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Research ArticleOriginal Research

Multiplex Ventilation: A Simulation-Based Study of Ventilating 2 Patients With a Single Ventilator

Robert L Chatburn, Richard D Branson and Umur Hatipoğlu
Respiratory Care July 2020, 65 (7) 920-931; DOI: https://doi.org/10.4187/respcare.07882
Robert L Chatburn
Department of Respiratory Therapy, Cleveland Clinic, Cleveland, Ohio.
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  • For correspondence: [email protected]
Richard D Branson
Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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Umur Hatipoğlu
Department of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio.
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Abstract

BACKGROUND: The overwhelming demand for mechanical ventilators due to COVID-19 has stimulated interest in using one ventilator for multiple patients (ie, multiplex ventilation). Despite a plethora of information on the internet, there is little supporting evidence and no human studies. The risk of multiplex ventilation is that ventilation and PEEP effects are largely uncontrollable and depend on the difference between patients’ resistance and compliance. It is not clear whether volume control ventilation or pressure control ventilation is safer or more effective. We designed a simulation-based study to allow complete control over the relevant variables to determine the effects of various degrees of resistance-compliance imbalance on tidal volume (VT), end-expiratory lung volume (EELV), and imputed pH.

METHODS: Two separate breathing simulators were ventilated with a ventilator using pressure control and volume control ventilation modes. Evidence-based lung models simulated a range of differences in resistance and compliance (6 pairs of simulated patients). Differences in VT, EELV, and imputed pH were recorded.

RESULTS: Depending on differences in resistance and compliance, differences in VT ranged from 1% (with equal resistance and compliance) to 79%. Differences in EELV ranged from 2% to 109%, whereas differences in pH ranged from 0% to 5%. Failure due to excessive VT (ie, > 8 mL/kg) did not occur, but failure due to excessive EELV difference (ie, > 10%) was evident in 50% of patient pairs. There was no difference in failure rate between volume control and pressure control ventilation modes.

CONCLUSIONS: These experiments confirmed the potential for markedly different ventilation and oxygenation for patients with uneven respiratory system impedances during multiplex ventilation. Three critical problems must be solved to minimize risk: (1) partitioning of inspiratory flow from the ventilator individually between the 2 patients, (2) measurement of VT delivered to each patient, and (3) provision for individual PEEP. We provide suggestions for solving these problems.

  • mechanical ventilation
  • ventilator modes
  • disaster medicine

Footnotes

  • Correspondence: Robert L Chatburn MHHS RRT RRT-NPS FAARC. E-mail: chatbur{at}ccf.org
  • Mr Chatburn has disclosed relationships with IngMar Medical, and Vyaire Medical. Mr Branson has disclosed relationships with Mallinckrodt, Ventec Life Systems, and Zoll Medical Corporation. Dr Hatipoğlu has disclosed no conflicts of interest.

  • SEE THE RELATED EDITORIAL ON PAGE 1059

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (7)
Respiratory Care
Vol. 65, Issue 7
1 Jul 2020
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Multiplex Ventilation: A Simulation-Based Study of Ventilating 2 Patients With a Single Ventilator
Robert L Chatburn, Richard D Branson, Umur Hatipoğlu
Respiratory Care Jul 2020, 65 (7) 920-931; DOI: 10.4187/respcare.07882

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Multiplex Ventilation: A Simulation-Based Study of Ventilating 2 Patients With a Single Ventilator
Robert L Chatburn, Richard D Branson, Umur Hatipoğlu
Respiratory Care Jul 2020, 65 (7) 920-931; DOI: 10.4187/respcare.07882
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