Splitting one ventilator for multiple patients

Due to the recent coronavirus outbreak, many efforts and innovative solutions have surfaced to deal with the possible shortage of ventilators upon catastrophic surges of patients. One solution involves splitting one ventilator to treat multiple patients and is in principle easy to implement, but there are obvious risks and little is known on how the technique would work on patients with ARDS from Covid-19. Previous studies have shown that multiple test lungs of equal characteristics can be successfully ventilated from one machine, but that large variations in tidal volume delivery occurs when lungs with different compliance are connected. In contribution to the discussion of the feasibility of the technique, a technical assessment was done including experiments expanding on the previous studies with different ventilator setting and lung characteristics. Using two test lungs connected to a ventilator, the tidal volumes and pressures into both lungs were measured for different combinations of lung compliance, airway resistances, modes of ventilation, inspiratory and end-expiratory pressure levels. We found large discrepancies in delivered tidal volumes for paired test lungs with compliance differences, little influence from differences in airway resistances, and that higher PEEP settings could strongly influence the tidal volume balance between the test lungs. The most balanced, although far from ideal, delivery of tidal volumes for the test lungs with different compliance was measured using pressure-controlled ventilation with a maximum inspiratory pressure of 30 mbar and a PEEP at 6 or 10 mbar. From this study and from a technical point of view, we were not able to identify reliable settings, adjustments or any simple measures to overcome the hazards of the technique.

Project leader:

Håvard Kalvøy

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