Simulated Ventilation of Two Patients With a Single Ventilator in a Pandemic Setting release_i6xklcckrnc7zp3dcsfgmpkgci

by Pascal Schepat, Benjamin Kober, Martin Eble, Volker Wenzel, Holger Herff

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<jats:title>Abstract</jats:title> <jats:bold>Background:</jats:bold> Simultaneous ventilation of two patients, e.g., due to a shortage of ventilators in a pandemic, may result in hypoventilation in one patient and hyperinflation in the other patient. <jats:bold>Methods:</jats:bold> In a simulation of double patient ventilation using artificial lungs with equal compliances (70mL∙mbar<jats:sup>-1</jats:sup>), we tried to voluntarily direct gas flow to one patient by using 3D-printed y-adapters and stenosis adapters during volume-, and pressure-controlled ventilation. Subsequently, we modified the model using a special one-way valve on the limited flow side and measured in pressure-controlled ventilation with the flow sensor adjusted on either side in a second and third setup. In the last setup, we also measured with different lung compliances.<jats:bold>Results:</jats:bold> Volume- or pressure-controlled ventilation using standard connection tubes with the same compliance in each lung resulted in comparable minute volumes in both lungs, even if one side was obstructed to 3mm (6.6±0.2vs.6.5±0.1L for volume-controlled ventilation, p=.25 continuous severe alarm and 7.4±0.1vs.6.1±0.1L for pressure-controlled ventilation, p=.02 no alarm). In the second setup, pressure-controlled ventilation resulted at a 3mm flow limitation in minute ventilation of 9.4±0.3vs3.5±0.1L∙min<jats:sup>-1</jats:sup>, p=.001. In a third setup using the special one-way valve and the flow sensor on the unobstructed side, pressure-controlled ventilation resulted at a 3mm flow limitation in minute ventilation of 7.4±0.2vs3±0L∙min<jats:sup>-1</jats:sup>, at the compliance of 70mL∙mbar<jats:sup>-1</jats:sup> for both lungs, 7.2±0vs4.1±0L∙ min<jats:sup>-1</jats:sup>, at the compliances of 50 vs. 70mL∙mbar<jats:sup>-1</jats:sup>, and 7.2±0.2vs5.7±0L∙ min<jats:sup>-1</jats:sup>, at the compliance of 30 vs. 70mL∙mbar<jats:sup>-1</jats:sup> (all p=.001).<jats:bold>Conclusions:</jats:bold> Overriding a modern intensive care ventilator's safety features are possible, thereby ventilating two lungs with one ventilator simultaneously in a laboratory simulation using 3D-printed y-adapters. Directing tidal volumes in different pulmonary conditions towards one lung using 3D-printed flow limiters with diameters &lt;6mm was also possible. While this ventilation setting was technically feasible in a bench model, it would be volatile, if not dangerous in a clinical situation.
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