Ventilator Sharing: The Good, the Bad, and the Ugly

Hess, Dean; Kallet, Richard H; Beitler, Jeremy R.

doi:10.4187/respcare.08140

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…Such a double circuit design is also suitable at the time of patient selection for simultaneous ventilation. The safety guideline is to share the single ventilator between patients with respiratory mechanics as close as possible [8,14]. We wanted to explore how much V T would depart from each patient to the other when the respiratory mechanics markedly differ between them.…”

Section: Methodsmentioning

confidence: 99%

“…Simultaneous ventilation provides ventilatory support to two or more patients with the same ventilator [6]. This approach raised ethical issues [7] due to the many technical problems to solve from sharing the same ventilator with patients with different respiratory mechanics and, hence different requirements [8]. For simultaneous ventilation, with no means of independently controlling positive end-expiratory pressure (PEEP) and tidal volume (V T ), patients sharing the same ventilator should have respiratory mechanics as similar as possible.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Such a double circuit design is also suitable at the time of patient selection for parallel ventilation. The safety guard is to share the single ventilator between patients with respiratory mechanics as close as possible [7, 19]. We wanted to explore how much V T would depart from each patient to the other when the respiratory mechanics markedly differ between them.…”

Section: Methodsmentioning

confidence: 99%

“…Sharing ventilation provides ventilatory support to two or more patients with the same ventilator [5]. This approach raised ethical issues [6] due to the many technical problems to solve from sharing the same ventilator with patients with different respiratory mechanics and, hence different requirements [7]. For multiplex ventilation, with no means of independently controlling positive end-expiratory pressure (PEEP) and tidal volume (V T ), patients sharing the same ventilator should have respiratory mechanics as similar as possible.…”

Section: Introductionmentioning

confidence: 99%

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

Guérin

Cour

Stevic

et al. 2020

Preprint

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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.

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“…There are many potential engineering solutions to share one ventilator among two or more patients, including those advocated by Chase and colleagues and Milner and colleagues. Proposals that increase circuit complexity also may increase risk of (potentially fatal) adverse events from equipment issues, clinical events, or human error ( 3 ). Reliance on components that are not routinely used in similar clinical applications, are not medical grade, and/or have not undergone rigorous testing increases these risks; this is especially true for mechanical components that regulate airflow, in which component failure could cause abrupt cessation of ventilator support for one or both patients.…”

mentioning

confidence: 99%