Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island.
Department of Emergency Medicine, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island.
Respir Care. 2021 May;66(5):758-768. doi: 10.4187/respcare.08446. Epub 2020 Dec 9.
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.
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.
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.
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.
在危机时期，可能需要使用双患者、单呼吸机协议（即使用单个传统呼吸机为 2 名患者通气的协议）。本研究展示了一种在通过双患者、单呼吸机回路通气的测试肺中滴定峰吸气压（PIP）、呼气末正压（PEEP）和[Formula: see text]的方法。
这项前瞻性观察研究使用连接到 2 个测试肺的呼吸机进行。对实验肺进行 PIP、PEEP 和[Formula: see text]的变化，而对照肺则不进行任何变化。从每个测试肺同时获得测量值。通过在吸气回路中添加 3D 打印电阻器来滴定 PIP。通过在呼气回路管上附加手动 PEEP 阀来滴定 PEEP。通过在呼吸机管路上添加分流器来滴定[Formula: see text]。
在实验肺中，PIP、PEEP 和[Formula: see text]能够可靠地和递增地滴定，在这些滴定过程中，对照肺中记录到一些显著但可管理的压力和[Formula: see text]变化。在具有相同和不同顺应性的肺中测量到类似的结果。
通过对回路进行简单、低成本的修改，使用双患者、单呼吸机回路可以可靠地调整压力和[Formula: see text]。在资源有限或危机环境中，这种创新可能具有救生作用。了解这些回路的相互作用对于确保其使用更安全至关重要。
