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Related Concept Videos

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Assessment of Ventilation II: Respiratory Depth and Rhythm01:29

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Simultaneous ventilation in the Covid-19 pandemic. A bench study.

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During the COVID-19 pandemic, a lower-level ventilator performed similarly to an ICU ventilator when sharing one machine between two patients. Pressure control is recommended for maintaining adequate tidal volume (VT) when lung compliance or resistance changes.

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Area of Science:

  • Mechanical Ventilation
  • Respiratory Physiology
  • Critical Care Medicine

Background:

  • The COVID-19 pandemic created a critical shortage of ventilators.
  • Sharing a single ventilator between multiple patients is a strategy to address equipment scarcity.
  • Assessing the performance of ventilators under such conditions is crucial for patient safety.

Purpose of the Study:

  • To evaluate tidal volume (VT) delivery and air recirculation when one ventilator is split between two test lungs.
  • To compare the performance of an ICU ventilator (V500) and a lower-level ventilator (Elisée 350) in a dual-lung setup.
  • To analyze the impact of varying lung compliance (C) and resistance (R) on ventilator performance.

Main Methods:

  • Two test lungs (QuickLung) with specified compliance and resistance settings were connected to a flow-splitter.
  • An ICU ventilator (V500) and a lower-level ventilator (Elisée 350) were tested in both volume and pressure control modes, aiming for an 800mL VT.
  • Tidal volume, pendelluft air, and expiratory resistance were measured using a pneumotachograph and analyzed via non-parametric tests.

Main Results:

  • Both ventilators demonstrated significant differences in VT delivery across various compliance and resistance settings (P<0.001).
  • The lower-level ventilator (Elisée 350) showed comparable performance to the ICU ventilator (V500) in the dual-lung configuration.
  • Pendelluft air volume ranged from 0.7 to 37.8 mL and was inversely correlated with expiratory resistance in specific steps.

Conclusions:

  • Lower-level ventilators can perform adequately when sharing a single unit between two patients.
  • In clinical practice, pressure control mode is advisable for ensuring adequate VT, especially when lung mechanics fluctuate.
  • Careful monitoring of VT is essential, and increasing expiratory resistance may help minimize pendelluft air volume.