II. Indications
- Number of patients requiring Mechanical Ventilation exceeds number of mechanical Ventilators
- Local resources are overun by patients in Respiratory Failure
- Pandemics (e.g. COVID-19)
- Mass Casualty Incident
- Resource Limited Environments where evacuation is delayed
III. Precautions
- Make use of all other reasonable alternatives before resorting to Mechanical Ventilator Sharing
- Repurpose available machines (e.g. operating room devices, positive pressure devices such as BiPap)
- Continued bag-valve mask (highly resource intensive) could be considered
- Consider offering Palliative Care measures for those with low likelihood of survival
- However, keep available reserve Ventilators for acute emergency stabilizations
- Ventilator Sharing may be life saving for those who would otherwise not have a Ventilator available
- However, Ventilator Sharing increases the risk of adverse events
IV. Adverse Effects
- No patient on circuit receives ideal respiratory support titrated to their specific condition and requirements
- Some patients will be underventilated
- Some patients will be over-ventilated (with risk of Barotrauma)
- Individual patient monitoring difficulties
- Ventilator Alarms and parameters are more difficult to interpret
- Cross-Contamination of Infection
V. Approach
- Identify patients with similar Ventilator requirements (Tidal Volume, Lung Compliance)
- Monitor for changing respiratory requirements among the patients on same Ventilator circuit
- Prepare for Deep Sedation and continued paralysis
- Ventilator dyssynchrony occurs with shared Ventilators and is poorly tolerated
- Attach T-Tubes and filters to Ventilator
- Apply a filter (if available) to the inspiratory port
- Attach T-Tube and Adapter to the inspiratory port
- Attach T-Tube and Adapter to the expiratory port
- If Ventilator Sharing among 4 patients
- Apply a T-Tube to each port on the inspiratory T-Tube (2) and expiratory T-Tube (2)
- This will require a total of 3 T-Tubes on inspiratory port and 3 T-Tubes on expiratory port
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Ventilator Tubing
- Attach Ventilator tubing to and from each patient and the Ventilator ports
VI. References
- Warrington (2020) Crit Dec Emerg Med 34(5): 10
- Beitler (2020) Am J Respir Crit Care Med 202(4): 600-4 [PubMed]