A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge

Neyman, Greg; Irvin, C.B.

doi:10.1111/j.1553-2712.2006.tb01657.x

Cited by 66 publications

(93 citation statements)

References 4 publications

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“…However, given the original description that did not provide any scientific measurements 5 and the follow-on animal trial, 6 this trial is justified to highlight limitations of a single ventilator for 4 patients concept.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] While these remedies continue to be pursued, no mass-casualty respiratory failure event with too many patients and too few ventilators has thus far been encountered. The idea of using one ventilator to provide ventilation for more than one patient has been discussed by others.…”

Section: Discussionmentioning

confidence: 99%

“…A modified ventilator circuit, as described by Neyman and Irvin, was connected to the ventilator outlet. 5 The outlet of the ventilator led to a T-piece that split the outlet in 2 and then into 2 additional T-pieces, thus creating 4 outlets for gas flow (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…5 This paper did not subject the observations to any scientific measurement or critical evaluation. Paladino and colleagues followed that observation with an animal study using 4 sheep with normal lungs.…”

Section: Introductionmentioning

confidence: 99%

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Use of a Single Ventilator to Support 4 Patients: Laboratory Evaluation of a Limited Concept

et al. 2012

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INTRODUCTION:A mass-casualty respiratory failure event where patients exceed available ventilators has spurred several proposed solutions. One proposal is use of a single ventilator to support 4 patients. METHODS: A ventilator was modified to allow attachment of 4 circuits. Each circuit was connected to one chamber of 2 dual-chambered, test lungs. The ventilator was set at a tidal volume (V T ) of 2.0 L, respiratory frequency of 10 breaths/min, and PEEP of 5 cm H 2 O. Tests were repeated with pressure targeted breaths at 15 cm H 2 O. Airway pressure, volume, and flow were measured at each chamber. The test lungs were set to simulate 4 patients using combinations of resistance (R) and compliance (C). These included equivalent C and R, constant R and variable C, constant C and variable R, and variable C and variable R. Results. When R and C were equivalent the V T distributed to each chamber of the test lung was similar during both volume (range 428 -442 mL) and pressure (range 528 -544 mL) breaths. Changing C while R was constant resulted in large variations in delivered V T (volume range 257-621 mL, pressure range 320 -762 mL). Changing R while C was constant resulted in a smaller variation in V T (volume range 418 -460 mL, pressure range 502-554 mL) compared to only C changes. When R and C were both varied, the range of delivered V T in both volume (336 -517 mL) and pressure (417-676 mL) breaths was greater, compared to only R changes. CONCLUSIONS: Using a single ventilator to support 4 patients is an attractive concept; however, the V T cannot be controlled for each subject and V T disparity is proportional to the variability in compliance. Along with other practical limitations, these findings cannot support the use of this concept for mass-casualty respiratory failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of a Single Ventilator to Support 4 Patients: Laboratory Evaluation of a Limited Concept

et al. 2012

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“…Initially, the ICU of the MIH was understaffed. Staffing of the ICU and the amount of mechanical ventilators are always potential bottlenecks during a MCI [49][50][51]. Using the secondary calling system would have alarmed more ICU staff members as well as volunteers of the Dutch Red Cross, resulting in more helping hands.…”

Section: Discussionmentioning

confidence: 99%

Indoor fire in a nursing home: evaluation of the medical response to a mass casualty incident based on a standardized protocol

Koning

Ellerbroek

Leenen

2014

Eur J Trauma Emerg Surg

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Purpose This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home. Methods Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent research institute were used. The protocol for reports from major accidents and disaster was used to standardize the reporting [Lennquist, in Int J Disaster Med 1(1): [79][80][81][82][83][84][85][86] 2003]. Results The emergency services were quickly at the scene. The different levels of pre-hospital management performed a tight coordination. However, miscommunication led to confusion in the registration and tracking of patients. In total, 49 persons needed medical treatment, 46 were treated in the MIH. Because of (possible) inhalation injury nine patients needed mechanical ventilation and nine patients were hospitalized to exclude delayed onset of pulmonary symptoms. No incident related deaths occurred. The intensive care unit of the MIH was initially understaffed despite the efforts of the automated calling system and switchboard operators. The handwritten registration of incoming staff was incomplete and should be performed digitally. Some staff members were unfamiliar with the MIH procedures. The medical chart appeared too extensive. Miscommunication between chain partners resulted in the delayed sharing of (semi) medical information. Conclusion The different levels of incident managers performed a tight coordination. The MIH demonstrated its potency to provide emergency care for 46 patients and 9 intubated patients. No deaths or persistent disabilities occurred. Areas of improvement were recognized both in the pre-hospital as the hospital phase.

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Development of a multi-patient ventilator circuit with validation in an ARDS porcine model

et al. 2021

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Purpose The COVID-19 pandemic threatens our current ICU capabilities nationwide. As the number of COVID-19 positive patients across the nation continues to increase, the need for options to address ventilator shortages is inevitable. Multi-patient ventilation (MPV), in which more than one patient can use a single ventilator base unit, has been proposed as a potential solution to this problem. To our knowledge, this option has been discussed but remains untested in live patients with differing severity of lung pathology. Methods The objective of this study was to address ventilator shortages and patient stacking limitations by developing and validating a modified breathing circuit for two patients with differing lung compliances using simple, off-the-shelf components. A multi-patient ventilator circuit (MPVC) was simulated with a mathematical model and validated with four animal studies. Each animal study had two human-sized pigs: one healthy and one with lipopolysaccharide (LPS) induced ARDS. LPS was chosen because it lowers lung compliance similar to COVID-19. In a previous study, a control group of four pigs was given ARDS and placed on a single patient ventilation circuit (SPVC). The oxygenation of the MPVC ARDS animals was then compared to the oxygenation of the SPVC animals. Results Based on the comparisons, similar oxygenation and morbidity rates were observed between the MPVC ARDS animals and the SPVC animals. Conclusion As healthcare systems worldwide deal with inundated ICUs and hospitals from pandemics, they could potentially benefit from this approach by providing more patients with respiratory care. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02948-2.

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A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge

Cited by 66 publications

References 4 publications

Use of a Single Ventilator to Support 4 Patients: Laboratory Evaluation of a Limited Concept

Use of a Single Ventilator to Support 4 Patients: Laboratory Evaluation of a Limited Concept

Indoor fire in a nursing home: evaluation of the medical response to a mass casualty incident based on a standardized protocol

Development of a multi-patient ventilator circuit with validation in an ARDS porcine model

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