One ventilator for two patients: feasibility and considerations of a last resort solution in case of equipment shortage

Ventilator Sharing Using Volume-controlled Ventilation during the COVID-19 Pandemic

“…This is distinct from pressure-controlled ventilation used by Beitler and colleagues, and the ability to deliver individualized volumes would permit the correction of respiratory alkaloses and acidosis without the addition or removal of dead space, respectively, to the circuit, as was required in their study. Beitler and colleagues matched patients by exact ventilator requirements, and a recent in vitro study by Tonetti and colleagues proposes matching patients by compliance ( 2 ). Matching compliance is both inherently challenging and potentially harmful, as it varies over time.…”

Two for one with split- or co-ventilation at the peak of the COVID-19 tsunami: is there any role for communal care when the resources for personalised medicine are exhausted?

“…2 3 Tonetti and colleagues describe a simple circuit which can be used to ventilate two patients with one ventilator and report on its use in mechanical lung models of differing compliance and resistance. 4 While this report again demonstrates the technical feasibility of ventilating multiple patients with a single ventilator, there are many areas of caution to consider before widespread implementation of this technique in the current pandemic.…”

“…Given the above issues, if co-ventilation is to be used, it should only be as an absolute last resort after all other available resources and options have been exhausted, as clearly stated by the authors of this report. 4 Co-ventilation should occur under a prospective protocol approved by an institutional review or ethics board. If co-ventilation is used, the process should be standardised, thoughtful and not driven by subjective decisions made at the bedside.…”

Successful ventilation of two animals with a single ventilator: individualized shared ventilator setup in an in vivo model

“…As the ongoing COVID-19 crisis is spreading from developed into developing nations, a shortage of ventilators in ICUs can be expected during peak prevalence. Sharing a ventilator among patients has been put forward as a rescue solution [1,2]; in this setting, the so-called pairing of patients with similar characteristics is needed [3][4][5]. We have developed a modified shared ventilator design that allows for individualization of tidal volumes and driving pressures, positive end-expiratory pressure (PEEP), and inspired oxygen fraction (FiO 2 ) [6], which can thus substantially individualize the delivered breaths, removing the need of pairing (see Fig.…”