton Associates while they monitored the tragedies in the New York City hospitals and watched COVID-19 death tolls rise. They wanted to stay ahead of the curve and be prepared when the spread of COVID-19 cases reached their patient population. The hospital’s clinical team had prepared a Pandemic Response Plan for intake and treatment of up to 200 critically ill COVID-19 patients. The Director of Facilities needed to verify that the existing oxygen piping system would be able to support ventilated patients. In this case, the facilities director was not concerned about their medical gas system, so the analysis was focused on the oxygen delivery systems.

Based on initial demand and friction loss calculations using industry standards for designing new systems as the guide (an expected oxygen demand of 10 liters per minute (LPM) per patient bed and 30 LPM per ventilator), it appeared that the existing oxygen piping system would not be adequate to meet the needs of the hospital’s Pandemic Response Plan. With this realization, we decided to interview the hospital’s respiratory therapy team to compare the recommended theoretical oxygen demand against what they projected from a clinical perspective. Their expected consumption of oxygen was far lower than what is recommended in the various engineering and design manuals deemed as best practice in the industry. The respiratory team anticipated each patient on a ventilator would consume a maximum of 10 LPM and the general non-COVID-19 patient population was expected to consume approximately 2-4 LPM per bed at a diversity (predicted simultaneous use) of 25%. When using these figures, our calculations proved the oxygen piping system would be expected to perform safely under the predicted conditions. Thankfully, the hospital did not have to rewrite the Pandemic Response Plan or make emergency changes to their system. (The treatment approach to providing oxygen therapy to COVID-19 patients has shifted, and invasive mechanical ventilation has become the last resort rather than the first step in treatment. Read Part Two of our series to learn more)

When we finished the first round of calculations, our collective hearts sank. “What will we do now?”, was the immediate response. Thankfully, the final rounds of calculations revealed a much better result. In this case, the main lesson learned is to include the clinical team and respiratory therapists in engineering discussions and review, particularly when planning for atypical response plans. When planning for new facilities, the industry standards are still appropriate. But in this case, we needed real values from the front line to validate the system and give our client a level of comfort that they would be ready for the coming surge of critical care patients.

Looking Ahead to Medical Gas Systems for Ventilated Patients — Planning & Response, Part Two

While the results of this study predicted that the oxygen system infrastructure could be trusted to serve the number of patients predicted by the Pandemic Response Plan, the best time to assess the capacity of your infrastructure is not while your ICU beds are filling up with patients during a pandemic. In our next article we will provide insight into planning for future potential oxygen and medical air demands and considerations on upgrading your medical gas system infrastructure to help clients stay proactive in supporting our front-line healthcare workers. If you have any questions or need more information, please contact Jonathan B. Slagel, PE, LEED AP HFDP, at

If you are interested in learning more about this assessment and the process we followed as we worked through the Hospital-wide oxygen system evaluation, please read Case Study – Detailed Review of Oxygen System Infrastructure for Adequacy in Serving Pandemic Response Plan.