Pulmonology Book

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Ventilator Sharing

Aka: Ventilator Sharing, Mechanical Ventilator Sharing
  1. See Also
    1. Mechanical Ventilation
    2. Ventilator Troubleshooting
    3. Ventilator Weaning
    4. Rapid Sequence Intubation
    5. Endotracheal Intubation (includes Post-intubation Management)
    6. Post-Intubation Sedation and Analgesia
    7. Positive End-Expiratory Pressure (PEEP)
    8. Continuous Positive Airways Pressure (CPAP)
    9. High Humidity High Flow Nasal Oxygen (HHFNC)
    10. Critical Care
  2. Indications
    1. Number of patients requiring Mechanical Ventilation exceeds number of mechanical Ventilators
    2. Local resources are overun by patients in Respiratory Failure
      1. Pandemics (e.g. COVID-19)
      2. Mass Casualty Incident
      3. Resource Limited Environments where evacuation is delayed
  3. Precautions
    1. Make use of all other reasonable alternatives before resorting to Mechanical Ventilator Sharing
      1. Repurpose available machines (e.g. operating room devices, positive pressure devices such as BiPap)
      2. Continued bag-valve mask (highly resource intensive) could be considered
      3. Consider offering Palliative Care measures for those with low likelihood of survival
      4. However, keep available reserve Ventilators for acute emergency stabilizations
    2. Ventilator Sharing may be life saving for those who would otherwise not have a Ventilator available
      1. However, Ventilator Sharing increases the risk of adverse events
  4. Adverse Effects
    1. No patient on circuit receives ideal respiratory support titrated to their specific condition and requirements
      1. Some patients will be underventilated
      2. Some patients will be over-ventilated (with risk of Barotrauma)
    2. Individual patient monitoring difficulties
      1. Ventilator Alarms and parameters are more difficult to interpret
    3. Cross-Contamination of Infection
  5. Approach
    1. Identify patients with similar Ventilator requirements (Tidal Volume, lung compliance)
      1. Monitor for changing respiratory requirements among the patients on same Ventilator circuit
    2. Prepare for Deep Sedation and continued paralysis
      1. Ventilator dyssynchrony occurs with shared Ventilators and is poorly tolerated
    3. Attach T-Tubes and filters to Ventilator
      1. Apply a filter (if available) to the inspiratory port
      2. Attach T-Tube and Adapter to the inspiratory port
      3. Attach T-Tube and Adapter to the expiratory port
    4. If Ventilator Sharing among 4 patients
      1. Apply a T-Tube to each port on the inspiratory T-Tube (2) and expiratory T-Tube (2)
      2. This will require a total of 3 T-Tubes on inspiratory port and 3 T-Tubes on expiratory port
    5. Ventilator Tubing
      1. Attach Ventilator tubing to and from each patient and the Ventilator ports
  6. References
    1. Warrington (2020) Crit Dec Emerg Med 34(5): 10
    2. Beitler (2020) Am J Respir Crit Care Med 202(4): 600-4 [PubMed]
      1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427377/

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