Successful ventilation of two animals with a single ventilator: individualized shared ventilator setup in an in vivo model

Stiers, Michiel; Bleeser, Tom; Mergeay, Matthias; Pinson, Hannah; Janssen, Luc; Schepens, Tom

doi:10.1186/s13054-020-03248-z

Cited by 14 publications

(13 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Preclinical studies should be considered to increase our experience and knowledge in simultaneous ventilation in the dawn of the second wave of COVID-19 pandemic [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Started before the current COVID-19 pandemic [3,21], it was stressed that simultaneous ventilation cannot support its use in mass causality because V T was too much variable across C-R conditions and largely dependent on changes in compliance [3]. Since then, the current COVID-19 pandemic prompted additional bench studies to extend these previous results and proposed solutions to try to overwhelm some related issues [9,12,[22][23][24][25][26][27][28][29][30][31][32][33][34] (Table 5).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Simultaneous ventilation in the Covid-19 pandemic. A bench study

et al. 2021

View full text Add to dashboard Cite

COVID-19 pandemic sets the healthcare system to a shortage of ventilators. We aimed at assessing tidal volume (VT) delivery and air recirculation during expiration when one ventilator is divided into 2 test-lungs. The study was performed in a research laboratory in a medical ICU of a University hospital. An ICU (V500) and a lower-level ventilator (Elisée 350) were attached to two test-lungs (QuickLung) through a dedicated flow-splitter. A 50 mL/cmH2O Compliance (C) and 5 cmH2O/L/s Resistance (R) were set in both A and B test-lungs (A C50R5 / B C50R5, step1), A C50-R20 / B C20-R20 (step 2), A C20-R20 / B C10-R20 (step 3), and A C50-R20 / B C20-R5 (step 4). Each ventilator was set in volume and pressure control mode to deliver 800mL VT. We assessed VT from a pneumotachograph placed immediately before each lung, pendelluft air, and expiratory resistance (circuit and valve). Values are median (1st-3rd quartiles) and compared between ventilators by non-parametric tests. Between Elisée 350 and V500 in volume control VT in A/B test- lungs were 381/387 vs. 412/433 mL in step 1, 501/270 vs. 492/370 mL in step 2, 509/237 vs. 496/332 mL in step 3, and 496/281 vs. 480/329 mL in step 4. In pressure control the corresponding values were 373/336 vs. 430/414 mL, 416/185 vs. 322/234 mL, 193/108 vs. 176/ 92 mL and 422/201 vs. 481/329mL, respectively (P<0.001 between ventilators at each step for each volume). Pendelluft air volume ranged between 0.7 to 37.8 ml and negatively correlated with expiratory resistance in steps 2 and 3. The lower-level ventilator performed closely to the ICU ventilator. In the clinical setting, these findings suggest that, due to dependence of VT to C, pressure control should be preferred to maintain adequate VT at least in one patient when C and/or R changes abruptly and monitoring of VT should be done carefully. Increasing expiratory resistance should reduce pendelluft volume.

show abstract

“…Preclinical studies should be considered to increase our experience and knowledge in simultaneous ventilation in the dawn of the second wave of COVID-19 pandemic [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Simultaneous ventilation in the Covid-19 pandemic. A bench study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Nevertheless, the presence of such a valve could affect the capacities of the ventilator to maintain the PEEP. Preclinical studies should be considered to increase our experience and knowledge in sharing ventilation in the dawn of the second wave of COVID-19 pandemic that is hitting the planet [33]…”

Section: Discussionmentioning

confidence: 99%

“…Preclinical studies should be considered to increase our experience and knowledge in sharing ventilation in the dawn of the second wave of COVID-19 pandemic that is hitting the planet [33]…”

Section: Discussionmentioning

confidence: 99%

Sharing ventilators in the Covid-19 pandemics. A bench study

Guérin

Cour

Stevic

et al. 2020

Preprint

View full text Add to dashboard Cite

COVID-19 pandemics sets the healthcare system to a shortage of ventilators. We aimed at assessing tidal volume (VT) delivery and air recirculation during expiration when one ventilator is divided into 2 patients. The study was performed in a research laboratory in a medical ICU of a University hospital. An ICU-dedicated (V500) and a lower-level ventilator (Elisee 350) were attached to two test-lungs (QuickLung) through a dedicated flow-splitter. A 50 mL/cmH2O Compliance (C) and 5 cmH2O/L/s Resistance (R) were set in both A and B lungs (step1), C50R20 in A / C20R20 in B (step 2), C20R20 in A / C10R20 in B (step 3), and C50R20 in A / C20R5 in B (step 4). Each ventilator was set in volume and pressure control mode to deliver 0.8L VT. We assessed VT from a pneumotachograph placed immediately before each lung, rebreathed volume, and expiratory resistance (circuit and valve). Values are median (1st-3rd quartiles) and compared between ventilators by non-parametric tests. Between Elisee 350 and V500 in volume control VT in A/B patients were 0.381/0.387 vs. 0.412/0.433L in step 1, 0.501/0.270 vs. 0.492/0.370L in step 2, 0.509/0.237 vs. 0.496/0.332L in step 3, and 0.496/0.281 vs. 0.480/0.329L in step 4. In pressure control the corresponding values were 0.373/0.336 vs. 0.430/0.414L, 0.416/0.185/0.322/0.234L, 0.193/0.108 vs. 0.176/0.092L and 0.422/0.201 vs. 0.481/0.329L, respectively (P<0.001 between ventilators at each step for each volume). Rebreathed air volume ranged between 0.7 to 37.8 ml and negatively correlated with expiratory resistance in steps 2 and 3. The lower-level ventilator performed closely to the ICU-dedicated ventilator. Due to dependence of VT to C pressure control should be used to maintain adequate VT at least in one patient when C and/or R changes abruptly and monitoring of VT should be done carefully. Increasing expiratory resistance should reduce rebreathed volume.

show abstract

“…The Table outlines the degree to which previously published approaches meet our criteria for translational ventilator splitting. The earliest approaches, including those by Neyman and Irvin, 7 Paladino et al, 8 and Tonetti et al, 11 22 ), sometimes paired with expiratory PGVs to modulate PEEP (Lugones et al, 23 Stiers et al, 24 and Srinivasan et al 25 ). While providing more personalization than simple T-piece-based ventilator-splitting methods, these designs fail to prevent one patient from altering the ventilation of the other.…”

Section: Comparison To Other Approachesmentioning

confidence: 99%

Pressure-Regulated Ventilator Splitting for Disaster Relief: Design, Testing, and Clinical Experience

Raredon

Fisher

Heerdt

et al. 2021

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID-19) pandemic has revealed that even the best-resourced hospitals may lack sufficient ventilators to support patients under surge conditions. During a pandemic or mass trauma, an affordable, low-maintenance, off-the-shelf device that would allow health care teams to rapidly expand their ventilator capacity could prove lifesaving, but only if it can be safely integrated into a complex and rapidly changing clinical environment. Here, we define an approach to safe ventilator sharing that prioritizes predictable and independent care of patients sharing a ventilator. Subsequently, we detail the design and testing of a ventilator-splitting circuit that follows this approach and describe our clinical experience with this circuit during the COVID-19 pandemic. This circuit was able to provide individualized and titratable ventilatory support with individualized positive end-expiratory pressure (PEEP) to 2 critically ill patients at the same time, while insulating each patient from changes in the other’s condition. We share insights from our experience using this technology in the intensive care unit and outline recommendations for future clinical applications.

show abstract

Successful ventilation of two animals with a single ventilator: individualized shared ventilator setup in an in vivo model

Cited by 14 publications

References 8 publications

Simultaneous ventilation in the Covid-19 pandemic. A bench study

Simultaneous ventilation in the Covid-19 pandemic. A bench study

Sharing ventilators in the Covid-19 pandemics. A bench study

Pressure-Regulated Ventilator Splitting for Disaster Relief: Design, Testing, and Clinical Experience

Contact Info

Product

Resources

About