Virusinfektion und fehlende Beatmungsgeräte – ein Déjà-vu?

Briegel, Josef

doi:10.1007/s00101-020-00782-x

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…This remains an ethical dilemma that can only be answered in a situation of acute crisis. 28 29 Accordingly, although it works perfectly in this laboratory setting, such a setting is only conceivable in a desperate situation for a limited time after emergency intubation in deeply sedated patients to bridge until a second ventilator becomes available. 30 31 Furthermore, our data, if applicable, only support the use of the specific ventilator used in this study; the use of another ventilator may require a substantially different approach.…”

Section: Discussionmentioning

confidence: 99%

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

Schepat,

Kober,

Eble

et al. 2024

Med Gas Res

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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.

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Section: Discussionmentioning

confidence: 99%

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

Schepat,

Kober,

Eble

et al. 2024

Med Gas Res

View full text Add to dashboard Cite

show abstract

“…As a result, death tolls rose dramatically in these regions. [9] Case reports from the U.S. show that despite concerns of the SCCM, comparable systems had been used at the height of the Pandemic in spring 2020 [ [4, 6, 9] ] . Governor Cuomo of New York explicitly authorised the use of such systems on March 26th, 2020 [3]; we do not know how countries with less sophisticated intensive care medicine systems handled this challenge.…”

Section: Discussionmentioning

confidence: 99%

Simulated Ventilation of two Patients with a Single Ventilator in a Pandemic Setting

Schepat¹,

Kober²,

Eble³

et al. 2021

Preprint

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Background: Simultaneous ventilation of two patients, e.g. due to a shortage of ventilators in a pandemic, may result in hypoventilation in one patient and hyperinflation in the other patient. Methods: In a simulation of double patient ventilation using artificial lungs with equal compliances (70mL∙mbar-1), we tried to voluntarily direct gas flow to one patient by using 3D-printed y-adapters and stenosis adapters during volume-, and pressure-controlled ventilation. Subsequently, we modified the model using a special one-way valve on the limited flow side and measured in pressure-controlled ventilation with the flow sensor adjusted to either side in a second and third setup. In the last setup, we also measured with different lung compliances.Results: Volume- or pressure-controlled ventilation using standard connection tubes with the same compliance in each lung resulted in comparable minute volumes in both lungs, even if one side was obstructed to 3mm (6.6±0.2vs.6.5±0.1L for volume-controlled ventilation, p=.25 continuous severe alarm and 7.4±0.1vs.6.1±0.1L for pressure-controlled ventilation, p=.02 no alarm). In the second setup, pressure-controlled ventilation resulted at 3mm flow limitation in minute ventilation of 9.4±0.3vs3.5±0.1L∙min-1, p=.001. In a third setup using the special one-way valve and the flow sensor on the unobstructed side, pressure-controlled ventilation resulted at 3mm flow limitation in minute ventilation of 7.4±0.2vs3±0L∙min-1, at the compliance of 70mL∙mbar-1 for both lungs, 7.2±0vs4.1±0L∙ min-1, at the compliances of 50 vs. 70mL∙mbar-1, and 7.2±0.2vs5.7±0L∙ min-1, at the compliance of 30 vs. 70mL∙mbar-1 (all p=.001).Conclusions: Overriding a modern intensive care ventilator's safety features are possible, thereby ventilating two lungs with one ventilator simultaneously in a laboratory simulation using 3D-printed y-adapters. Directing tidal volumes in different pulmonary conditions towards one lung using 3D-printed flow limiters with diameters <6mm was also possible. While this ventilation setting was technically feasible in a bench model, it would be volatile, if not dangerous in a clinical situation.

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“…As a result, death tolls rose dramatically in these regions. [9] Case reports from the U.S. show that despite the concerns of the SCCM, comparable systems had been used at the height of the Pandemic in spring 2020 [4,6,9]. Governor Cuomo of New York explicitly authorised the use of such systems on March 26th, 2020 [3]; we do not know how countries with less sophisticated intensive care medicine systems handle this challenge.…”

Section: Discussionmentioning

confidence: 99%

Simulated Ventilation of Two Patients With a Single Ventilator in a Pandemic Setting

Schepat

Kober²,

Eble

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Simultaneous ventilation of two patients, e.g., due to a shortage of ventilators in a pandemic, may result in hypoventilation in one patient and hyperinflation in the other patient. Methods: In a simulation of double patient ventilation using artificial lungs with equal compliances (70mL∙mbar-1), we tried to voluntarily direct gas flow to one patient by using 3D-printed y-adapters and stenosis adapters during volume-, and pressure-controlled ventilation. Subsequently, we modified the model using a special one-way valve on the limited flow side and measured in pressure-controlled ventilation with the flow sensor adjusted on either side in a second and third setup. In the last setup, we also measured with different lung compliances.Results: Volume- or pressure-controlled ventilation using standard connection tubes with the same compliance in each lung resulted in comparable minute volumes in both lungs, even if one side was obstructed to 3mm (6.6±0.2vs.6.5±0.1L for volume-controlled ventilation, p=.25 continuous severe alarm and 7.4±0.1vs.6.1±0.1L for pressure-controlled ventilation, p=.02 no alarm). In the second setup, pressure-controlled ventilation resulted at a 3mm flow limitation in minute ventilation of 9.4±0.3vs3.5±0.1L∙min-1, p=.001. In a third setup using the special one-way valve and the flow sensor on the unobstructed side, pressure-controlled ventilation resulted at a 3mm flow limitation in minute ventilation of 7.4±0.2vs3±0L∙min-1, at the compliance of 70mL∙mbar-1 for both lungs, 7.2±0vs4.1±0L∙ min-1, at the compliances of 50 vs. 70mL∙mbar-1, and 7.2±0.2vs5.7±0L∙ min-1, at the compliance of 30 vs. 70mL∙mbar-1 (all p=.001).Conclusions: Overriding a modern intensive care ventilator's safety features are possible, thereby ventilating two lungs with one ventilator simultaneously in a laboratory simulation using 3D-printed y-adapters. Directing tidal volumes in different pulmonary conditions towards one lung using 3D-printed flow limiters with diameters <6mm was also possible. While this ventilation setting was technically feasible in a bench model, it would be volatile, if not dangerous in a clinical situation.

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Virusinfektion und fehlende Beatmungsgeräte – ein Déjà-vu?

Cited by 3 publications

References 6 publications

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

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

Simulated Ventilation of two Patients with a Single Ventilator in a Pandemic Setting

Simulated Ventilation of Two Patients With a Single Ventilator in a Pandemic Setting

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