Use of a novel “Split” ventilation system in bench and porcine modeling of acute respiratory distress syndrome

Split ventilation (using a single ventilator to ventilate multiple patients) is technically feasible. However, connecting two patients with acute respiratory distress syndrome (ARDS) and differing lung mechanics to a single ventilator is concerning. This study aimed to: (1) determine functionality of a split ventilation system in benchtop tests, (2) determine whether standard ventilation would be superior to split ventilation in a porcine model of ARDS and (3) assess usability of a split ventilation system with minimal specific training. The functionality of a split ventilation system was assessed using test lungs. The usability of the system was assessed in simulated clinical scenarios. The feasibility of the system to provide modified lung protective ventilation was assessed in a porcine model of ARDS (n = 30). In bench testing a split ventilation system independently ventilated two test lungs under conditions of varying compliance and resistance. In usability tests, a high proportion of naïve operators could assemble and use the system. In the porcine model, modified lung protective ventilation was feasible with split ventilation and produced similar respiratory mechanics, gas exchange and biomarkers of lung injury when compared to standard ventilation. Split ventilation can provide some elements of lung protective ventilation and is feasible in bench testing and an in vivo model of ARDS.

[1]  Arturo Briva,et al.  Mechanical Risks of Ventilator Sharing in the COVID-19 Era: A Simulation-Based Study , 2020, Archivos de Bronconeumología (English Edition).

[2]  T. Schepens,et al.  Successful ventilation of two animals with a single ventilator: individualized shared ventilator setup in an in vivo model , 2020, Critical Care.

[3]  Michael Kim,et al.  Rapid Ventilator Splitting During COVID-19 Pandemic Using 3D Printed Devices and Numerical Modeling of 200 Million Patient Specific Air Flow Scenarios , 2020, Research square.

[4]  L. Brochard,et al.  Ventilator Sharing during Shortages. A Siren’s Song? , 2020, American journal of respiratory and critical care medicine.

[5]  Laureen L. Hill,et al.  Ventilator Sharing during an Acute Shortage Caused by the COVID-19 Pandemic , 2020, American journal of respiratory and critical care medicine.

[6]  R. Ahmed,et al.  Innovative Use of High-Fidelity Lung Simulators to Test a Ventilator Splitter Device , 2020, A&A practice.

[7]  J. Laffey,et al.  Supporting more than one patient with a single mechanical ventilator: useful last resort or unjustifiable risk? , 2020, British Journal of Anaesthesia.

[8]  Jhaymie Cappiello,et al.  Shared Ventilation: Toward Safer Ventilator Splitting in Resource Emergencies , 2020, Anesthesiology.

[9]  Robert Langer,et al.  A rapidly deployable individualized system for augmenting ventilator capacity , 2020, Science Translational Medicine.

[10]  David W. Kaczka,et al.  Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions , 2020, Respiratory Care.

[11]  Arthur S Slutsky,et al.  Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept , 2020, Critical care explorations.

[12]  Daniel Cook.  Implementing shared ventilation must be scientific and ethical, or it risks harm , 2020, British Journal of Anaesthesia.

[13]  S. Nava,et al.  One ventilator for two patients: feasibility and considerations of a last resort solution in case of equipment shortage , 2020, Thorax.

[14]  D. Reich,et al.  Differential Ventilation Using Flow Control Valves as a Potential Bridge to Full Ventilatory Support during the COVID-19 Crisis , 2020, medRxiv.

[15]  T. J. Byrne,et al.  Coping with COVID‐19: ventilator splitting with differential driving pressures using standard hospital equipment , 2020, Anaesthesia.

[16]  Megan L Ranney,et al.  Critical Supply Shortages - The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. , 2020, The New England journal of medicine.

[17]  Lisa Rosenbaum,et al.  Facing Covid-19 in Italy - Ethics, Logistics, and Therapeutics on the Epidemic's Front Line. , 2020, The New England journal of medicine.

[18]  American Association of Critical-Care Nurses (AACN) , 2019, The Grants Register 2020.

[19]  M. Balaan,et al.  Acute Respiratory Distress Syndrome , 2016, Critical care nursing quarterly.

[20]  L. Pazart,et al.  Performance of manual ventilation: how to define its efficiency in bench studies? A review of the literature* , 2015, Anaesthesia.

[21]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[22]  Brian P. Kavanagh,et al.  Ventilator-induced lung injury. , 2013, The New England journal of medicine.

[23]  Thomas C Blakeman,et al.  Use of a Single Ventilator to Support 4 Patients: Laboratory Evaluation of a Limited Concept , 2012, Respiratory Care.

[24]  R. Smith,et al.  Simultaneous ventilation of two healthy subjects with a single ventilator , 2009, Resuscitation.

[25]  R. Sinert,et al.  Increasing ventilator surge capacity in disasters: ventilation of four adult-human-sized sheep on a single ventilator with a modified circuit. , 2008, Resuscitation.

[26]  P. Parsons,et al.  Pathogenetic significance of biological markers of ventilator-associated lung injury in experimental and clinical studies. , 2006, Chest.

[27]  Rrt Richard D. Branson MSc.  A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge , 2006 .

[28]  C. Irvin,et al.  A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge , 2006, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[29]  J. Siddiqui,et al.  Role of Interleukin-6 in Mortality from and Physiologic Response to Sepsis , 2005, Infection and Immunity.

[30]  G. Bernard,et al.  Lower tidal volume ventilation and plasma cytokine markers of inflammation in patients with acute lung injury* , 2005, Critical care medicine.

[31]  G Saumon,et al.  Ventilator-Induced Lung Injury , 2009 .

[32]  A. Hoeft,et al.  Kinetic and reversibility of mechanical ventilation-associated pulmonary and systemic inflammatory response in patients with acute lung injury , 2002, Intensive Care Medicine.

[33]  Douglas G Altman,et al.  Guidelines for the design and statistical analysis of experiments using laboratory animals. , 2002, ILAR journal.

[34]  Arthur S Slutsky,et al.  Effects of mechanical ventilation of isolated mouse lungs on surfactant and inflammatory cytokines. , 2001, The European respiratory journal.

[35]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[36]  Peter M. Suter,et al.  Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. , 1999, JAMA.

[37]  Arthur S Slutsky,et al.  Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. , 1997, The Journal of clinical investigation.

[38]  Y. Benjamini,et al.  Controlling the false discovery rate: a practical and powerful approach to multiple testing , 1995 .

[39]  George C. Derringer,et al.  The design of experiments: Statistical principles for practical applications. , 1990 .