For example, if the clinician anticipates that the patient will be placed on Ventilator 1 (PIP = 20 cmH2O, PEEP = 10 cmH2O, I:E = 30:70) then the transport ventilator PEEP should be set to approximately 10 cmH2O when measuring C. To account for this, the transport ventilator used to measure the patient-specific C should be set at a PEEP the clinician judges to be within similar range of what they would expect for the PEEP value on the final long-term ventilator. Therefore, the value of C found on the transport ventilator is only valid for PEEPs similar to what is set on the transport ventilator. In many ARDS patients, lung compliance is non-linearly dependent on ventilation pressure due to volume-dependent tissue stiffness and pressure-dependent derecruitment 27, 28. Of course, the operator would also confirm that the total required Vt for the 4 patients does not exceed the maximum available Vt from the ventilator. Ideally, a free ventilator would be kept near the shared ventilation ward to use for weaning and if lung function rapidly deteriorates in any patient. If the patient was deteriorating, the patient could also be moved to a higher-numbered ventilator. Patient lung mechanics (C and R) could be periodically re-evaluated, along with gas exchange, and if they improved, they could be moved to a lower-number ventilator (lower number ventilator indicated lower PIP, lower PEEP, and lower FiO2) 3. Alternatively, the patient could also be assigned to a single-patient ventilator if lung function is not compatible with shared ventilation. Based on those measurements, and the settings on the transport ventilator, the patient would be assigned to one of the five ventilator categories listed in Table 1 (or in Fig. These patients would be intubated and ventilated for 30-60 min using a transport ventilator that measures R and C while they are moved within the hospital. Our hypothetical clinical workflow would be initiated in a patient when 15 L/min O 2 delivered via nasal cannula is insufficient to maintain oxygenation. We will also provide a discussion of possible complications to be considered in a clinical setting when supporting more than one patient on a single mechanical ventilator. Based on these 3 controlled parameters for each ventilator, we provide a graphical reference for choosing the correct ventilator for a simulated patient, based on lung compliance (C) and resistance (R), to achieve the desired tidal volume (Vt). ![]() A pre-set fraction of inspired oxygen (FiO 2 ), positive end-expiratory pressure (PEEP), peak inspiratory pressure (PIP), and inspiratory:expiatory ratio (I:E) is suggested for each ventilator. Farkas MD has suggested a setup of 5 ventilator configurations 3, which could each support 4 patients. This manuscript has the following overall objective: J. In this study, we utilized a computational modeling approach to evaluate the efficacy and considerations of ventilating multiple patients on a single ventilator. This is particularly of concern when attempting to ventilate multiple patients on a single machine because ventilator adjustments are applied to both patients, making titration to avoid VILI challenging. ![]() Ventilation of any patient must be done with great care to avoid ventilator induced lung injury (VILI) 10 that damages the lung through the combined effects of tissue overdistension (volutrauma) 11- 15, cyclic derecruitment and recruitment of small airways and alveoli (atelectrauma) 16- 20, and inflammatory effects (biotrauma) 21- 24. Nevertheless, faced with few good options, New York-Presbyterian Hospital and Columbia University have distributed a protocol for this approach 9. ![]() They also correctly point out that previous citations experimenting with this technique have also cautioned against using it 4, 7, 8. They list numerous important safety concerns for ventilating multiple patients on a single ventilator and warn that it could lead to poor outcomes and increased mortality. However, the American College of Chest Physicians (CHES) and other leading organizations issued a statement on March 26 th, 2020, warning practitioners not to attempt this practice 2. The sudden surge in patients flooding intensive care units (ICUs) around the country has created a scarcity of mechanical ventilators 2, 3, which has caused some centers to consider dual-patient (and sometimes even quad-patient) ventilation during critical ventilator shortages 3- 6. According to the World Health Organization (WHO), as of March 28 th, 2020, the novel coronavirus (SARS-CoV-2, causing the disease COVID-19) initiated in Wuhan, China, has now been detected in 202 countries with over half-a-million confirmed cases worldwide 1.
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