Increasing ventilator surge capacity in disasters: Ventilation of four adult-human-sized sheep on a single ventilator with a modified circuit

Paladino, Lorenzo; Silverberg, Mark; Charchaflieh, Jean; Eason, Julie K.; Wright, Brian J.; Palamidessi, Nicholas; Arquilla, Bonnie; Sinert, Richard; Manoach, Seth

doi:10.1016/j.resuscitation.2007.10.016

Cited by 110 publications

(97 citation statements)

References 24 publications

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“…This system would be superior to the one suggested by Neyman and Irvin. 6 The major findings of our study are that, while equivalent ventilation can be provided when compliance and ETT size are identical, differences in compliance can result in a wide variation in delivered V T , and since PEEP is constant, FRC is variable as well. Changes in ETT size alone resulted in variable V T , but to a lesser extent, compared to compliance changes.…”

Section: Discussionmentioning

confidence: 75%

“…[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%

“…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%

“…Paladino and colleagues followed that observation with an animal study using 4 sheep with normal lungs. 6 In this trial there were significant differences in gas exchange, requiring frequent blood gas evaluations and manipulation of animal position to maintain homeostasis. While each of these investigations have been criticized at length, 7,8 support for this idea continues.…”

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: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…97 Both Rab25 and Rab11 overexpression augmented the pace of cell migration by affecting small-scale fast recycling within the tips of the cell and basal long-distance transport from the rear end to the front of the migrating cell, respectively, in HeLa and MDA-MB 231 cell lines. 98 Rab5, a GTPase essential for early endosomal formation and trafficking, is involved in lamellipodia formation and actin remodeling in response to growth factor stimulation 99,100 and this may be attributed to tyrosine signaling and subsequent activation of Ras and Rab5 GAPs. 101,102 It is expressed differentially in cancer cells where Yu and others identified Rab5a as a potential major factor in the transformation of tumor cells in human lung adenocarcinoma, to an aggressive phenotype where overexpression of Rab5a was associated with increasing metastatic capacity.…”

Section: 93mentioning

confidence: 99%

The role of endocytic Rab GTPases in regulation of growth factor signaling and the migration and invasion of tumor cells

Porther

Barbieri

2015

Small GTPases

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Metastasis is characterized pathologically by uncontrolled cell invasion, proliferation, migration and angiogenesis. It is a multistep process that encompasses the modulation of membrane permeability and invasion, cell spreading, cell migration and proliferation of the extracellular matrix, increase in cell adhesion molecules and interaction, decrease in cell attachment and induced survival signals and propagation of nutrient supplies (blood vessels). In cancer, a solid tumor cannot expand and spread without a series of synchronized events. Changes in cell adhesion receptor molecules (e.g., integrins, cadherin-catenins) and protease expressions have been linked to tumor invasion and metastasis. It has also been determined that ligand-growth factor receptor interactions have been associated with cancer development and metastasis via the endocytic pathway. Specifically, growth factors, which include IGF-1 and IGF-2 therapy, have been associated with most if not all of the features of metastasis. In this review, we will revisit some of the key findings on perhaps one of the most important hallmarks of cancer metastasis: cell migration and cell invasion and the role of the endocytic pathway in mediating this phenomenon

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Answering the Challenge of COVID-19 Pandemic Through Innovation and Ingenuity

Kelley

Kamler

Stawicki

2021

Advances in Experimental Medicine and Biology

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Increasing ventilator surge capacity in disasters: Ventilation of four adult-human-sized sheep on a single ventilator with a modified circuit

Cited by 110 publications

References 24 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

The role of endocytic Rab GTPases in regulation of growth factor signaling and the migration and invasion of tumor cells

Answering the Challenge of COVID-19 Pandemic Through Innovation and Ingenuity

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