Implementing shared ventilation must be scientific and ethical, or it risks harm

Abstract

containment of both droplets and aerosols, the ability to clear the bag of aerosolised particles with negative air flow, and the protection of the operator and environment. Airway devices are supported on hooks, which increases the working space available. During a simulated airway management training session of our COVID-19 intubation team, direct vision, communication, and manoeuverability were accomplished for 12 operators. Even though our results are preliminary and qualitative in nature, we demonstrate proof of concept for an additional physical barrier during aerosol-generating procedures. We believe that this easily constructed barrier, and others, have the potential to protect healthcare providers in caring for confirmed or suspected COVID-19 patients. These include patients undergoing monitored anaesthesia care or regional anaesthesia, treated with noninvasive ventilation, in overcrowded emergency department or wards, in endoscopy/bronchoscopy suites, in radiology suites, and during patient transportation. We acknowledge that further research and testing are necessary to quantify the contamination level within the multipurpose portable negative air flow protection isolation chamber and whether it is possible to inactivate any virus before removal and doffing of the plastic drape and frame. We remain concerned that healthcare providers may develop a false sense of security if these barriers are used, so we strongly emphasise that local guidelines for PPE be maintained, and that new devices being developed during this healthcare crisis are used mainly as an additional complementary resource, not a replacement, to face the undeniable scarcity of PPE.

Supporting more than one patient with a single mechanical ventilator: useful last resort or unjustifiable risk?

“…16 We must also consider that shared ventilation will inevitably reduce the fidelity (and thus likely benefit) of the ventilation that would have been provided to a single patient (with their own ventilator), creating another ethical dilemma. 17 Thus, the decision to share a ventilator does not bring the same benefit as an additional ventilator would have brought. In that scenario, it might be argued that in many cases the 'net gain' (i.e.…”

Development and assessment of the performance of a shared ventilatory system that uses clinically available components to individualize tidal volumes

“…Any discussion of shared ventilation in the context of a strategy of last resort to preserve life must also acknowledge the significant and difficult ethical implications inherent in this act. This strategy necessitates depriving a single patient of 'standard-of-care' treatment in order to seek to preserve the life of two patients [24] . Taking this action in the absence of robust data of the efficacy of shared ventilation for COVID-19 patients is extremely challenging given that one cannot be certain that it will confer benefit.…”

COVID-19 Pandemic and Equal Access to Vaccines

“…With regard to the COVID-19 containment measures, access to treatment and access to vaccination are issues that demand careful assessment and decision making based on one of the recognized principles of bioethics, namely justice. In the initial phase of the pandemic, the insufficiency of available resources became apparent when compared with the treatment needs of patients, resulting in the need to determine more specific criteria in relation to access to certain treatments, especially that of intensive care [ 13 , 14 , 15 , 16 , 17 , 18 ]. The availability of the various vaccines posed certain problems concerning (1) proper administration to the world population and vaccine distribution methods to each nation on a global level, and (2) the order in which to vaccinate individuals and communities in individual nations.…”