Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions.

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  • Additional Information
    • Affiliation:
      Department of Biomedical Engineering, Boston University, Boston, Massachusetts
      OscillaVent, Iowa City, Iowa
      Department of Anesthesia, University of Iowa, Iowa City, Iowa
      Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
      Departments of Anesthesia, Biomedical Engineering, and Radiology, University of Iowa, Iowa City, Iowa
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      BACKGROUND: The use of shared ventilation, or the simultaneous support of multiple patients connected in parallel to a single mechanical ventilator, is receiving considerable interest for addressing the severe shortage of mechanical ventilators available during the novel coronavirus pandemic (COVID-19). In this paper we highlight the potentially disastrous consequences of naïve shared ventilation, in which patients are simply connected in parallel to a ventilator without any regard to their individual ventilatory requirements. We then examine possible approaches for individualization of mechanical ventilation, using modifications to the breathing circuit that may enable tuning of individual tidal volumes and driving pressures during either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV). METHODS: Breathing circuit modifications included a PEEP valve on each expiratory limb for both VCV and PCV, an adjustable constriction and one-way valve on the inspiratory limb for VCV, and a pressure-relief valve for peak inspiratory pressure reduction on the inspiratory limb for PCV. The ability to regulate individual tidal volumes using these breathing circuit modifications was tested both theoretically in computer simulations as well as experimentally in mechanical test lungs. RESULTS: In both the simulations and experimental measurements, naïve shared ventilation resulted in large imbalances across individual tidal volume delivery, dependent on imbalances across patient mechanical properties. The proposed breathing circuit modifications for shared VCV and shared PCV enabled optimization of tidal volume distributions. Individual tidal volume for one patient during shared VCV was sensitive to changes in the mechanical properties of other patients. By contrast, shared PCV enabled independent control of individual patient-received ventilation. CONCLUSIONS: Of the shared ventilation strategies considered, shared PCV, with the inclusion of in-line pressure-relief valves in the individual inspiratory and expiratory limbs, offers the greatest degree of safety and lowest risk of catastrophic mechanical interactions between multiple patients connected to a single ventilator.
    • Journal Subset:
      Allied Health; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA
    • ISSN:
      0020-1324
    • MEDLINE Info:
      NLM UID: 7510357
    • Notes:
      For CE see www.rcjournal.com
    • Publication Date:
      20200626
    • Publication Date:
      20200630
    • DOI:
      http://dx.doi.org/10.4187/respcare.07919
    • Accession Number:
      144207921
  • Citations
    • ABNT:
      HERRMANN, J. et al. Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions. Respiratory Care, [s. l.], v. 65, n. 7, p. 932–945, 2020. DOI 10.4187/respcare.07919. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=144207921. Acesso em: 10 ago. 2020.
    • AMA:
      Herrmann J, Fonseca da Cruz A, Hawley ML, Branson RD, Kaczka DW. Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions. Respiratory Care. 2020;65(7):932-945. doi:10.4187/respcare.07919
    • APA:
      Herrmann, J., Fonseca da Cruz, A., Hawley, M. L., Branson, R. D., & Kaczka, D. W. (2020). Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions. Respiratory Care, 65(7), 932–945. https://doi.org/10.4187/respcare.07919
    • Chicago/Turabian: Author-Date:
      Herrmann, Jacob, Andrea Fonseca da Cruz, Monica L. Hawley, Richard D. Branson, and David W. Kaczka. 2020. “Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions.” Respiratory Care 65 (7): 932–45. doi:10.4187/respcare.07919.
    • Harvard:
      Herrmann, J. et al. (2020) ‘Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions’, Respiratory Care, 65(7), pp. 932–945. doi: 10.4187/respcare.07919.
    • Harvard: Australian:
      Herrmann, J, Fonseca da Cruz, A, Hawley, ML, Branson, RD & Kaczka, DW 2020, ‘Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions’, Respiratory Care, vol. 65, no. 7, pp. 932–945, viewed 10 August 2020, .
    • MLA:
      Herrmann, Jacob, et al. “Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions.” Respiratory Care, vol. 65, no. 7, July 2020, pp. 932–945. EBSCOhost, doi:10.4187/respcare.07919.
    • Chicago/Turabian: Humanities:
      Herrmann, Jacob, Andrea Fonseca da Cruz, Monica L. Hawley, Richard D. Branson, and David W. Kaczka. “Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions.” Respiratory Care 65, no. 7 (July 2020): 932–45. doi:10.4187/respcare.07919.
    • Vancouver/ICMJE:
      Herrmann J, Fonseca da Cruz A, Hawley ML, Branson RD, Kaczka DW. Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions. Respiratory Care [Internet]. 2020 Jul [cited 2020 Aug 10];65(7):932–45. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=144207921