Abstract

Ventilator sharing has been proposed as a method of increasing ventilator capacity during instances of critical shortage. We sought to assess the ability of a regulated, shared ventilator system, the multisplit ventilator system, to individualize support to multiple simulated patients using one ventilator. We employed simulated patients of varying size, compliance, minute ventilation requirement, and positive end-expiratory pressure (PEEP) requirement. Performance tests were performed to assess the ability of the system, versus control, to achieve individualized respiratory goals to clinically disparate patients sharing a single ventilator following ARDSNet guidelines (Acute Respiratory Distress Syndrome). Resilience tests measured the effects of simulated adverse events occurring to one patient on another patient sharing a single ventilator. The multisplit ventilator system met individual oxygenation and ventilation requirements for multiple simulated patients with a tolerance similar to that of a single ventilator. Abrupt endotracheal tube occlusion or extubation occurring to one patient resulted in modest, clinically tolerable changes in ventilation parameters for the remaining patients. The proof-of-concept ventilator system presented in this paper is a regulated, shared ventilator system capable of individualizing ventilatory support to clinically dissimilar simulated patients. It is resilient to common adverse events and represents a feasible option to ventilate multiple patients during a severe ventilator shortage.

References

1.
Hui
,
D. S.
,
Azhar
,
E. I.
,
Madani
,
T. A.
,
Ntoumi
,
F.
,
Kock
,
R.
,
Dar
,
O.
,
Ippolito
,
G.
, et al.,
2020
, “
The Continuing 2019-nCoV Epidemic Threat of Novel Coronaviruses to Global Health—The Latest 2019 Novel Coronavirus Outbreak in Wuhan
,”
Int. J. Infectious Diseases
,
91
, pp.
264
266
.10.1016/j.ijid.2020.01.009
2.
Johns Hopkins University of Medicine, 2021, “
Johns Hopkins Coronavirus Resource Center
,” Johns Hopkins University of Medicine, Baltimore, MD, accessed Jan. 9, 2021, http://coronavirus.jhu.edu/
3.
King
,
W. P.
,
Amos
,
J.
,
Azer
,
M.
,
Baker
,
D.
,
Bashir
,
R.
,
Best
,
C.
,
Bethke
,
E.
, et al.,
2020
, “
Emergency Ventilator for COVID-19
,”
PLoS One
,
15
(
12
), p.
e0244963
.10.1371/journal.pone.0244963
4.
Auld
,
S. C.
,
Caridi-Scheible
,
M.
,
Blum
,
J. M.
,
Robichaux
,
C.
,
Kraft
,
C.
,
Jacob
,
J. T.
,
Jabaley
, et al.,
2020
, “
ICU and Ventilator Mortality Among Critically Ill Adults With COVID-19
,”
Crit. Care Med.
,
48
(
9
), pp.
e799
804
.10.1097/CCM.0000000000004457
5.
Bhatt
,
H.
, and
Singh
,
S.
,
2020
, “
The Ethical Dilemma of Ventilator Sharing During the COVID-19 Pandemic
,”
J. Global Health
,
10
(
2
), p.
020392
.10.7189/jogh.10.020392
6.
Branson
,
R. D.
, and
Rubinson
,
L.
,
2006
, “
A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge
,”
Acad. Emer. Med.
,
13
(
12
), pp.
1352
1353
.10.1197/j.aem.2006.10.002
7.
Powner
,
D. J.
,
Eross
,
B.
, and
Grenvik
,
A.
,
1977
, “
Differential Lung Ventilation With PEEP in the Treatment of Unilateral Pneumonia
,”
Crit. Care Med.
,
5
(
4
), pp.
170
172
.10.1097/00003246-197707000-00002
8.
Cavanilles
,
J. M.
,
Garrigosa
,
F.
,
Prieto
,
C.
, and
Oncins
,
J. R.
,
1979
, “
A Selective Ventilation Distribution Circuit (S.V.D.C)
,”
Intensive Care Med.
,
5
(
2
), pp.
95
98
.10.1007/BF01686056
9.
Mancebo
,
J.
,
Richard
,
J. C.
, and
Brochard
,
L.
,
2020
, “
Ventilator Sharing During Shortages. A Siren's Song?
,”
Am. J. Respir. Crit. Care Med.
,
202
(
4
), pp.
490
491
.10.1164/rccm.202006-2438ED
10.
Clarke
,
A. L.
,
Stephens
,
A. F.
,
Liao
,
S.
,
Byrne
,
T. J.
, and
Gregory
,
S. D.
,
2020
, “
Coping With COVID‐19: Ventilator Splitting With Differential Driving Pressures Using Standard Hospital Equipment
,”
Anaesthesia
,
75
(
7
), pp.
872
880
.10.1111/anae.15078
11.
Neyman
,
G.
, and
Irvin
,
C. B.
,
2006
, “
A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge
,”
Acad. Emer. Med.
,
13
(
11
), pp.
1246
1249
.10.1197/j.aem.2006.05.009
12.
Paladino
,
L.
,
Silverberg
,
M.
,
Charchaflieh
,
J. G.
,
Eason
,
J. K.
,
Wright
,
B. J.
,
Palamidessi
,
N.
,
Arquilla
,
B.
,
Sinert
,
R.
, and
Manoach
,
S.
,
2008
, “
Increasing Ventilator Surge Capacity in Disasters: Ventilation of Four Adult-Human-Sized Sheep on a Single Ventilator With a Modified Circuit
,”
Resuscitation
,
77
(
1
), pp.
121
126
.10.1016/j.resuscitation.2007.10.016
13.
Angulo
,
M.
,
Beltramelli
,
R.
,
Amarelle
,
L.
,
Alzugaray
,
P.
,
Briva
,
A.
, and
Santos
,
C.
,
2020
, “
Mechanical Risks of Ventilator Sharing in the COVID-19 Era: A Simulation-Based Study
,”
Arch. Bronconeumol.
,
56
(
11
), pp.
752
753
.10.1016/j.arbres.2020.06.006
14.
Hess
,
D. R.
,
Kallet
,
R. H.
, and
Beitler
,
J. R.
,
2020
, “
Ventilator Sharing: The Good, the Bad, and the Ugly
,”
Respir. Care
,
65
(
7
), pp.
1059
1062
.10.4187/respcare.08140
15.
Herrmann
,
J.
,
da Cruz
,
A. F.
,
Hawley
,
M. L.
,
Branson
,
R. D.
, and
Kaczka
,
D. W.
,
2020
, “
Shared Ventilation in the Era of Covid-19: A Theoretical Consideration of the Dangers and Potential Solutions
,”
Respir. Care
,
65
(
7
), pp.
932
945
.10.4187/respcare.07919
16.
Chatburn
,
R. L.
,
Branson
,
R. D.
, and
Hatipoğlu
,
U.
,
2020
, “
Multiplex Ventilation: A Simulation-Based Study of Ventilating 2 Patients With a Single Ventilator
,”
Respir. Care
,
65
(
7
), pp.
920
931
.10.4187/respcare.07882
17.
Menes
,
K.
,
Tintinalli
,
J.
, and
Plaster
,
L.
,
2017
, “
How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History
,” Emergency Physicians Monthly, Galesville, MD, accessed Jan. 11, 2021, https://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/
18.
U.S. Department of Health and Human Services, 2020, “Optimizing Ventilator Use During the COVID-19 Pandemic,” U.S. Department of Health and Human Services, Galesville, MD, accessed Jan. 11, 2021, www.hhs.gov/sites/default/files/optimizing-ventilator-use-during-covid19-pandemic.pdf
19.
Beitler
,
J. R.
,
Kallet
,
R.
,
Kacmarek
,
R.
,
Branson
,
R.
,
Brodie
,
D.
,
Mittel
,
A. M.
,
Olson
,
M.
,
Hill
,
L. L.
,
Hess
,
D.
, and
Thompson
,
B. T.
,
2020
, “
Ventilator Sharing Protocol: Dual-Patient Ventilation With a Single Mechanical Ventilator for Use During Critical Ventilator Shortages
,” New York Presbyterian/Columbia, New York.
20.
Mehrotra
,
S.
,
Rahimian
,
H.
,
Barah
,
M.
,
Luo
,
F.
, and
Schantz
,
K.
,
2020
, “
A Model of Supply‐Chain Decisions for Resource Sharing With an Application to Ventilator Allocation to Combat COVID‐19
,”
Nav. Res. Logistics
,
67
(
5
), pp.
303
320
.10.1002/nav.21905
21.
Nacharaju
,
D.
,
Menzel
,
W.
,
Fontaine
,
E.
,
Child
,
D.
,
El Haddi
,
S. J.
,
Nonas
,
S.
, and
Chi
,
A.
,
2020
, “
Three-Dimensional Printed Ventilators: A Rapid Solution to Coronavirus Disease 2019–Induced Supply-Chain Shortages
,”
Crit. Care Explor.
,
2
(
10
), p.
e0226
.10.1097/CCE.0000000000000226
22.
Lamdin
,
C.
,
2020
, “UVM Scientists, Engineers Team Up to Create ‘Vermontilator’,” Da Capo Publishing, Inc., Burlington, VT, accessed Jan. 9, 2021, https://www.sevendaysvt.com/OffMessage/archives/2020/04/07/uvm-scientists-engineers-team-up-to-create-vermontilator
23.
Somers
,
J.
,
2020
, “The Engineers Taking on the Ventilator Shortage,” The New Yorker, New York, accessed Jan. 11, 2021, https://www.newyorker.com/magazine/2020/05/18/the-engineers-taking-on-the-ventilator-shortage
24.
Dhanani
,
J.
,
Pang
,
G.
,
Pincus
,
J.
,
Ahern
,
B.
,
Goodwin
,
W.
,
Cowling
,
N.
,
Whitten
,
G.
,
Abdul-Aziz
,
M. H.
,
Martin
,
S.
,
Corke
,
P.
, and
Laupland
,
K. B.
,
2020
, “
Increasing Ventilator Surge Capacity in COVID 19 Pandemic: Design, Manufacture and in Vitro–in Vivo Testing in Anaesthetized Healthy Pigs of a Rapid Prototyped Mechanical Ventilator
,”
BMC Res. Notes
,
13
(
1
), p.
421
.10.1186/s13104-020-05259-z
25.
Szlosarek
,
R.
,
Teichert
,
R.
,
Wetzel
,
A.
,
Fichtner
,
A.
,
Reuter
,
F.
, and
Kröger
,
M.
,
2021
, “
Design and Construction of a Simplified, Gas-Driven, Pressure-Controlled Emergency Ventilator
,”
Afr. J. Emer. Med.
,
11
(
1
), pp.
175
181
.10.1016/j.afjem.2020.09.018
26.
Levin
,
M. A.
,
Shah
,
A.
,
Shah
,
R.
,
Kane
,
E.
,
Zhou
,
G.
,
Eisenkraft
,
J. B.
, and
Chen
,
M. D.
,
for the Mount Sinai HELPS Innovate
,
2020
, “
Differential Ventilation Using Flow Control Valves as a Potential Bridge to Full Ventilatory Support During the COVID-19 Crisis
,”
Anesthesiology
,
133
(
4
), pp.
892
904
.10.1097/ALN.0000000000003473
27.
Solis-Lemus
,
J. A.
,
Costar
,
E.
,
Doorly
,
D.
,
Kerrigan
,
E. C.
,
Kennedy
,
C. H.
,
Tait
,
F.
,
Niederer
,
S.
,
Vincent
,
P. E.
, and
Williams
,
S. E.
,
2020
, “
A Simulated Single Ventilator/Dual Patient Ventilation Strategy for Acute Respiratory Distress Syndrome During the COVID-19 Pandemic
,”
R. Soc. Open Sci.
,
7
(
8
), pp.
200585
12
.10.1098/rsos.200585
28.
Srinivasan
,
S. S.
,
Ramadi
,
K. B.
,
Vicario
,
F.
,
Gwynne
,
D.
,
Hayward
,
A.
,
Lagier
,
D.
,
Langer
,
R.
,
Frassica
,
J. J.
,
Baron
,
R. M.
, and
Traverso
,
G.
,
2020
, “
A Rapidly Deployable Individualized System for Augmenting Ventilator Capacity
,”
Sci. Transl. Med.
,
12
(
549
), p. eabb9401.10.1126/scitranslmed.abb9401
29.
Galbiati
,
C.
, Bonivento, W., Caravati, M., De Cecco, S., Dinon, T., Fiorillo, G., Franco, D., et al.,
2020
, “Mechanical Ventilator Milano (MVM): A Novel Mechanical Ventilator Designed for Mass Scale Production in Response to the COVID-19 Pandemics,”
medRxiv
.10.1101/2020.03.24.20042234
30.
Anesthesia Patient Safety Foundation, 2020, “Joint Statement on Multiple Patients Per Ventilator,” Anesthesia Patient Safety Foundation, Rochester, MN, accessed Jan. 11, 2021, https://www.apsf.org/news-updates/joint-statement-on-multiple-patients-per-ventilator
31.
Gaucher
,
D. J.
,
Trimble
,
A. Z.
,
Yamamoto
,
B. E.
,
Miller
,
S. F.
,
Vossler
,
J. D.
,
Mahoney
,
R. C.
,
Bellomy
,
R. L.
,
Heilbron
,
W. R.
,
Harvey
,
S. A.
,
Johnson
,
S. M.
,
Puapong
,
D. P.
, and
Woo
,
R. K.
,
2021
, “
The Multisplit Ventilator System: Design and Function of a Regulated, Shared Ventilator System
,”
ASME J. Med. Devices
,
15
(
2
), p.
021008
.10.1115/1.4049397
32.
NIH NHLBI ARDS Clinical Network, 2021, “NIH NHLBI ARDS Clinical Network Mechanical Ventilation Protocol Summary,” NIH NHLBI ARDS Clinical Network, Boston, MA, accessed Jan. 9, 2021, http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf
33.
Desai
,
J. P.
, and
Moustarah
,
F.
,
2021
,
Pulmonary Compliance
,
StatPearls Publishing
,
Treasure Island, FL
.
34.
Pinson
,
H.
,
2020
, “
A Better Way of Connecting Multiple Patients to a Single Ventilator
,” Medium, online, accessed Jan. 9, 2021, https://medium.com/@pinsonhannah/a-better-way-of-connecting-multiple-patients-to-a-single-ventilator-fa9cf42679c6
35.
Clarke
,
A. L.
,
2020
, “
3D Printed Circuit Splitter and Flow Restriction Devices for Multiple Patient Lung Ventilation Using One Anaesthesia Workstation or Ventilator
,”
Anaesthesia
,
75
(
6
), pp.
819
820
.10.1111/anae.15063
36.
Han
,
J. S.
,
Mashari
,
A.
,
Singh
,
D.
,
Dianti
,
J.
,
Goligher
,
E.
,
Long
,
M.
,
Ng
,
W.
,
Wasowicz
,
M.
,
Preiss
,
D.
,
Vesely
,
A.
,
Kacmarek
,
R.
,
Keshavjee
,
S.
,
Brochard
,
L.
,
Fisher
,
J. A.
, and
Slutsky
,
A. S.
,
2020
, “
Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept
,”
Crit. Care Explor.
,
2
(
5
), p.
e0118
.10.1097/CCE.0000000000000118
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