Individualized mechanical ventilation in a shared ventilator setting: limits, safety and technical details.

  • PDF / 1,716,108 Bytes
  • 11 Pages / 595.276 x 790.866 pts Page_size
  • 0 Downloads / 195 Views

DOWNLOAD

REPORT


ORIGINAL RESEARCH

Individualized mechanical ventilation in a shared ventilator setting: limits, safety and technical details. Michiel Stiers1   · Matthias Mergeay2 · Hannah Pinson3 · Luc Janssen2 · Evy Voets2 · Harald De Cauwer4,5 · Tom Schepens6 Received: 29 April 2020 / Accepted: 21 September 2020 © Springer Nature B.V. 2020

Abstract The COVID-19 pandemic has resulted in an increased need for ventilators. The potential to ventilate more than one patient with a single ventilator, a so-called split ventilator setup, provides an emergency solution. Our hypothesis is that ventilation can be individualized by adding a flow restrictor to limit tidal volumes, add PEEP, titrate ­FiO2 and monitor ventilation. This way we could enhance optimization of patient safety and clinical applicability. We performed bench testing to test our hypothesis and identify limitations. We performed a bench testing in two test lungs: (1) determine lung compliance (2) determine volume, plateau pressure and PEEP, (3) illustrate individualization of airway pressures and tidal volume with a flow restrictor, (4a) illustrate that PEEP can be applied and individualized (4b) create and measure intrinsic PEEP (4c and d) determine PEEP as a function of flow restriction, (5) individualization of ­FiO2. The lung compliance varied between 13 and 27 mL/cmH2O. Set ventilator settings could be applied and measured. Extrinsic PEEP can be applied except for settings with a large expiratory time. Volume and pressure regulation is possible between 70 and 39% flow restrictor valve closure. Flow restriction in the tested circuit had no effect on the other circuit or on intrinsic PEEP. ­FiO2 could be modulated individually between 0.21 and 0.8 by gradually adjusting the additional flow, and minimal affecting F ­ iO2 in the other circuit. Tidal volumes, PEEP and ­FiO2 can be individualized and monitored in a bench testing of a split ventilator. In vivo research is needed to further explore the clinical limitations and outcomes, making implementation possible as a last resort ventilation strategy. Keywords  COVID-19 · ARDS · Bench testing · Individualized split ventilation

1 Introduction Electronic supplementary material  The online version of this article (https​://doi.org/10.1007/s1087​7-020-00596​-7) contains supplementary material, which is available to authorized users. * Michiel Stiers [email protected] 1



Department of Emergency Medicine, AZ St-Dimpna, J‑B Stessensstraat 2, 2440 Geel, Belgium

2



Department of Critical care Medicine and anesthesiology, AZ St-Dimpna, Geel, Belgium

3

Applied Physics/Data Analytics, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, Belgium

4

Department of Neurology, AZ St-Dimpna, Geel, Belgium

5

Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

6

Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium



The COVID-19 pandemic has resulted in an increased need for ventilators, as the amount of ventilated patients in some ar