Benjamin Kozyak, MD
Attending Physician, Cardiac Critical Care Medicine
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Yale Goldman, MD PhD
Professor of Physiology; Professor of Engineering & Applied Mechanics
The University of Pennsylvania
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title: Independent Pressure Regulation Enables Safe Multi-Patient Ventilation without Adverse Interactions
Background: The ongoing COVID-19 pandemic has severely strained critical care resources worldwide. Although abating in some areas, new variants may cause vaccine-resistant resurgence, and future pandemics have the potential to be even more severe. Ventilator-sharing has the potential to address equipment shortages in time of crisis, but has generated controversy due to concerns over adverse inter-patient interactions. Our objective was to design and test a robust, low-cost ventilator multiplication device that would adequately mitigate these risks, safely augmenting capacity while minimizing burden on staff and infrastructure.
Methods: We developed a novel, streamlined ventilation multiplier that we hypothesized would maintain stable, independent pressure-control parameters for each patient in the face of wide swings in the other. Inspiratory and expiratory pressures are independently adjusted by mechanical controls. Inexpensive electronics deliver monitoring and individualized alarms to provider devices. Two simulated patients were connected to a single mechanical ventilator via the MultiVent device. Perturbations of pressure and compliance in one simulated patient were made, while monitoring the pressure waveform and tidal volume delivered to the paired patient.
Results and
Conclusions: The device effectively maintained desired pressure-control ventilation parameters to each simulated patient under multiple perturbations. Abrupt changes were made to Patient A, including large changes in compliance as well as adjustments to the pressures prescribed. In all cases, Patient B maintained stable pressures and tidal volumes, with no adjustments needed. Although other ventilator splitters have been reported, this is the first description of an integrated device that independently regulates both inspiratory and expiratory pressure for each patient. In doing so, it enables individualized pressure-control ventilation that is resilient to changes in the lung mechanics and support requirements of paired patients. The device presented here addresses many concerns that have been voiced related to ventilator-sharing. Supporting multiple patients from a single ventilator may be feasible in times of pandemic respiratory failure or in places with severely constrained resources, when conventional ventilator supplies are inadequate.