Sakina H Sojar1, Austin M Quinn2, William H Bortcosh3, Paul C Decerbo4, Esther Chung5, Carolyn J La Vita5, Gregory D Jay2,4,6. 1. Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island. sakina_sojar@brown.edu. 2. Department of Emergency Medicine, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island. 3. Division of Pediatric Critical Care Medicine, University of Florida Shands Hospital, Gainesville, Florida. 4. Lifespan Simulation Center, Rhode Island Hospital, Providence, Rhode Island. 5. Division of Respiratory Therapy, Massachusetts General Hospital, Boston, Massachusetts. 6. School of Engineering, Brown University, Providence, Rhode Island.
Abstract
BACKGROUND: Dual-patient, single-ventilator protocols (ie, protocols to ventilate 2 patients with a single conventional ventilator) may be required in times of crisis. This study demonstrates a means to titrate peak inspiratory pressure (PIP), PEEP, and [Formula: see text] for test lungs ventilated via a dual-patient, single-ventilator circuit. METHODS: This prospective observational study was conducted using a ventilator connected to 2 test lungs. Changes in PIP, PEEP, and [Formula: see text] were made to the experimental lung, while no changes were made to the control lung. Measurements were obtained simultaneously from each test lung. PIP was titrated using 3D-printed resistors added to the inspiratory circuit. PEEP was titrated using expiratory circuit tubing with an attached manual PEEP valve. [Formula: see text] was titrated by using a splitter added to the ventilator tubing. RESULTS: PIP, PEEP, and [Formula: see text] were reliably and incrementally titratable in the experimental lung, with some notable but manageable changes in pressure and [Formula: see text] documented in the control lung during these titrations. Similar results were measured in lungs with identical and different compliances. CONCLUSIONS: Pressures and [Formula: see text] can be reliably adjusted when utilizing a dual-patient, single-ventilator circuit with simple, low-cost modifications to the circuit. This innovation could potentially be lifesaving in a resource-limited or crisis setting. Understanding the interactions of these circuits is imperative for making their use safer.
BACKGROUND: Dual-patient, single-ventilator protocols (ie, protocols to ventilate 2 patients with a single conventional ventilator) may be required in times of crisis. This study demonstrates a means to titrate peak inspiratory pressure (PIP), PEEP, and [Formula: see text] for test lungs ventilated via a dual-patient, single-ventilator circuit. METHODS: This prospective observational study was conducted using a ventilator connected to 2 test lungs. Changes in PIP, PEEP, and [Formula: see text] were made to the experimental lung, while no changes were made to the control lung. Measurements were obtained simultaneously from each test lung. PIP was titrated using 3D-printed resistors added to the inspiratory circuit. PEEP was titrated using expiratory circuit tubing with an attached manual PEEP valve. [Formula: see text] was titrated by using a splitter added to the ventilator tubing. RESULTS:PIP, PEEP, and [Formula: see text] were reliably and incrementally titratable in the experimental lung, with some notable but manageable changes in pressure and [Formula: see text] documented in the control lung during these titrations. Similar results were measured in lungs with identical and different compliances. CONCLUSIONS: Pressures and [Formula: see text] can be reliably adjusted when utilizing a dual-patient, single-ventilator circuit with simple, low-cost modifications to the circuit. This innovation could potentially be lifesaving in a resource-limited or crisis setting. Understanding the interactions of these circuits is imperative for making their use safer.
Authors: Helen Xun; Christopher Shallal; Justin Unger; Runhan Tao; Alberto Torres; Michael Vladimirov; Jenna Frye; Mohit Singhala; Brockett Horne; Bo Soo Kim; Broc Burke; Michael Montana; Michael Talcott; Bradford Winters; Margaret Frisella; Bradley S Kushner; Justin M Sacks; James K Guest; Sung Hoon Kang; Julie Caffrey Journal: 3D Print Med Date: 2022-09-14