From the Department of Biomedical Engineering, Yale University, New Haven, Connecticut.
Medical Scientist Training Program and.
Anesth Analg. 2022 May 1;134(5):1094-1105. doi: 10.1213/ANE.0000000000005825.
The coronavirus disease 2019 (COVID-19) pandemic has revealed that even the best-resourced hospitals may lack sufficient ventilators to support patients under surge conditions. During a pandemic or mass trauma, an affordable, low-maintenance, off-the-shelf device that would allow health care teams to rapidly expand their ventilator capacity could prove lifesaving, but only if it can be safely integrated into a complex and rapidly changing clinical environment. Here, we define an approach to safe ventilator sharing that prioritizes predictable and independent care of patients sharing a ventilator. Subsequently, we detail the design and testing of a ventilator-splitting circuit that follows this approach and describe our clinical experience with this circuit during the COVID-19 pandemic. This circuit was able to provide individualized and titratable ventilatory support with individualized positive end-expiratory pressure (PEEP) to 2 critically ill patients at the same time, while insulating each patient from changes in the other's condition. We share insights from our experience using this technology in the intensive care unit and outline recommendations for future clinical applications.
2019 年冠状病毒病（COVID-19）大流行表明，即使是资源最丰富的医院，在供应激增的情况下也可能缺乏足够的呼吸机来支持患者。在大流行或大规模创伤期间，如果有一种负担得起、低维护、现成的设备能够让医疗团队迅速扩大其呼吸机容量，那将证明是救命的，前提是它能够安全地融入复杂且快速变化的临床环境。在这里，我们定义了一种安全共享呼吸机的方法，该方法优先考虑共享呼吸机的患者可预测和独立的护理。随后，我们详细介绍了遵循这种方法的呼吸机分割电路的设计和测试，并描述了我们在 COVID-19 大流行期间使用该电路的临床经验。该电路能够同时为 2 名危重症患者提供个体化和可滴定的通气支持，并为每个患者提供个体化的呼气末正压（PEEP），同时使每个患者免受对方病情变化的影响。我们分享了在重症监护病房使用该技术的经验，并概述了未来临床应用的建议。
