Simulated ventilation of two patients with a single ventilator in a pandemic setting

Abstract

Simultaneous ventilation of two patients may lead to hypoventilation in one patient and hyperinflation in the other patient. In a simulation of ventilation in two patients using artificial lungs, we voluntarily directed gas flow to one patient by using three-dimensional-printed Y-adapters and stenosis adapters during volume- and pressure-controlled ventilation in the first set up. We continuously modified the model using a special one-way valve on the flow-limited side and measured it in pressure-controlled ventilation with the flow sensor of the ventilator adjusted on both sides in a second and third setup. In the first setup, volume- or pressure-controlled ventilation resulted in comparable minute volumes in both lungs, even when one side was obstructed to 3 mm. In the second setup, with a 3-mm flow limitation, we had a minute ventilation of 9.4 ± 0.3 vs . 3.5 ± 0.1 L/min. In the third setup, ventilation with a 3-mm flow limitation resulted in minute ventilation of 7.2 ± 0.2 vs . 5.70 L/min at a compliance of 30 vs . 70 mL/mbar. It is possible to override the safety features of a modern intensive care ventilator and thus direct tidal volumes in different lung conditions to one lung using three-dimensional-printed flow limiters. While this ventilation setting was technically feasible in a bench model, it would be unstable, if not dangerous, in a clinical situation.