Titration of Parameters in Shared Ventilation With a Portable Ventilator

Respir Care. 2021 May;66(5):758-768. doi: 10.4187/respcare.08446. Epub 2020 Dec 9.

Abstract

Background: Dual-patient, single-ventilator protocols (ie, protocols to ventilate 2 patients with a single conventional ventilator) may be required in times of crisis. This study demonstrates a means to titrate peak inspiratory pressure (PIP), PEEP, and [Formula: see text] for test lungs ventilated via a dual-patient, single-ventilator circuit.

Methods: This prospective observational study was conducted using a ventilator connected to 2 test lungs. Changes in PIP, PEEP, and [Formula: see text] were made to the experimental lung, while no changes were made to the control lung. Measurements were obtained simultaneously from each test lung. PIP was titrated using 3D-printed resistors added to the inspiratory circuit. PEEP was titrated using expiratory circuit tubing with an attached manual PEEP valve. [Formula: see text] was titrated by using a splitter added to the ventilator tubing.

Results: PIP, PEEP, and [Formula: see text] were reliably and incrementally titratable in the experimental lung, with some notable but manageable changes in pressure and [Formula: see text] documented in the control lung during these titrations. Similar results were measured in lungs with identical and different compliances.

Conclusions: Pressures and [Formula: see text] can be reliably adjusted when utilizing a dual-patient, single-ventilator circuit with simple, low-cost modifications to the circuit. This innovation could potentially be lifesaving in a resource-limited or crisis setting. Understanding the interactions of these circuits is imperative for making their use safer.

Keywords: critical care; hospital equipment and supplies; mechanical ventilators; pandemics; positive-pressure respiration; three-dimensional printing.

Publication types

  • Observational Study

MeSH terms

  • Humans
  • Lung
  • Positive-Pressure Respiration*
  • Respiration
  • Respiration, Artificial
  • Ventilators, Mechanical*