Covid 19, several patients on one ventilator, with interpatient compliance inequality settlement.

See also our blog for the improved system. https://medium.com/@ pinsonhannah/a-better-way- of-connecting-multiple-patients-to-a-single-ventilator-fa9cf42679 c6 and https://youtu.be/JzvjM9iHuZ0 and https://youtu.be/1Hci-FGUh8o

This is a description of a setup for aerating numerous patiënts by splitting a ventilator. It is a test setup. We decrease any duty for utilizing this technique in genuine patients.

This setup is for 2 patients, but you can extrapolate the setup to 4 patients by utilizing additional T-connectors. We customized the standard strategy for multiventilating currently suggested by other physicians ( https://emcrit.org/pulmcrit/split-ventilators/ ), by utilizing a rotary valve on the inspiratory limb for each client, that can be closed, so you can change the pressure and flow to each client individually with the patient particular valve.
So the ventilation can be titrated for each patient individually.

We think you can utilize any type of valve, as long as it can be closed and opened. This method you can compensate for a compliance mismatch in between the patients on your ventilator and titrate the ventilation individually in a rough way.

To our knowledge this kind of modified system as shown, has not been tested yet in real patients however our company believe that it can be a service in a catastrophe scenario when this is the only option left. This is not for standard scenarios, just in case of disasters and emergencies when there are excessive patients and not enough ventilators.

Adjusting the valves to each client and adjusting the main tidal volume requires to be done on a scientific basis, with basic tracking, with arterial blood gases if available and with capnography if available.

This setup has actually been tested for more than 48 hours continously en with various settings: Volume control, pressure controle and different peep, and it appears that the peep is not lost however is kept in both systems. This needs further screening. There are issues for the build-up of auto-peep and hypercapnia in the circuit with the partially closed valve, and this needs to be investigated.

We added also on each expiratory limb an one-way valve to keep the system pressurized. Viral filters should be utilized to prevent cross-contamination of pathogens in between various patients.

The kind of valve we used can be obtained by means of the hospital technical assistance department or purchased in a do-it-yourself store. The internal diameter of our tubes is 22 mm, and they fit fairly well on these sort of valves. Most likely one can utilize any type of valve, as long as it can be gradually closed and opened.
The ventilator is being set at a pressure-cycled ventilation in a lung protective way for patient A with low driving pressure and relatively high PEEP. By using a rotary valve on the inspiratory limb for client B, the pressure can gradually be adjusted adhere the patient lung compliance. Thus fitting the ventilator to the patient and not the other method around. This way one can make up for a compliance mismatch in between the different patients on the ventilator.
It’s possible to extrapolate this strategy to more patients, depending on the regional ventilator capacity, by using two additional T-connectors per extra patient and a rotary valve per inspiratory line and a one-way valve per expiratory line. Very crucial is making use of the expiratory valves, this is comfirmed by other healthcare facilities who are evaluating the system as well, after seeing this video.

We suggest to use one-way valves on the expiratory limbs since on the ventilator used in our setup, the pressure is rerouted from inspiratory to expiratory side through our ventilator, therefore reducing the effect of the rotary valves when leaving out the one way valves. This was evaluated extensively and we couldn’t titrate separately without the one-way expiratory valves. We have actually not yet tested this on other ventilators. In anesthesia makers such valves typically already are integrated. You require to examine this before making your own system! More testing and examining is necessary.

Unique thanks to Dr. Evy Voets and Dr. Luc Janssen of the anaesthesiology and vital care department, Dr. Michiel Stiers (Emergency situation department), Dr. Harald De cauwer (Neurology department) and to all other members of the Anesthesia – important care personnel. We would likewise like to thank Mr. Luc Geens from our technical staff and Ir.
We likewise want to thank Hannah Pinson and all others @coronadenktank!

Interaction can be done via www.ziekenhuisgeel.be or https://www.ziekenhuisgeel.be/contacteer-ons

Scienfitific post has actually been sent 19 march, waiting on acceptance.

https://covid19globalcases.com/covid-19-several-patients-on-one-ventilator-with-interpatient-compliance-inequality-settlement/