Harnisch Lars-Olav, Czock Christian, Levin Matthew A, Wieditz Johannes, Saager Leif, Meissner Konrad, Moerer Onnen
Department of Anaesthesiology, University Medical Center, Georg-August-University, Göttingen, Germany.
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
PLoS One. 2025 Aug 7;20(8):e0328813. doi: 10.1371/journal.pone.0328813. eCollection 2025.
The concept of ventilating multiple patients concurrently using a single ventilator has been proposed as a solution when the demand for ventilators surpasses the available supply. While the practicality of this approach has been established, a thorough evaluation of the risks involved has yet to be comprehensively addressed.
Two circuits, a simple one (circuit-1) and another with an adjustable resistance valve (circuit-2), were evaluated within an experimental framework utilizing two computer-controlled lung simulators (TestChest and ASL 5000). These simulators were ventilated by an ICU (intensive care unit) ventilator (Servo-u) employing various ventilation modes (volume- and pressure-controlled ventilation). The study was conducted under differing respiratory conditions, characterized by low compliance (20 ml/cmH2O) as well as normal-high compliance (100 ml/cmH2O), in order to ascertain the applied tidal volume (VT), pressures, and the resultant mechanical power (MP).
Circuit-1: The applied VT, pressures, and MP differed significantly between the two simulators, as well as in relation to ventilation mode, compliance, and respiratory rate (RR) (p < 0.001); the differences were most pronounced in settings with differing compliance levels. Circuit-2: Differences in VT, pressures, and MP were observed between simulators concerning valve settings (p < 0.001). The VT demonstrated a negative correlation, with volumes derived from valve closure spanning from 50 to 100 ml across all settings. In the design of circuit-2, MP exceeded the 12 J/min threshold in both lung simulators at elevated RR and could only be decreased through valve closure followed by a consequential hypoventilation in one simulator.
The simultaneous ventilation of two patients using a single ventilator is technically viable, yet it presents considerable risks. Even with the integration of an adjustable resistance valve to accommodate varying lung complexities, the likelihood of unilateral hypoventilation and elevated mechanical stress remains high.
当呼吸机需求超过可用供应量时，有人提出使用一台呼吸机同时为多名患者通气的概念作为解决方案。虽然这种方法的实用性已经得到证实，但对其中涉及风险的全面评估尚未得到充分解决。
在一个实验框架内，利用两台计算机控制的肺模拟器（TestChest和ASL 5000）对两个回路进行了评估，一个是简单回路（回路1），另一个带有可调节阻力阀（回路2）。这些模拟器由一台重症监护病房（ICU）呼吸机（Servo-u）采用各种通气模式（容量控制通气和压力控制通气）进行通气。该研究在不同的呼吸条件下进行，其特征为低顺应性（20 ml/cmH2O）以及正常至高顺应性（100 ml/cmH2O），以确定施加的潮气量（VT）、压力以及由此产生的机械功率（MP）。
回路1：两台模拟器之间以及与通气模式、顺应性和呼吸频率（RR）相关的施加VT、压力和MP存在显著差异（p < 0.001）；在不同顺应性水平的设置中差异最为明显。回路2：模拟器之间在阀门设置方面观察到VT、压力和MP的差异（p < 0.001）。VT呈现负相关，在所有设置下，阀门关闭时产生的气量范围为50至100 ml。在回路2的设计中，在较高RR时，两台肺模拟器中的MP均超过12 J/min阈值，并且在一台模拟器中只能通过关闭阀门随后导致通气不足来降低。
使用一台呼吸机同时为两名患者通气在技术上是可行的，但存在相当大的风险。即使集成了可调节阻力阀以适应不同的肺部复杂性，单侧通气不足和机械应力升高的可能性仍然很高。
