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Kim D, Roy S, McBeth P, Lee J. Quantitative Comparison of Ventilation Parameters of Different Approaches to Ventilator Splitting and Multiplexing. Crit Care Explor 2024; 6:e1113. [PMID: 38916647 DOI: 10.1097/cce.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
CONTEXT Amid the COVID-19 pandemic, this study delves into ventilator shortages, exploring simple split ventilation (SSV), simple differential ventilation (SDV), and differential multiventilation (DMV). The knowledge gap centers on understanding their performance and safety implications. HYPOTHESIS Our hypothesis posits that SSV, SDV, and DMV offer solutions to the ventilator crisis. Rigorous testing was anticipated to unveil advantages and limitations, aiding the development of effective ventilation approaches. METHODS AND MODELS Using a specialized test bed, SSV, SDV, and DMV were compared. Simulated lungs in a controlled setting facilitated measurements with sensors. Statistical analysis honed in on parameters like peak inspiratory pressure (PIP) and positive end-expiratory pressure. RESULTS Setting target PIP at 15 cm H2O for lung 1 and 12.5 cm H2O for lung 2, SSV revealed a PIP of 15.67 ± 0.2 cm H2O for both lungs, with tidal volume (Vt) at 152.9 ± 9 mL. In SDV, lung 1 had a PIP of 25.69 ± 0.2 cm H2O, lung 2 at 24.73 ± 0.2 cm H2O, and Vts of 464.3 ± 0.9 mL and 453.1 ± 10 mL, respectively. DMV trials showed lung 1's PIP at 13.97 ± 0.06 cm H2O, lung 2 at 12.30 ± 0.04 cm H2O, with Vts of 125.8 ± 0.004 mL and 104.4 ± 0.003 mL, respectively. INTERPRETATION AND CONCLUSIONS This study enriches understanding of ventilator sharing strategy, emphasizing the need for careful selection. DMV, offering individualization while maintaining circuit continuity, stands out. Findings lay the foundation for robust multiplexing strategies, enhancing ventilator management in crises.
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Affiliation(s)
- Doowon Kim
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada
| | - Steven Roy
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Paul McBeth
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Jihyun Lee
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada
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Stiers M, Vercauteren J, Schepens T, Mergeay M, Janssen L, Hoogmartens O, Neyrinck A, Marinus BG, Sabbe M. Design of a flow modulation device to facilitate individualized ventilation in a shared ventilator setup. J Clin Monit Comput 2024; 38:679-690. [PMID: 38557919 PMCID: PMC11164813 DOI: 10.1007/s10877-024-01138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
This study aims to resolve the unmet need for ventilator surge capacity by developing a prototype device that can alter patient-specific flow in a shared ventilator setup. The device is designed to deliver a predictable tidal volume (VT), requiring minimal additional monitoring and workload. The prototyped device was tested in an in vitro bench setup for its performance against the intended use and design criteria. The ventilation parameters: VT and airway pressures, and ventilation profiles: pressure, flow and volume were measured for different ventilator and device settings for a healthy and ARDS simulated lung pathology. We obtained VTs with a linear correlation with valve openings from 10 to 100% across set inspiratory pressures (IPs) of 20 to 30 cmH2O. Airway pressure varied with valve opening and lung elastance but did not exceed set IPs. Performance was consistent in both healthy and ARDS-simulated lung conditions. The ventilation profile diverged from traditional pressure-controlled profiles. We present the design a flow modulator to titrate VTs in a shared ventilator setup. Application of the flow modulator resulted in a characteristic flow profile that differs from pressure- or volume controlled ventilation. The development of the flow modulator enables further validation of the Individualized Shared Ventilation (ISV) technology with individualization of delivered VTs and the development of a clinical protocol facilitating its clinical use during a ventilator surge capacity problem.
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Affiliation(s)
- Michiel Stiers
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven, 3000, Leuven, Belgium.
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Jan Vercauteren
- Department of Mechanical Engineering, Royal Military Academy, Renaissancelaan 30, Brussels, Belgium
| | - Tom Schepens
- Department of Intensive Care Medicine, Ghent University Hospital, C Heymanslaan 10, Ghent, Belgium
| | - Matthias Mergeay
- Department of Anesthesiology and Critical Care Medicine, St-Dimpna, J.-B. Stessensstraat 2, 2440, Geel, Belgium
| | - Luc Janssen
- Department of Anesthesiology and Critical Care Medicine, St-Dimpna, J.-B. Stessensstraat 2, 2440, Geel, Belgium
| | - Olivier Hoogmartens
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven, 3000, Leuven, Belgium
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Arne Neyrinck
- Department of Cardiovascular Sciences, Research unit Anesthesiology and Algology, KU Leuven, 3000, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Benoît G Marinus
- Department of Mechanical Engineering, Royal Military Academy, Renaissancelaan 30, Brussels, Belgium
| | - Marc Sabbe
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven, 3000, Leuven, Belgium
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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3
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McMahon JW, Doukas DJ, Hanuscin C, Quale J, Eason J, Asrat H, Silverberg M, Paladino L. Re-Evaluating Cross-Contamination: Additional Trials on Co-Ventilation. J Emerg Med 2024; 66:e477-e482. [PMID: 38433037 DOI: 10.1016/j.jemermed.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 09/02/2023] [Accepted: 10/01/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Medical equipment can become scarce in disaster scenarios. Prior work has reported that four sheep could be ventilated together on a single ventilator. Others found that this maneuver is possible when needed, but no one has yet investigated whether cross-contamination occurs in co-ventilated individuals. OBJECTIVE Our goal was to investigate whether an infection could spread between co-ventilated individuals. METHODS Four 2-L anesthesia bags were connected to a sterilized ventilator circuit that used heat and moisture exchange filters and bacterial and viral filters, as would be expected in this dire scenario. Serratia marcescens was inoculated into "lung" no. 1. After running for 24 h, each lung and three additional points in the circuit were cultured to see whether S. marcescens had spread. These cultures were examined at 24 and 48 h to assess for cross-contamination. This entire procedure was performed three times. RESULTS S. marcescens was not found in lung no. 2, 3, or 4 or the three additional sites on the expiratory limb at 24 and 48 h in all three trials. CONCLUSIONS Cross-contamination does not occur within 24 h using the described ventilator circuit configuration.
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Affiliation(s)
- Jonathan W McMahon
- Department of Emergency Medicine, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York; Department of Internal Medicine, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York
| | - Donald J Doukas
- Department of Emergency Medicine, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York; Department of Internal Medicine, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York
| | - Christopher Hanuscin
- Department of Emergency Medicine, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York
| | - John Quale
- Department of Infectious Disease, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York
| | - Julie Eason
- Department of Respiratory Therapy, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Habtamu Asrat
- Department of Infectious Disease, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York
| | - Mark Silverberg
- Department of Emergency Medicine, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York
| | - Lorenzo Paladino
- Department of Emergency Medicine, SUNY Downstate Health Sciences University and Kings County Hospital Center, Brooklyn, New York
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Hannon DM, Jones T, Conolly J, Judge C, Iqbal T, Shahzad A, Madden M, Kirrane F, Conneely P, Harte BH, O'Halloran M, Laffey JG. Development and assessment of the performance of a shared ventilatory system that uses clinically available components to individualize tidal volumes. BMC Anesthesiol 2023; 23:239. [PMID: 37454135 PMCID: PMC10349497 DOI: 10.1186/s12871-023-02200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES To develop and assess a system for shared ventilation using clinically available components to individualize tidal volumes. DESIGN Evaluation and in vitro validation study SETTING: Ventilator shortage during the SARS-CoV-2 pandemic. PARTICIPANTS The team consisted of physicians, bioengineers, computer programmers, and medical technology professionals. METHODS Using clinically available components, a system of ventilation consisting of two ventilatory limbs was assembled and connected to a ventilator. Monitors for each limb were developed using open-source software. Firstly, the effect of altering ventilator settings on tidal volumes delivered to each limb was determined. Secondly, the impact of altering the compliance and resistance of one limb on the tidal volumes delivered to both limbs was analysed. Experiments were repeated three times to determine system variability. RESULTS The system permitted accurate and reproducible titration of tidal volumes to each limb over a range of ventilator settings and simulated lung conditions. Alteration of ventilator inspiratory pressures, of respiratory rates, and I:E ratio resulted in very similar tidal volumes delivered to each limb. Alteration of compliance and resistance in one limb resulted in reproducible alterations in tidal volume to that test lung, with little change to tidal volumes in the other lung. All tidal volumes delivered were reproducible. CONCLUSIONS We demonstrate the reliability of a shared ventilation system assembled using commonly available clinical components that allows titration of individual tidal volumes. This system may be useful as a strategy of last resort for Covid-19, or other mass casualty situations, where the need for ventilators exceeds supply.
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Affiliation(s)
- David M Hannon
- Department of Anaesthesia, School of Medicine, Galway University Hospitals, University of Galway, Galway, Ireland
- Translational Medical Device Lab, University of Galway, Galway, Ireland
| | - Tim Jones
- Translational Medical Device Lab, University of Galway, Galway, Ireland
| | - Jack Conolly
- Translational Medical Device Lab, University of Galway, Galway, Ireland
| | - Conor Judge
- Translational Medical Device Lab, University of Galway, Galway, Ireland
| | - Talha Iqbal
- Smart Sensors Lab, School of Medicine, University of Galway, Galway, Ireland
| | - Atif Shahzad
- Smart Sensors Lab, School of Medicine, University of Galway, Galway, Ireland
| | - Michael Madden
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
| | - Frank Kirrane
- Department of Medical Physics and Clinical Engineering, Galway University Hospitals, Galway, Ireland
| | - Peter Conneely
- Department of Medical Physics and Clinical Engineering, Galway University Hospitals, Galway, Ireland
| | - Brian H Harte
- Department of Anaesthesia, School of Medicine, Galway University Hospitals, University of Galway, Galway, Ireland
| | - Martin O'Halloran
- Translational Medical Device Lab, University of Galway, Galway, Ireland
- CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, University of Galway, Galway, Ireland
| | - John G Laffey
- Department of Anaesthesia, School of Medicine, Galway University Hospitals, University of Galway, Galway, Ireland.
- Translational Medical Device Lab, University of Galway, Galway, Ireland.
- CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, University of Galway, Galway, Ireland.
- School of Medicine, Clinical Sciences Institute, University of Galway, Galway, Ireland.
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Moslehi S, Shirazi FB. Challenges of providing health services to patients with cardiovascular diseases during disasters in Iran: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:25. [PMID: 37034868 PMCID: PMC10079189 DOI: 10.4103/jehp.jehp_548_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/25/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Cardiovascular diseases are the most common causes of death in the world. Because of the rate of emergencies and disasters in the country, this study was conducted to investigate the challenges of providing health services to cardiovascular patients in emergencies and disasters in Iran. MATERIALS AND METHODS This conventional content analysis study was conducted in 2020. Subjects were selected from among 16 Iranian experts) epidemiologists, cardiologists, PhD in Disaster Health, and PhD in Nursing (using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. RESULTS The results were obtained after analyzing the data in the pre-emergency phase (lack of training on medication and nutrition, lack of training vulnerable groups, lack of databases of cardiovascular patients, and lack of identification of patients before disasters), the emergency response phase (lack of sleep and rest patterns, lack of health forces, lack of blood pressure control, lack of proper nutrition, increased medication needs, and lack of mental health interventions), and the post-emergency phase (lack of planning, lack of management of patients' mental problems). CONCLUSION Developing strategies for planning, training, providing resources, and mental health during the three phases of the emergency management cycle for specific groups such as cardiovascular patients together with empowering these patients in the event of disasters is one of the key strategies which can be used after curbed emergencies and disasters to reduce the rate of mortality.
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Affiliation(s)
- Shandiz Moslehi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Barghi Shirazi
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Zieliński K, Lisowska B, Siewruk K, Sady M, Ferenc K, Barwijuk M, Olszewski J, Anusz K, Jabłoński A, Gajewska M, Okrzeja P, Michnikowski M, Pijanowska DG, Pluta K, Remiszewska E, Darowski M, Zabielski R, Liebert A, Kramek-Romanowska K, Stecka A, Kozarski M, Pasledni R, Gajewski Z, Ładyżyński P. Automatic air volume control system for ventilation of two patients using a single ventilator: a large animal model study. Sci Rep 2022; 12:22591. [PMID: 36585425 PMCID: PMC9801355 DOI: 10.1038/s41598-022-26922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
The COVID-19 pandemic outbreak led to a global ventilator shortage. Hence, various strategies for using a single ventilator to support multiple patients have been considered. A device called Ventil previously validated for independent lung ventilation was used in this study to evaluate its usability for shared ventilation. We performed experiments with a total number of 16 animals. Eight pairs of pigs were ventilated by a ventilator or anesthetic machine and by Ventil for up to 27 h. In one experiment, 200 ml of saline was introduced to one subject's lungs to reduce their compliance. The experiments were analyzed in terms of arterial blood gases and respiratory parameters. In addition to the animal study, we performed a series of laboratory experiments with artificial lungs (ALs). The resistance and compliance of one AL (affected) were altered, while the tidal volume (TV) and peak pressure (Ppeak) in the second (unaffected) AL were analyzed. In addition, to assess the risk of transmission of pathogens between AL respiratory tracts, laboratory tests were performed using phantoms of virus particles. The physiological level of analyzed parameters in ventilated animals was maintained, except for CO2 tension, for which a permissive hypercapnia was indicated. Experiments did not lead to injuries in the animal's lungs except for one subject, as indicated by CT scan analysis. In laboratory experiments, changes in TV and Ppeak in the unaffected AL were less than 11%, except for 2 cases where the TV change was 20%. No cross-contamination was found in simulations of pathogen transmission. We conclude that ventilation using Ventil can be considered safe in patients undergoing deep sedation without spontaneous breathing efforts.
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Affiliation(s)
- Krzysztof Zieliński
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Barbara Lisowska
- Department of Anesthesiology and Intensive Medical Care, National Geriatrics, Rheumatology and Rehabilitation Institute, Warsaw, Poland
| | - Katarzyna Siewruk
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Maria Sady
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Karolina Ferenc
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Maciej Barwijuk
- grid.13339.3b0000000113287408I Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Olszewski
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Krzysztof Anusz
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Artur Jabłoński
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Magdalena Gajewska
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13339.3b0000000113287408Medical University of Warsaw, Warsaw, Poland
| | - Piotr Okrzeja
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Marcin Michnikowski
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Dorota G. Pijanowska
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Krzysztof Pluta
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Elżbieta Remiszewska
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Marek Darowski
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Romuald Zabielski
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Adam Liebert
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Katarzyna Kramek-Romanowska
- grid.1035.70000000099214842Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Anna Stecka
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Maciej Kozarski
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Raman Pasledni
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Zdzisław Gajewski
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Piotr Ładyżyński
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
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Geoghegan P, Clarke J, Hogan G, Keogh A, Marsh H, Donnelly K, McEvoy N, Doolan A, Madden SF, Martin-Loeches I, Power M, Laffey JG, Curley GF. Use of a novel "Split" ventilation system in bench and porcine modeling of acute respiratory distress syndrome. Physiol Rep 2022; 10:e15452. [PMID: 36082971 PMCID: PMC9461348 DOI: 10.14814/phy2.15452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022] Open
Abstract
Split ventilation (using a single ventilator to ventilate multiple patients) is technically feasible. However, connecting two patients with acute respiratory distress syndrome (ARDS) and differing lung mechanics to a single ventilator is concerning. This study aimed to: (1) determine functionality of a split ventilation system in benchtop tests, (2) determine whether standard ventilation would be superior to split ventilation in a porcine model of ARDS and (3) assess usability of a split ventilation system with minimal specific training. The functionality of a split ventilation system was assessed using test lungs. The usability of the system was assessed in simulated clinical scenarios. The feasibility of the system to provide modified lung protective ventilation was assessed in a porcine model of ARDS (n = 30). In bench testing a split ventilation system independently ventilated two test lungs under conditions of varying compliance and resistance. In usability tests, a high proportion of naïve operators could assemble and use the system. In the porcine model, modified lung protective ventilation was feasible with split ventilation and produced similar respiratory mechanics, gas exchange and biomarkers of lung injury when compared to standard ventilation. Split ventilation can provide some elements of lung protective ventilation and is feasible in bench testing and an in vivo model of ARDS.
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Affiliation(s)
- Pierce Geoghegan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grace Hogan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aoife Keogh
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Karen Donnelly
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Natalie McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Stephen F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - John G Laffey
- Department of Anaesthesia and Critical Care, Galway University Hospital, Galway, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
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8
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Wong JW, Chiew YS, Desaive T, Chase JG. Model-based patient matching for in-parallel pressure-controlled ventilation. Biomed Eng Online 2022; 21:11. [PMID: 35139858 PMCID: PMC8826717 DOI: 10.1186/s12938-022-00983-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background Surges of COVID-19 infections have led to insufficient supply of mechanical ventilators (MV), resulting in rationing of MV care. In-parallel, co-mechanical ventilation (Co-MV) of multiple patients is a potential solution. However, due to lack of testing, there is currently no means to match ventilation requirements or patients, with no guidelines to date. In this research, we have developed a model-based method for patient matching for pressure control mode MV. Methods The model-based method uses a single-compartment lung model (SCM) to simulate the resultant tidal volume of patient pairs at a set ventilation setting. If both patients meet specified safe ventilation criteria under similar ventilation settings, the actual mechanical ventilator settings for Co-MV are determined via simulation using a double-compartment lung model (DCM). This method allows clinicians to analyse Co-MV in silico, before clinical implementation. Results The proposed method demonstrates successful patient matching and MV setting in a model-based simulation as well as good discrimination to avoid mismatched patient pairs. The pairing process is based on model-based, patient-specific respiratory mechanics identified from measured data to provide useful information for guiding care. Specifically, the matching is performed via estimation of MV delivered tidal volume (mL/kg) based on patient-specific respiratory mechanics. This information can provide insights for the clinicians to evaluate the subsequent effects of Co-MV. In addition, it was also found that Co-MV patients with highly restrictive respiratory mechanics and obese patients must be performed with extra care. Conclusion This approach allows clinicians to analyse patient matching in a virtual environment without patient risk. The approach is tested in simulation, but the results justify the necessary clinical validation in human trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12938-022-00983-y.
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Affiliation(s)
- Jin Wai Wong
- School of Engineering, Monash University Malaysia, Selangor, Malaysia
| | | | - Thomas Desaive
- GIGA-In Silico Medicine, University of Liege, Liege, Belgium
| | - J Geoffrey Chase
- Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
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9
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Gaucher D, Trimble AZ, Yamamoto B, Seidi E, Miller S, Vossler J, Mahoney R, Bellomy R, Heilbron W, Harvey S, Johnson S, Puapong D, Ahn HJ, Woo R. The Multi Split Ventilator System: Performance Testing of Respiratory Support Shared by Multiple Patients. J Med Device 2022. [DOI: 10.1115/1.4053499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Ventilator sharing has been proposed as a method of increasing ventilator capacity during instances of critical shortage. We sought to assess the ability of a regulated, shared ventilator system (Multi Split Ventilator System, MSVS) to individualize support to multiple simulated patients using one ventilator. We employed simulated patients of varying size, compliance, minute ventilation requirement, and PEEP requirement. Performance tests were performed to assess the ability of the QSVS, versus control, to achieve individualized respiratory goals to clinically disparate patients sharing a single ventilator following ARDSNet guidelines. Resilience tests measured the effects of simulated adverse events occurring to one patient on another patient sharing a single ventilator. The QSVS met individual oxygenation and ventilation requirements for multiple simulated patients with a tolerance similar to a single ventilator. Abrupt endotracheal tube occlusion or extubation occurring to one patient resulted in modest, clinically tolerable changes in ventilation parameters for the remaining patients. The QSVS is a regulated, shared ventilator system capable of individualizing ventilatory support to clinically dissimilar simulated patients. It is also resilient to common adverse events. The QSVS represents a feasible option to ventilate multiple patients during a severe ventilator shortage.
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Affiliation(s)
- Donald Gaucher
- Department of Anesthesia, Straub Medical Center, Honolulu, HI 96813
| | - A Zachary Trimble
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | - Brennan Yamamoto
- Applied Research Laboratory, University of Hawaii, Honolulu, HI 96822
| | - Ebrahim Seidi
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | - Scott Miller
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | - John Vossler
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu HI 96813
| | - Reid Mahoney
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu HI 96813
| | - Ryan Bellomy
- Respiratory Therapy Department, Kapiolani Medical Center for Women and Children, Honolulu, HI 96826
| | - William Heilbron
- Respiratory Therapy Department, Kapiolani Medical Center for Women and Children, Honolulu, HI 96826
| | - Scott Harvey
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu HI 96813; Department of Obstetrics and Gynecology and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813
| | - Sidney Johnson
- Department of Obstetrics and Gynecology and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813
| | - Devin Puapong
- Department of Obstetrics and Gynecology and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813
| | - Hyeong Jun Ahn
- Department of Surgery, John A. Burns School of Medicine, Kapiolani Medical Center for Women and Children, University of Hawaii, Honolulu, HI 96826
| | - Russell Woo
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813
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Raredon MSB, Fisher C, Heerdt PM, Schonberger RB, Nargi A, Nivison S, Fajardo E, Deshpande R, Akhtar S, Greaney AM, Belter J, Raredon T, Zinter J, McKee A, Michalski M, Baevova P, Niklason LE. Pressure-Regulated Ventilator Splitting for Disaster Relief: Design, Testing, and Clinical Experience. Anesth Analg 2021; 134:1094-1105. [PMID: 34928890 DOI: 10.1213/ane.0000000000005825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has revealed that even the best-resourced hospitals may lack sufficient ventilators to support patients under surge conditions. During a pandemic or mass trauma, an affordable, low-maintenance, off-the-shelf device that would allow health care teams to rapidly expand their ventilator capacity could prove lifesaving, but only if it can be safely integrated into a complex and rapidly changing clinical environment. Here, we define an approach to safe ventilator sharing that prioritizes predictable and independent care of patients sharing a ventilator. Subsequently, we detail the design and testing of a ventilator-splitting circuit that follows this approach and describe our clinical experience with this circuit during the COVID-19 pandemic. This circuit was able to provide individualized and titratable ventilatory support with individualized positive end-expiratory pressure (PEEP) to 2 critically ill patients at the same time, while insulating each patient from changes in the other's condition. We share insights from our experience using this technology in the intensive care unit and outline recommendations for future clinical applications.
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Affiliation(s)
- Micha Sam Brickman Raredon
- From the Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Medical Scientist Training Program
| | - Clark Fisher
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Paul M Heerdt
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Alyssa Nargi
- Division of Respiratory Care, Yale-New Haven Hospital, New Haven, Connecticut
| | - Steven Nivison
- Division of Respiratory Care, Yale-New Haven Hospital, New Haven, Connecticut
| | - Elaine Fajardo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Shamsuddin Akhtar
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Allison M Greaney
- From the Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Joseph Belter
- Center for Engineering Innovation and Design, Yale University, New Haven, Connecticut
| | | | - Joseph Zinter
- Center for Engineering Innovation and Design, Yale University, New Haven, Connecticut
| | - Andrew McKee
- Headland Strategy Group, San Francisco, California
| | | | - Pavlina Baevova
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Laura E Niklason
- From the Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
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Wong JW, Chiew YS, Desaive T, Chase JG. Model-based Patient Matching for in-parallel Multiplexing Mechanical Ventilation Support. IFAC-PAPERSONLINE 2021; 54:121-126. [PMID: 38620762 PMCID: PMC8562132 DOI: 10.1016/j.ifacol.2021.10.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Surges of COVID-19 infections could lead to insufficient supply of mechanical ventilators, and rationing of needed care. Multiplexing mechanical ventilators (co-MV) to serve multiple patients is a potential temporary solution. However, if patients are ventilated in parallel ventilation, there is currently no means to match ventilation requirements or patients, with no guidelines to date for co-MV. This research uses patient-specific clinically validated respiratory mechanics models to propose a method for patient matching and mechanical ventilator settings for two-patient co-MV under pressure control mode. The proposed method can simulate and estimate the resultant tidal volume of different combinations of co-ventilated patients. With both patients fulfilling the specified constraint under similar ventilation settings, the actual mechanical ventilator settings for co-MV are determined. This method allows clinicians to analyze in silico co-MV before clinical implementation.
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Affiliation(s)
- Jin Wai Wong
- School of Engineering, Monash University Malaysia, Selangor, Malaysia
| | | | - Thomas Desaive
- GIGA-In Silico Medicine, University of Liege, Liege, Belgium
| | - J Geoffrey Chase
- Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
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Ventilator output splitting interface 'ACRA': Description and evaluation in lung simulators and in an experimental ARDS animal model. PLoS One 2021; 16:e0256469. [PMID: 34432821 PMCID: PMC8386869 DOI: 10.1371/journal.pone.0256469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
The current COVID-19 pandemic has led the world to an unprecedented global shortage of ventilators, and its sharing has been proposed as an alternative to meet the surge. This study outlines the performance of a preformed novel interface called 'ACRA', designed to split ventilator outflow into two breathing systems. The 'ACRA' interface was built using medical use approved components. It consists of four unidirectional valves, two adjustable flow-restrictor valves placed on the inspiratory limbs of each unit, and one adjustable PEEP valve placed on the expiratory limb of the unit that would require a greater PEEP. The interface was interposed between a ventilator and two lung units (phase I), two breathing simulators (phase II) and two live pigs with heterogeneous lung conditions (phase III). The interface and ventilator adjustments tested the ability to regulate individual pressures and the resulting tidal volumes. Data were analyzed using Friedman and Wilcoxon tests test (p < 0.05). Ventilator outflow splitting, independent pressure adjustments and individual tidal volume monitoring were feasible in all phases. In all experimental measurements, dual ventilation allowed for individual and tight adjustments of the pressure, and thus volume delivered to each paired lung unit without affecting the other unit's ventilation-all the modifications performed on the ventilator equally affected both paired lung units. Although only suggested during a dire crisis, this experiment supports dual ventilation as an alternative worth to be considered.
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Sharing Mechanical Ventilator: In Vitro Evaluation of Circuit Cross-Flows and Patient Interactions. MEMBRANES 2021; 11:membranes11070547. [PMID: 34357197 PMCID: PMC8307053 DOI: 10.3390/membranes11070547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/31/2022]
Abstract
During the COVID-19 pandemic, a shortage of mechanical ventilators was reported and ventilator sharing between patients was proposed as an ultimate solution. Two lung simulators were ventilated by one anesthesia machine connected through two respiratory circuits and T-pieces. Five different combinations of compliances (30–50 mL × cmH2O−1) and resistances (5–20 cmH2O × L−1 × s−1) were tested. The ventilation setting was: pressure-controlled ventilation, positive end-expiratory pressure 15 cmH2O, inspiratory pressure 10 cmH2O, respiratory rate 20 bpm. Pressures and flows from all the circuit sections have been recorded and analyzed. Simulated patients with equal compliance and resistance received similar ventilation. Compliance reduction from 50 to 30 mL × cmH2O−1 decreased the tidal volume (VT) by 32% (418 ± 49 vs. 285 ± 17 mL). The resistance increase from 5 to 20 cmH2O × L−1 × s−1 decreased VT by 22% (425 ± 69 vs. 331 ± 51 mL). The maximal alveolar pressure was lower at higher compliance and resistance values and decreased linearly with the time constant (r² = 0.80, p < 0.001). The minimum alveolar pressure ranged from 15.5 ± 0.04 to 16.57 ± 0.04 cmH2O. Cross-flows between the simulated patients have been recorded in all the tested combinations, during both the inspiratory and expiratory phases. The simultaneous ventilation of two patients with one ventilator may be unable to match individual patient’s needs and has a high risk of cross-interference.
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Nazir A, Azhar A, Nazir U, Liu YF, Qureshi WS, Chen JE, Alanazi E. The rise of 3D Printing entangled with smart computer aided design during COVID-19 era. JOURNAL OF MANUFACTURING SYSTEMS 2021; 60:774-786. [PMID: 33106722 PMCID: PMC7577663 DOI: 10.1016/j.jmsy.2020.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/18/2020] [Accepted: 10/18/2020] [Indexed: 05/04/2023]
Abstract
During the current Pandemic, seven and a half million flights worldwide were canceled which disrupted the supply chain of all types of goods such as, personal protective gears, medical health devices, raw materials, food, and other essential equipments. The demand for health and medical related goods increased during this period globally, while the production using classical manufacturing techniques were effected because of the lockdowns and disruption in the transporation system. This created the need of geo scattered, small, and rapid manufacturing units along with a smart computer aided design (CAD) facility. The availability of 3D printing technologies and open source CAD design made it possible to overcome this need. In this article, we present an extensive review on the utilization of 3D printing technology in the days of pandamic. We observe that 3D printing together with smart CAD design show promise to overcome the disruption caused by the lockdown of classical manufacturing units specially for medical and testing equipment, and protective gears. We observe that there are several short communications, commentaries, correspondences, editorials and mini reviews compiled and published; however, a systematic state-of-the-art review is required to identify the significance of 3D printing, design for additive manufacturing (AM), and digital supply chain for handling emergency situations and in the post-COVID era. We present a review of various benefits of 3DP particularly in emergency situations such as a pandemic. Furthermore, some relevant iterative design and 3DP case studies are discussed systematically. Finally, this article highlights the areas that can help to control the emergency situation such as a pandemic, and critically discusses the research gaps that need further research in order to exploit the full potential of 3DP in pandemic and post-pandemic future era.
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Affiliation(s)
- Aamer Nazir
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, No. 43, Section 4, Keelung Road, Taipei 106, Taiwan, ROC
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, No. 43, Section 4, Keelung Road, Taipei 106, Taiwan, ROC
| | - Aashir Azhar
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, No. 43, Section 4, Keelung Road, Taipei 106, Taiwan, ROC
| | - Usman Nazir
- Department of Civil Engineering, University of Sargodha, Pakistan
| | - Yun-Feng Liu
- Department of Mechanical Engineering, Zhejiang University of Technology, China
| | - Waqar S Qureshi
- Robot Design and Development Lab, NCRA, NUST C of E & ME, Rawalpindi, Pakistan
- Department of Computer Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jia-En Chen
- Medical 3D Printing Center, Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Eisa Alanazi
- Department of Computer Science, Umm Al-Qura University, Makkah, Saudi Arabia
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Possible solutions for oxygenation support in critically ill patients with COVID-19. RESEARCH ON BIOMEDICAL ENGINEERING 2021. [PMCID: PMC7778687 DOI: 10.1007/s42600-020-00124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose Due to the large number of patients with respiratory deficiency during the COVID-19 pandemic, several governments and their respective health care services have been studying ways to complement the care provided by offering immediate solutions. In view of this, the aim of this study was to carry out a systematic review of the advantages and disadvantages of possible solutions in oxygenation support. Methods This systematic review used the PRISMA-P methodology and sought to list alternatives in oxygenation support that are being applied and studied worldwide. A bibliographic search was conducted in the MEDLINE and Cochrane Central databases, using the keywords SARS-CoV-2, COVID19, or coronavirus; combined with extracorporeal membrane oxygenation (ECMO), mechanical ventilation, mechanical ventilation support, low-cost, anesthesia, anesthesia machine, and ventilation therapy. The records were also found in the gray literature. Results The search found 85 publications of which 41 articles were considered after excluding duplicate articles, reading the title and summary, and reading the articles in full. The oxygenation supports identified in these publications were the following: ECMO, shared mechanical ventilator, fast or low-cost production equipment, high-flow nasal cannula (HFNC), non-invasive ventilation, and use of anesthesia equipment as a mechanical ventilator. Conclusion This study demonstrated the importance of a trained clinical team in the application of technologies. The alternatives found for support oxygenation require a more robust clinical evaluation to demonstrate their efficacy and safety for the COVID-19 patient.
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Development of a multi-patient ventilator circuit with validation in an ARDS porcine model. J Anesth 2021; 35:543-554. [PMID: 34061251 PMCID: PMC8167306 DOI: 10.1007/s00540-021-02948-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/22/2021] [Indexed: 12/25/2022]
Abstract
Purpose The COVID-19 pandemic threatens our current ICU capabilities nationwide. As the number of COVID-19 positive patients across the nation continues to increase, the need for options to address ventilator shortages is inevitable. Multi-patient ventilation (MPV), in which more than one patient can use a single ventilator base unit, has been proposed as a potential solution to this problem. To our knowledge, this option has been discussed but remains untested in live patients with differing severity of lung pathology. Methods The objective of this study was to address ventilator shortages and patient stacking limitations by developing and validating a modified breathing circuit for two patients with differing lung compliances using simple, off-the-shelf components. A multi-patient ventilator circuit (MPVC) was simulated with a mathematical model and validated with four animal studies. Each animal study had two human-sized pigs: one healthy and one with lipopolysaccharide (LPS) induced ARDS. LPS was chosen because it lowers lung compliance similar to COVID-19. In a previous study, a control group of four pigs was given ARDS and placed on a single patient ventilation circuit (SPVC). The oxygenation of the MPVC ARDS animals was then compared to the oxygenation of the SPVC animals. Results Based on the comparisons, similar oxygenation and morbidity rates were observed between the MPVC ARDS animals and the SPVC animals. Conclusion As healthcare systems worldwide deal with inundated ICUs and hospitals from pandemics, they could potentially benefit from this approach by providing more patients with respiratory care. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02948-2.
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Garcia Eijo PM, D’Adamo J, Bianchetti A, Duriez T, Cabaleiro JM, Irrazabal C, Otero P, Artana G. Exhalatory dynamic interactions between patients connected to a shared ventilation device. PLoS One 2021; 16:e0250672. [PMID: 33945551 PMCID: PMC8096090 DOI: 10.1371/journal.pone.0250672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
In this work a shared pressure-controlled ventilation device for two patients is considered. By the use of different valves incorporated to the circuit, the device enables the restriction of possible cross contamination and the individualization of tidal volumes, driving pressures, and positive end expiratory pressure PEEP. Possible interactions in the expiratory dynamics of different pairs of patients are evaluated in terms of the characteristic exhalatory times. These characteristic times can not be easily established using simple linear lumped element models. For this purpose, a 1D model using the Hydraulic and Mechanical libraries in Matlab Simulink was developed. In this sense, experiments accompany this study to validate the model and characterize the different valves of the circuit. Our results show that connecting two patients in parallel to a ventilator always resulted in delays of time during the exhalation. The size of this effect depends on different parameters associated with the patients, the circuit and the ventilator. The dynamics of the exhalation of both patients is determined by the ratios between patients exhalatory resistances, compliances, driving pressures and PEEPs. Adverse effects on exhalations became less noticeable when respiratory parameters of both patients were similar, flow resistances of valves added to the circuit were negligible, and when the ventilator exhalatory valve resistance was also negligible. The asymmetries of driving pressures, compliances or resistances exacerbated the possibility of auto-PEEP and the increase in relaxation times became greater in one patient than in the other. In contrast, exhalatory dynamics were less sensitive to the ratio of PEEP imposed to the patients.
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Affiliation(s)
- Pedro M. Garcia Eijo
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Juan D’Adamo
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Arturo Bianchetti
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Thomas Duriez
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Juan M. Cabaleiro
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Célica Irrazabal
- División Terapia Intensiva del Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Otero
- Cátedra de Anestesiología y Algiología, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Artana
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
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Alwasel A, Zaky J, Alhussaini K, Alossimi B, Alharbi T. Increasing the efficiency of mechanical ventilators during pandemics through additive manufacturing. Bosn J Basic Med Sci 2021; 21:242-245. [PMID: 33052078 PMCID: PMC7982068 DOI: 10.17305/bjbms.2020.5165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/26/2020] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic tested medical facilities' readiness in terms of the number of available mechanical ventilators. Most countries raced to stock up on ventilators, which created a surge in demand and short in supply. Furthermore, other means of coping with the demand were proposed, such as using additive manufacturing. The purpose of this paper was to test whether the addition of 3D-printed splitters would help deliver required tidal volume to each patient, while supporting four patients on a single ventilator for 24 hours on pressure mode at 25-cm H2O, and to determine whether a fifth patient can be ventilated. The ventilation of four human lungs was simulated using 3D printed parts, a single ventilator, four test-lungs, and standard tubing. Peak pressure, positive end-expiratory pressure, total tidal volume, individual tidal volume, total minute volume, and individual tidal volume data were collected. Usage of a 3D printed small size splitter enabled a 26% increase in individual tidal volume compared to standard tubing and a series of two-way splitters. The ventilator was able to supply the required pressure and tidal volume for 24 hours. A single ventilator with a four-way splitter can ventilate four patients experiencing respiratory failure for at least 24 hours without interruption. The equipment cannot sustain ventilating a fifth patient owing to minute volume limitation. This study expands on an earlier study that tested similar circuitry and reveals that the desired individual tidal volume is achieved. However, further research is required to provide the monitoring ability of individual patient parameters and prevention of cross-contamination.
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Affiliation(s)
- Abdullatif Alwasel
- Department of Biomedical Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jean Zaky
- Department of Biomedical Engineering, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Khalid Alhussaini
- Department of Biomedical Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Bandr Alossimi
- Department of Biomedical Technology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Turki Alharbi
- Department of Biomedical Engineering, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
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Mechanical-Ventilation Supply and Options for the COVID-19 Pandemic. Leveraging All Available Resources for a Limited Resource in a Crisis. Ann Am Thorac Soc 2021; 18:408-416. [PMID: 33202144 PMCID: PMC7919160 DOI: 10.1513/annalsats.202004-317cme] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease (COVID-19) has exposed critical supply shortages both in the United States and worldwide, including those in intensive care unit (ICU) and hospital bed supply, hospital staff, and mechanical ventilators. Many of those who are critically ill have required days to weeks of supportive invasive mechanical ventilation (IMV) as part of their treatment. Previous estimates set the U.S. availability of mechanical ventilators at approximately 62,000 full-featured ventilators, with 98,000 non–full-featured devices (including noninvasive devices). Given the limited availability of this resource both in the United States and in low- and middle-income countries, we provide a framework to approach the shortage of IMV resources. Here we discuss evidence and possibilities to reduce overall IMV needs, discuss strategies to maximize the availability of IMV devices designed for invasive ventilation, discuss the underlying methods in the literature to create and fashion new sources of potential ventilation that are available to hospitals and front-line providers, and discuss the staffing needs necessary to support IMV efforts. The pandemic has already pushed cities like New York and Boston well beyond previous ICU capacity in its first wave. As hot spots continue to develop around the country and the globe, it is evident that issues may arise ahead regarding the efficient and equitable use of resources. This unique challenge may continue to stretch resources and require care beyond previously set capacities and boundaries. The approaches presented here provide a review of the known evidence and strategies for those at the front line who are facing this challenge.
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Doukas DJ, Paladino L, Hanuscin C, McMahon J, Quale J, Bhatt I, Eason J, Silverberg M. Evaluating cross contamination on a shared ventilator. Emerg Med J 2021; 38:220-223. [PMID: 33277345 PMCID: PMC7722357 DOI: 10.1136/emermed-2020-209972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/24/2020] [Accepted: 10/24/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Disasters have the potential to cause critical shortages of life-saving equipment. It has been postulated that during patient surge, multiple individuals could be maintained on a single ventilator. This was supported by a previous trial that showed one ventilator could support four sheep. The goal of our study is to investigate if cross contamination of pathological agents occurs between individuals on a shared ventilator with strategically placed antimicrobial filters. METHODS A multipatient ventilator circuit was assembled using four sterile, parallel standard tubing circuits attached to four 2 L anaesthesia bags, each representing a simulated patient. Each 'patient' was attached to a Heat and Moisture Exchange filter. An additional bacterial/viral filter was attached to each expiratory limb. 'Patient-Lung' number 1 was inoculated with an isolate of Serratia marcescens, and the circuit was run for 24 hours. Each 'lung' and three points in the expiratory limb tubing were washed with broth and cultured. All cultures were incubated for 48 hours with subcultures performed at 24 hours. RESULTS Washed cultures of patient 2, 3 and 4 failed to demonstrate growth of S. marcescens. Cultures of the distal expiratory tubing, expiratory limb connector and expiratory limb prefilter tubing yielded no growth of S. marcescens at 24 or 48 hours. CONCLUSION Based on this circuit configuration, it is plausible to maintain four individuals on a single ventilator for 24 hours without fear of cross contamination.
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Affiliation(s)
- Donald Joseph Doukas
- Emergency Medicine and Internal Medicine, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
| | - Lorenzo Paladino
- Emergency Medicine, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
| | - Christopher Hanuscin
- Emergency Medicine, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
| | - Jonathan McMahon
- Emergency Medicine and Internal Medicine, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
| | - John Quale
- Infectious Diseases, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
| | - Isha Bhatt
- Infectious Diseases, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
| | - Julie Eason
- Respiratory Therapy, SUNY Downstate, Brooklyn, New York, USA
| | - Mark Silverberg
- Emergency Medicine, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
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Korsós A, Peták F, Südy R, Schranc Á, Fodor GH, Babik B. Use of capnography to verify emergency ventilator sharing in the COVID-19 era. Respir Physiol Neurobiol 2021; 285:103611. [PMID: 33359758 PMCID: PMC7832691 DOI: 10.1016/j.resp.2020.103611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 01/29/2023]
Abstract
Exacerbation of COVID-19 pandemic may lead to acute shortage of ventilators, which may require shared use of ventilator as a lifesaving concept. Two model lungs were ventilated with one ventilator to i) test the adequacy of individual tidal volumes via capnography, ii) assess cross-breathing between lungs, and iii) offer a simulation-based algorithm for ensuring equal tidal volumes. Ventilation asymmetry was induced by placing rubber band around one model lung, and the uneven distribution of tidal volumes (VT) was counterbalanced by elevating airflow resistance (HR) contralaterally. VT, end-tidal CO2 concentration (ETCO2), and peak inspiratory pressure (Ppi) were measured. Unilateral LC reduced VT and elevated ETCO2 on the affected side. Under HR, VT and ETCO2 were re-equilibrated. In conclusion, capnography serves as simple, bedside method for controlling the adequacy of split ventilation in each patient. No collateral gas flow was observed between the two lungs with different time constants. Ventilator sharing may play a role in emergency situations.
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Affiliation(s)
- Anita Korsós
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, H 6725, Szeged, Hungary
| | - Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, 9 Koranyi Fasor, H 6720, Szeged, Hungary.
| | - Roberta Südy
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, H 6725, Szeged, Hungary
| | - Álmos Schranc
- Department of Medical Physics and Informatics, University of Szeged, 9 Koranyi Fasor, H 6720, Szeged, Hungary
| | - Gergely H Fodor
- Department of Medical Physics and Informatics, University of Szeged, 9 Koranyi Fasor, H 6720, Szeged, Hungary
| | - Barna Babik
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, H 6725, Szeged, Hungary
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Wong AH, Ahmed RA, Ray JM, Khan H, Hughes PG, McCoy CE, Auerbach MA, Barach P. Supporting the Quadruple Aim Using Simulation and Human Factors During COVID-19 Care. Am J Med Qual 2021; 36:73-83. [PMID: 33830094 PMCID: PMC8030878 DOI: 10.1097/01.jmq.0000735432.16289.d2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.
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Affiliation(s)
- Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Rami A. Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Jessica M. Ray
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Humera Khan
- Department of Internal Medicine, Central Michigan University College of Medicine, Mount Pleasant, MI
| | - Patrick G. Hughes
- Department of Emergency Medicine, Florida Atlantic University College of Medicine, Boca Raton, FL
| | | | - Marc A. Auerbach
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Paul Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI
- College of Population Health, Thomas Jefferson University, Philadelphia, PA
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Guvener O, Eyidogan A, Oto C, Huri PY. Novel additive manufacturing applications for communicable disease prevention and control: focus on recent COVID-19 pandemic. EMERGENT MATERIALS 2021; 4:351-361. [PMID: 33585795 PMCID: PMC7874037 DOI: 10.1007/s42247-021-00172-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/24/2021] [Indexed: 05/02/2023]
Abstract
COVID-19 disease caused by the SARS-CoV-2 virus has had serious adverse effects globally in 2020 which are foreseen to extend in 2021, as well. The most important of these effects was exceeding the capacity of the healthcare infrastructures, and the related inability to meet the need for various medical equipment especially within the first months of the crisis following the emergence and rapid spreading of the virus. Urgent global demand for the previously unavailable personal protective equipment, sterile disposable medical supplies as well as the active molecules including vaccines and drugs fueled the need for the coordinated efforts of the scientific community. Amid all this confusion, the rapid prototyping technology, 3D printing, has demonstrated its competitive advantage by repositioning its capabilities to respond to the urgent need. Individual and corporate, amateur and professional all makers around the world with 3D printing capacity became united in effort to fill the gap in the supply chain until mass production is available especially for personal protective equipment and other medical supplies. Due to the unexpected, ever-changing nature of the COVID-19 pandemic-like all other potential communicable diseases-the need for rapid design and 3D production of parts and pieces as well as sterile disposable medical equipment and consumables is likely to continue to keep its importance in the upcoming years. This review article summarizes how additive manufacturing technology can contribute to such cases with special focus on the recent COVID-19 pandemic.
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Affiliation(s)
- Orcun Guvener
- Ankara University Medical Design Research and Application Center, MEDITAM, Ankara, Turkey
- Ankara University Faculty of Veterinary Medicine, Department of Anatomy, Ankara, Turkey
| | - Abdullah Eyidogan
- Ankara University Medical Design Research and Application Center, MEDITAM, Ankara, Turkey
- Ankara University Faculty of Engineering, Department of Biomedical Engineering, Ankara, Turkey
| | - Cagdas Oto
- Ankara University Medical Design Research and Application Center, MEDITAM, Ankara, Turkey
- Ankara University Faculty of Veterinary Medicine, Department of Anatomy, Ankara, Turkey
| | - Pinar Yilgor Huri
- Ankara University Medical Design Research and Application Center, MEDITAM, Ankara, Turkey
- Ankara University Faculty of Engineering, Department of Biomedical Engineering, Ankara, Turkey
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Abstract
PURPOSE OF REVIEW The recent COVID-19 outbreak has clearly shown how epidemics/pandemics can challenge developed countries' healthcare systems. Proper management of equipment and human resources is critical to provide adequate medical care to all patients admitted to the hospital and the ICU for both pandemic-related and unrelated reasons. RECENT FINDINGS Appropriate separate paths for infected and noninfected patients and prompt isolation of infected critical patients in dedicated ICUs play a pivotal role in limiting the contagions and optimizing resources during pandemics. The key to handle these challenging events is to learn from past experiences and to be prepared for future occurrences. Hospital space should be redesigned to quickly increase medical and critical care capacity, and healthcare workers (critical and noncritical) should be trained in advance. SUMMARY A targeted improvement of hospital and ICU protocols will increase medical care quality for patients admitted to the hospital for any clinical reasons during a pandemic.
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Affiliation(s)
- Gaetano Florio
- Department of Pathophysiology and Transplantation, University of Milan
| | - Alberto Zanella
- Department of Pathophysiology and Transplantation, University of Milan
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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25
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Abstract
BACKGROUND Non-invasive respiratory support for neonates using bubble continuous positive airway pressure (bCPAP) delivery systems is now widespread owing to its safety, cost effectiveness and easy applicability. Many innovative solutions have been suggested to deal with the possible shortage in desperate situations like disasters, pandemics and resource-limited settings. Although splitting of invasive ventilation has been reported previously, no attempts to split non-invasive respiratory support have been reported. OBJECTIVE The primary objective was to test the feasibility of splitting the bCPAP assembly using a T-piece splitter in a simulation model. METHODS A pilot simulation-based study was done to split a single bCPAP assembly using a T-piece. Other materials consisted of a heated humidification system, an air oxygen blender, corrugated inspiratory and expiratory tubing, nasal interfaces and two intercostal chest tube drainage bags. Two pressure manometers were used simultaneously to measure delivered pressures at different levels of set bCPAPs at the expiratory limb of nasal interfaces. RESULTS Pressures measured at the expiratory end of two nasal interfaces were 5.1 and 5.2 cm H2O, respectively, at a flow of 6 L/min and a water level of 5 cm H2O in both chest bags. When tested across different levels of set continuous positive airway pressure (3-8 cmH2O) and fractional inspired oxygen concentration (0.30-1.0), measured parameters corresponded to set parameters. CONCLUSION bCPAP splitting using a T-piece splitter is a technically simple, feasible and reliable strategy tested in a simulation model. Further testing is needed in a simulated lung model.
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Affiliation(s)
- Akanksha Verma
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Jaiswal
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kirti M Naranje
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Girish Gupta
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anita Singh
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Gaucher DJ, Trimble AZ, Yamamoto BE, Miller SF, Vossler JD, Mahoney RC, Bellomy RL, Heilbron WR, Harvey SA, Johnson SM, Puapong DP, Woo RK. The Multisplit Ventilator System: Design and Function of a Regulated, Shared Ventilator System. J Med Device 2021. [DOI: 10.1115/1.4049397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
The objective of this paper is to describe the design and function of the multisplit ventilator system (MSVS); an airflow apparatus that enables physicians to provide individualized, isolated ventilation to up to four patients using a single ventilator. Method: The study design is laboratory assessment of the ability of the MSVS to decouple the pressures and resulting tidal volumes between patient limbs in response to adverse extubation (disconnection) or endotracheal tube occlusion of one of the patients in the system. We compare the airflow decoupling of the MSVS against an existing unregulated split ventilator system (USVS) design over eight prototypical patient pairs. Simulated patient prototypes of varying size, minute ventilation requirement, and positive end-expiratory pressure (PEEP) requirement were employed. Result: Respiratory support was developed for varying simulated patient pairs using the MSVS and a USVS. The results demonstrate that patients supported with the MSVS showed significantly smaller changes to tidal volume and PEEP after extubation events, and tidal volume after occlusion events. Conclusion: It was found that the MSVS as a regulated, shared ventilator system effectively buffered simulated patients from clinical changes occurring to another patient connected to the split ventilator. This decoupling ability resulted in significantly smaller changes in delivered support when compared to existing USVS designs, which is an important patient safety consideration if deciding to support multiple patients with a single ventilator.
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Affiliation(s)
| | - A. Zachary Trimble
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | | | - Scott F. Miller
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, HI 96822
| | - John D. Vossler
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu HI 96813
| | - Reid C. Mahoney
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu HI 96813
| | - Ryan L. Bellomy
- Respiratory Therapy Department, Kapiolani Medical Center for Women and Children, Honolulu, HI 96826
| | - William R. Heilbron
- Respiratory Therapy Department, Kapiolani Medical Center for Women and Children, Honolulu, HI 96826
| | - Scott A. Harvey
- Department of Obstetrics and Gynecology and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu HI 96813; Department of Surgery (Surgical and Trauma Critical Care), John A Burns School of Medicine, University of Hawaii, Honolulu HI 96813
| | - Sidney M. Johnson
- Department of Surgery, John A. Burns School of Medicine, Kapiolani Medical Center for Women and Children, University of Hawaii, Honolulu, HI 96826
| | - Devin P. Puapong
- Department of Surgery, John A. Burns School of Medicine, Kapiolani Medical Center for Women and Children, University of Hawaii, Honolulu, HI 96826
| | - Russell K. Woo
- Department of Surgery, John A. Burns School of Medicine, Kapiolani Medical Center for Women and Children, University of Hawaii, Honolulu, HI 96826
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Kelley KC, Kamler J, Garg M, Stawicki SP. Answering the Challenge of COVID-19 Pandemic Through Innovation and Ingenuity. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:859-873. [PMID: 33973216 DOI: 10.1007/978-3-030-63761-3_48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has created a maelstrom of challenges affecting virtually every aspect of global healthcare system. Critical hospital capacity issues, depleted ventilator and personal protective equipment stockpiles, severely strained supply chains, profound economic slowdown, and the tremendous human cost all culminated in what is questionably one of the most profound challenges that humanity faced in decades, if not centuries. Effective global response to the current pandemic will require innovation and ingenuity. This chapter discusses various creative approaches and ideas that arose in response to COVID-19, as well as some of the most impactful future trends that emerged as a result. Among the many topics discussed herein are telemedicine, blockchain technology, artificial intelligence, stereolithography, and distance learning.
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Affiliation(s)
- Kathryn Clare Kelley
- Department of Surgery, University Campus, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jonathan Kamler
- Departments of Emergency Medicine, NewYork-Presbyterian Health System, New York City, NY, USA
| | - Manish Garg
- Departments of Emergency Medicine, Weill Cornell Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, USA
| | - Stanislaw P Stawicki
- Department of Surgery, University Campus, St. Luke's University Health Network, Bethlehem, PA, USA.
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28
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Mebrate Y, Phillips S, Field D, Mumuni I, Josse P, Alexander D, Das-Gupta R, Trimlett R, Polkey MI. Modification of a domiciliary ventilator to increase FiO 2: an off-label modification which may be of value in COVID-19. Thorax 2021; 76:83-85. [PMID: 33077616 PMCID: PMC7569708 DOI: 10.1136/thoraxjnl-2020-215487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/07/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022]
Abstract
Although nasal continuous positive airway pressure or non-invasive ventilation is used to manage some patients with acute lung injury due to COVID-19, such patients also demonstrate increased minute ventilation which makes it hard, if the device is used in line with the manufacturer's instructions, to achieve adequate oxygen delivery. In addition, if a hospital contains many such patients, then it is possible that the oxygen requirements will exceed infrastructure capacity. Here we describe a simple modification of two exemplar ventilators normally used for domiciliary ventilation, which substantially increased the fraction of inspired oxygen (FiO2) delivered.
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Affiliation(s)
- Yoseph Mebrate
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Steven Phillips
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Debbie Field
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ivy Mumuni
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Paul Josse
- Department of Design, Brunel University College of Engineering Design and Physical Sciences, Uxbridge, Hillingdon, UK
| | - David Alexander
- Department of Anesthesia, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rishi Das-Gupta
- Department of Innovation and Technology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Richard Trimlett
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Michael I Polkey
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Thoracic Medicine, National Heart and Lung Institute, Imperial College London, London, UK
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29
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A New Medical Device to Provide Independent Ventilation to Two Subjects Using a Single Ventilator: Evaluation in Lung-Healthy Pigs. Anesthesiol Res Pract 2020; 2020:8866806. [PMID: 33456461 PMCID: PMC7774300 DOI: 10.1155/2020/8866806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/25/2020] [Accepted: 12/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background The global crisis situation caused by SARS-CoV-2 has created an explosive demand for ventilators, which cannot be met even in developed countries. Designing a simple and inexpensive device with the ability to increase the number of patients that can be connected to existing ventilators would have a major impact on the number of lives that could be saved. We conducted a study to determine whether two pigs with significant differences in size and weight could be ventilated simultaneously using a single ventilator connected to a new medical device called DuplicARⓇ. Methods Six pigs (median weight 12 kg, range 9–25 kg) were connected in pairs to a single ventilator using the new device for 6 hours. Both the ventilator and the device were manipulated throughout the experiment according to the needs of each animal. Tidal volume and positive end-expiratory pressure were individually controlled with the device. Primary and secondary outcome variables were defined to assess ventilation and hemodynamics in all animals throughout the experiment. Results Median difference in weight between the animals of each pair was 67% (range: 11–108). All animals could be successfully oxygenated and ventilated for 6 hours through manipulation of the ventilator and the DuplicARⓇ device, despite significant discrepancies in body size and weight. Mean PaCO2 in arterial blood was 42.1 ± 4.4 mmHg, mean PaO2 was 162.8 ± 46.8 mmHg, and mean oxygen saturation was 98 ± 1.3%. End-tidal CO2 values showed no statistically significant difference among subjects of each pair. Mean difference in arterial PaCO2 measured at the same time in both animals of each pair was 4.8 ± 3 mmHg, reflecting the ability of the device to ventilate each animal according to its particular requirements. Independent management of PEEP was achieved by manipulation of the device controllers. Conclusion It is possible to ventilate two lung-healthy animals with a single ventilator according to each one's needs through manipulation of both the ventilator and the DuplicARⓇ device. This gives this device the potential to expand local ventilators surge capacity during disasters or pandemics until emergency supplies can be delivered from central stockpiles.
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Bhatt H, Singh S. The ethical dilemma of ventilator sharing during the COVID-19 pandemic. J Glob Health 2020; 10:020392. [PMID: 33282219 PMCID: PMC7688199 DOI: 10.7189/jogh.10.020392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Harshil Bhatt
- Goshen Hospital, Goshen, Indiana, USA.,Indiana University School of Medicine, South Bend, Indiana, USA
| | - Sandeep Singh
- Indiana University School of Medicine, South Bend, Indiana, USA
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31
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Computational simulation to assess patient safety of uncompensated COVID-19 two-patient ventilator sharing using the Pulse Physiology Engine. PLoS One 2020; 15:e0242532. [PMID: 33237927 PMCID: PMC7688119 DOI: 10.1371/journal.pone.0242532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic is stretching medical resources internationally, sometimes creating ventilator shortages that complicate clinical and ethical situations. The possibility of needing to ventilate multiple patients with a single ventilator raises patient health and safety concerns in addition to clinical conditions needing treatment. Wherever ventilators are employed, additional tubing and splitting adaptors may be available. Adjustable flow-compensating resistance for differences in lung compliance on individual limbs may not be readily implementable. By exploring a number and range of possible contributing factors using computational simulation without risk of patient harm, this paper attempts to define useful bounds for ventilation parameters when compensatory resistance in limbs of a shared breathing circuit is not possible. This desperate approach to shared ventilation support would be a last resort when alternatives have been exhausted. Methods A whole-body computational physiology model (using lumped parameters) was used to simulate each patient being ventilated. The primary model of a single patient with a dedicated ventilator was augmented to model two patients sharing a single ventilator. In addition to lung mechanics or estimation of CO2 and pH expected for set ventilation parameters (considerations of lung physiology alone), full physiological simulation provides estimates of additional values for oxyhemoglobin saturation, arterial oxygen tension, and other patient parameters. A range of ventilator settings and patient characteristics were simulated for paired patients. Findings To be useful for clinicians, attention has been directed to clinically available parameters. These simulations show patient outcome during multi-patient ventilation is most closely correlated to lung compliance, oxygenation index, oxygen saturation index, and end-tidal carbon dioxide of individual patients. The simulated patient outcome metrics were satisfactory when the lung compliance difference between two patients was less than 12 mL/cmH2O, and the oxygen saturation index difference was less than 2 mmHg. Interpretation In resource-limited regions of the world, the COVID-19 pandemic will result in equipment shortages. While single-patient ventilation is preferable, if that option is unavailable and ventilator sharing using limbs without flow resistance compensation is the only available alternative, these simulations provide a conceptual framework and guidelines for clinical patient selection.
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Plummer AR, du Bois JL, Flynn JM, Roesner J, Lee SM, Magee P, Thornton M, Padkin A, Gill HS. A simple method to estimate flow restriction for dual ventilation of dissimilar patients: The BathRC model. PLoS One 2020; 15:e0242123. [PMID: 33196687 PMCID: PMC7668571 DOI: 10.1371/journal.pone.0242123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With large numbers of COVID-19 patients requiring mechanical ventilation and ventilators possibly being in short supply, in extremis two patients may have to share one ventilator. Careful matching of patient ventilation requirements is necessary. However, good matching is difficult to achieve as lung characteristics can have a wide range and may vary over time. Adding flow restriction to the flow path between ventilator and patient gives the opportunity to control the airway pressure and hence flow and volume individually for each patient. This study aimed to create and validate a simple model for calculating required flow restriction. METHODS AND FINDINGS We created a simple linear resistance-compliance model, termed the BathRC model, of the ventilator tubing system and lung allowing direct calculation of the relationships between pressures, volumes, and required flow restriction. Experimental measurements were made for parameter determination and validation using a clinical ventilator connected to two test lungs. For validation, differing amounts of restriction were introduced into the ventilator circuit. The BathRC model was able to predict tidal lung volumes with a mean error of 4% (min:1.2%, max:9.3%). CONCLUSION We present a simple model validated model that can be used to estimate required flow restriction for dual patient ventilation. The BathRC model is freely available; this tool is provided to demonstrate that flow restriction can be readily estimated. Models and data are available at DOI 10.15125/BATH-00816.
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Affiliation(s)
- Andrew R. Plummer
- Department of Mechanical Engineering, University of Bath, Bath, North Somerset, United Kingdom
| | - Jonathan L. du Bois
- Department of Mechanical Engineering, University of Bath, Bath, North Somerset, United Kingdom
| | - Joseph M. Flynn
- Department of Mechanical Engineering, University of Bath, Bath, North Somerset, United Kingdom
| | - Jens Roesner
- Department of Mechanical Engineering, University of Bath, Bath, North Somerset, United Kingdom
| | - Siu Man Lee
- Royal United Hospitals NHS Foundation Trust, Bath, North Somerset, United Kingdom
| | - Patrick Magee
- BMI Bath Clinic, Bath, North Somerset, United Kingdom
| | - Malcolm Thornton
- Royal United Hospitals NHS Foundation Trust, Bath, North Somerset, United Kingdom
| | - Andrew Padkin
- Royal United Hospitals NHS Foundation Trust, Bath, North Somerset, United Kingdom
| | - Harinderjit S. Gill
- Department of Mechanical Engineering, University of Bath, Bath, North Somerset, United Kingdom
- Centre for Therapeutic Innovation, University of Bath, Bath, North Somerset, United Kingdom
- * E-mail:
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Milner A, Siner JM, Balcezak T, Fajardo E. Ventilator Sharing Using Volume-controlled Ventilation during the COVID-19 Pandemic. Am J Respir Crit Care Med 2020; 202:1317-1319. [PMID: 32744456 PMCID: PMC7605199 DOI: 10.1164/rccm.202006-2452le] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Individualized mechanical ventilation in a shared ventilator setting: limits, safety and technical details. J Clin Monit Comput 2020; 35:1299-1309. [PMID: 33025322 PMCID: PMC7537776 DOI: 10.1007/s10877-020-00596-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
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 FiO2 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.
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Stiers M, Bleeser T, Mergeay M, Pinson H, Janssen L, Schepens T. Successful ventilation of two animals with a single ventilator: individualized shared ventilator setup in an in vivo model. Crit Care 2020; 24:523. [PMID: 32854740 PMCID: PMC7450145 DOI: 10.1186/s13054-020-03248-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Michiel Stiers
- Department of Emergency Medicine, St-Dimpna, J-B Stessensstraat 2, 2440, Geel, Belgium.
| | - Tom Bleeser
- Department of Anesthesiology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias Mergeay
- Department of Anesthesiology and Critical Care Medicine, St-Dimpna, J-B Stessensstraat 2, 2440, Geel, Belgium
| | - Hannah Pinson
- Applied Physics and Data Analytics, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Luc Janssen
- Department of Anesthesiology and Critical Care Medicine, St-Dimpna, J-B Stessensstraat 2, 2440, Geel, Belgium
| | - Tom Schepens
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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36
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Beitler JR, Mittel AM, Kallet R, Kacmarek R, Hess D, Branson R, Olson M, Garcia I, Powell B, Wang DS, Hastie J, Panzer O, Brodie D, Hill LL, Thompson BT. Ventilator Sharing during an Acute Shortage Caused by the COVID-19 Pandemic. Am J Respir Crit Care Med 2020; 202:600-604. [PMID: 32515988 PMCID: PMC7427377 DOI: 10.1164/rccm.202005-1586le] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jeremy R Beitler
- Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian HospitalNew York, New York
| | - Aaron M Mittel
- Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian HospitalNew York, New York
| | - Richard Kallet
- San Francisco General Hospital and University of California, San FranciscoSan Francisco, California
| | | | - Dean Hess
- Massachusetts General HospitalBoston, Massachusetts
| | | | - Murray Olson
- New York-Presbyterian HospitalNew York, New Yorkand
| | - Ivan Garcia
- New York-Presbyterian HospitalNew York, New Yorkand
| | - Barbara Powell
- New York-Presbyterian HospitalNew York, New Yorkand.,Hospital of the University of PennsylvaniaPhiladelphia, Pennsylvania
| | - David S Wang
- Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian HospitalNew York, New York
| | - Jonathan Hastie
- Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian HospitalNew York, New York
| | - Oliver Panzer
- Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian HospitalNew York, New York
| | - Daniel Brodie
- Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian HospitalNew York, New York
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37
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Kheyfets VO, Lammers SR, Wagner J, Bartels K, Piccoli J, Smith BJ. PEEP/ FIO2 ARDSNet Scale Grouping of a Single Ventilator for Two Patients: Modeling Tidal Volume Response. Respir Care 2020; 65:1094-1103. [PMID: 32712582 DOI: 10.4187/respcare.07931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic is creating ventilator shortages in many countries that is sparking a conversation about placing multiple patients on a single ventilator. However, on March 26, 2020, six leading medical organizations released a joint statement warning clinicians that attempting this technique could lead to poor outcomes and high mortality. Nevertheless, hospitals around the United States and abroad are considering this technique out of desperation (eg, New York), but there is little data to guide their approach. The overall objective of this study is to utilize a computational model of mechanically ventilated lungs to assess how patient-specific lung mechanics and ventilator settings impact lung tidal volume (VT). METHODS We developed a lumped-parameter computational model of multiple patients connected to a shared ventilator and validated it against a similar experimental study. We used this model to evaluate how patient-specific lung compliance and resistance would impact VT under 4 ventilator settings of pressure control level, PEEP, breathing frequency, and inspiratory:expiratory ratio. RESULTS Our computational model predicts VT within 10% of experimental measurements. Using this model to perform a parametric study, we provide proof-of-concept for an algorithm to better match patients in different hypothetical scenarios of a single ventilator shared by > 1 patient. CONCLUSIONS Assigning patients to preset ventilators based on their required level of support on the lower PEEP/higher [Formula: see text] scale of the National Institute of Health's National Heart, Lung, and Blood Institute ARDS Clinical Network (ARDSNet), secondary to lung mechanics, could be used to overcome some of the legitimate concerns of placing multiple patients on a single ventilator. We emphasize that our results are currently based on a computational model that has not been validated against any preclinical or clinical data. Therefore, clinicians considering this approach should not look to our study as an exact estimate of predicted patient VT values.
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Affiliation(s)
- Vitaly O Kheyfets
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
| | - Steven R Lammers
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer Wagner
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Karsten Bartels
- Department of Anesthesiology, Psychiatry, Medicine, and Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Jerome Piccoli
- University of Colorado School of Medicine, Aurora, Colorado
| | - Bradford J Smith
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
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38
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Ayyıldız S, Dursun AM, Yıldırım V, İnce ME, Gülçelik MA, Erdöl C. 3D-Printed Splitter for Use of a Single Ventilator on Multiple Patients During COVID-19. 3D PRINTING AND ADDITIVE MANUFACTURING 2020; 7:181-185. [PMID: 36654927 PMCID: PMC9586234 DOI: 10.1089/3dp.2020.0102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
During epidemics or pandemics affecting the respiratory systems, hospital equipment such as ventilators may become insufficient and different solutions can be considered. In fast spreading respiratory illnesses such as COVID-19 due to the rapidly increasing number of patients, ventilatory machine insufficiencies may appear. It may be considered to use one hospital ventilator for more than one patient by dividing the airway of the machine with a specially designed splitter. The aim of this study was to determine whether a ventilator can be modified to provide ventilation of two or more patients simultaneously by using 3D designed and manufactured splitters. A two-port and four-port splitter were designed in Autodesk Fusion 360 computer program and manufactured by 3D printer using PolyJet technology (Stratasys J750). Two sets of splitters were used to adapt to the ventilator during trial process: one for inspiratory and one for expiratory outputs. Two intensive care specialists voluntarily tried this study on themselves. It was concluded from the study that 3D designed and manufactured two-port splitter can be used to separate the airway of a single ventilator to multiple patients within a very limited indication and time interval.
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Affiliation(s)
- Simel Ayyıldız
- Gülhane Medical Design and Manufacturing Application and Research Center, University of Health Sciences Turkey, Ankara, Turkey
- Department of Prosthodontics, Gülhane Faculty of Dentistry, University of Health Sciences Turkey, Ankara, Turkey
- Address correspondence to: Simel Ayyıldız, Department of Prosthodontics, Gülhane Faculty of Dentistry, University of Health Sciences Turkey, Ankara 06018, Turkey
| | - Ahmet Murat Dursun
- Gülhane Medical Design and Manufacturing Application and Research Center, University of Health Sciences Turkey, Ankara, Turkey
| | - Vedat Yıldırım
- Department of Anesthesiology, University of Health Sciences Turkey, Gülhane Training and Education Hospital, Ankara, Turkey
| | - Mehmet Emin İnce
- Department of Anesthesiology, University of Health Sciences Turkey, Gülhane Training and Education Hospital, Ankara, Turkey
| | - Mehmet Ali Gülçelik
- Department of General Surgery, Faculty of Medicine, University of Health Sciences Turkey, Ankara, Turkey
| | - Cevdet Erdöl
- Department of Cardiology, Faculty of Medicine, University of Health Sciences Turkey, Ankara, Turkey
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39
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Solís-Lemus JA, Costar E, Doorly D, Kerrigan EC, Kennedy CH, Tait F, Niederer S, Vincent PE, Williams SE. A simulated single ventilator/dual patient ventilation strategy for acute respiratory distress syndrome during the COVID-19 pandemic. ROYAL SOCIETY OPEN SCIENCE 2020; 7:200585. [PMID: 32968521 PMCID: PMC7481711 DOI: 10.1098/rsos.200585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
The potential for acute shortages of ventilators at the peak of the COVID-19 pandemic has raised the possibility of needing to support two patients from a single ventilator. To provide a system for understanding and prototyping designs, we have developed a mathematical model of two patients supported by a mechanical ventilator. We propose a standard set-up where we simulate the introduction of T-splitters to supply air to two patients and a modified set-up where we introduce a variable resistance in each inhalation pathway and one-way valves in each exhalation pathway. Using the standard set-up, we demonstrate that ventilating two patients with mismatched lung compliances from a single ventilator will lead to clinically significant reductions in tidal volume in the patient with the lowest respiratory compliance. Using the modified set-up, we demonstrate that it could be possible to achieve the same tidal volumes in two patients with mismatched lung compliances, and we show that the tidal volume of one patient can be manipulated independently of the other. The results indicate that, with appropriate modifications, two patients could be supported from a single ventilator with independent control of tidal volumes.
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Affiliation(s)
- José A. Solís-Lemus
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
| | | | - Denis Doorly
- Department of Aeronautics, Imperial College London, UK
| | - Eric C. Kerrigan
- Department of Aeronautics, Imperial College London, UK
- Department of Electrical and Electronic Engineering, Imperial College London, UK
| | | | | | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
| | | | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
- Department of Cardiology, Guy's and St Thomas’ NHS Foundation Trust, UK
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40
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Zuckerberg J, Shaik M, Widmeier K, Kilbaugh T, Nelin TD. A lung for all: Novel mechanical ventilator for emergency and low-resource settings. Life Sci 2020; 257:118113. [PMID: 32687919 PMCID: PMC7366115 DOI: 10.1016/j.lfs.2020.118113] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/04/2022]
Abstract
Aims To create a low-cost ventilator that could be constructed with readily-available hospital equipment for use in emergency or low-resource settings. Main methods The novel ventilator consists of an inspiratory limb composed of an elastic flow-inflating bag encased within a non-compliant outer sheath and an expiratory limb composed of a series of two, one-way bidirectional splitter valves derived from a self-inflating bag system. An Arduino Uno microcontroller controls a solenoid valve that can be programmed to open and close to produce a set respiratory rate and inspiratory time. Using an ASL 5000 Lung Simulator, we obtained flow, pressure, and volume waveforms at different lung compliances. Key findings At a static lung compliance of 50 mL/cm H2O and an airway resistance of 6 cm H2O/L/s, ventilated at a PIP and PEEP of 16 and 5 cm H2O, respectively, tidal volumes of approximately 540 mL were achieved. At a static lung compliance of 20 mL/cm H2O and an airway resistance of 6 cm H2O/L/s, ventilated at a PIP and PEEP of 38 and 15 cm H2O, respectively, tidal volumes of approximately 495 mL were achieved. Significance This novel ventilator is able to safely and reliably ventilate patients with a range of pulmonary disease in a simulated setting. Opportunities exist to utilize our ventilator in emergency situations and low-resource settings.
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Affiliation(s)
- Jeremy Zuckerberg
- The Children's Hospital of Philadelphia, Department of Pediatrics, United States of America
| | - Mohammed Shaik
- The Children's Hospital of Philadelphia, Department of Pediatrics, United States of America
| | - Keith Widmeier
- The Children's Hospital of Philadelphia, Center for Simulation, Advanced Education, and Innovation, United States of America
| | - Todd Kilbaugh
- The Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care Medicine, United States of America
| | - Timothy D Nelin
- The Children's Hospital of Philadelphia, Department of Pediatrics, United States of America.
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41
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de Jongh FHC, de Vries HJ, Warnaar RSP, Oppersma E, Verdaasdonk R, Heunks LMA, Doorduin J. Ventilating two patients with one ventilator: technical setup and laboratory testing. ERJ Open Res 2020; 6:00256-2020. [PMID: 32665947 PMCID: PMC7335837 DOI: 10.1183/23120541.00256-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
During health crises, including terrorist attacks or pandemics like coronavirus disease 2019 (COVID-19), the number of mechanical ventilators might fall short of the number of patients with severe respiratory failure [1–3]. A possible emergency solution is to ventilate multiple patients with one ventilator. Sharing ventilators was applied anecdotally during the 2017 Las Vegas (USA) shootings and has raised interest in lay media with the current COVID-19 pandemic [4]. However, ventilating two patients with one ventilator can be dangerous when incorrectly applied. Different setups have been published online, but none have reported any technical safety testing. With a modified circuit, it is feasible to ventilate two patients with one ventilator over a relevant range of compliances. Adding inspiratory resistance allows individual titration of tidal volume, and incorporating one-way valves prevents pendelluft.https://bit.ly/3ex8SYP
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Affiliation(s)
- Frans H C de Jongh
- Dept of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands.,TechMed Centre, University of Twente, Enschede, The Netherlands.,Dept of Neonatal Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,These authors contributed equally
| | - Heder J de Vries
- Dept of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,These authors contributed equally
| | - Rob S P Warnaar
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Eline Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Rudolf Verdaasdonk
- Health Technology Implementation, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Leo M A Heunks
- Dept of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jonne Doorduin
- Dept of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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42
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Bunting L, Roy S, Pinson H, Greensweig T. A novel inline PEEP valve design for differential multi-ventilation. Am J Emerg Med 2020; 38:2045-2048. [PMID: 33142172 PMCID: PMC7351030 DOI: 10.1016/j.ajem.2020.06.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background Ventilator sharing is one option to emergently increase ventilator capacity during a crisis but has been criticized for its inability to adjust for individual patient needs. Newer ventilator sharing designs use valves and restrictors to control pressures for each patient. A key component of these designs is an inline Positive End Expiratory Pressure (PEEP) Valve but these are not readily available. Creating an inline PEEP valve by converting a standard bag-valve-mask PEEP valve is possible with the addition of a 3D printed collar. Methods This was a feasibility study assessing the performance and safety of a method for converting a standard PEEP valve into an inline PEEP valve. A collar was designed and printed that covers the exhaust ports of the valve and returns exhaled gases to the ventilator. Results The collar piece was simple to print and easily assembled with the standard PEEP valve. In bench testing it successfully created differential pressures in 2 simulated expiratory limbs without leaking to the atmosphere at pressures greater than 60 cm of H2O. Conclusion Our novel inline PEEP valve design shows promise as an option for building a safer ventilator sharing system.
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Affiliation(s)
- Leonard Bunting
- Wayne State University, Detroit, MI, United States of America; Department of Emergency Medicine, Ascension Providence, Southfield, MI, United States of America.
| | - Steven Roy
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Hannah Pinson
- Applied Physics/Data Analytics, Vrije Universiteit, Brussels, Belgium
| | - Tobin Greensweig
- Department of Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
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43
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Aziz S, Arabi YM, Alhazzani W, Evans L, Citerio G, Fischkoff K, Salluh J, Meyfroidt G, Alshamsi F, Oczkowski S, Azoulay E, Price A, Burry L, Dzierba A, Benintende A, Morgan J, Grasselli G, Rhodes A, Møller MH, Chu L, Schwedhelm S, Lowe JJ, Bin D, Christian MD. Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive Care Med 2020; 46:1303-1325. [PMID: 32514598 PMCID: PMC7276667 DOI: 10.1007/s00134-020-06092-5] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.
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Affiliation(s)
- Shadman Aziz
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Alhazzani
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Laura Evans
- Department of Pulmonary and Critical Care Medicine, University of Washington, Seattle, USA
| | | | | | - Jorge Salluh
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | | | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, UAE
| | - Simon Oczkowski
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Elie Azoulay
- Assistance publique - Hôpitaux de Paris, Paris, France
| | - Amy Price
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | - Lisa Burry
- Sinai Health System, University of Toronto, Toronto, Canada
| | - Amy Dzierba
- New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | | | | | - Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Andrew Rhodes
- St Georges Hospitals NHS Foundation Trust, London, UK
| | - Morten H Møller
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Larry Chu
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | | | - John J Lowe
- Department of Environmental and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Du Bin
- Peking Union Medical College Hospital, Beijing, China
| | - Michael D Christian
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK.
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44
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Chen GH, Hellman S, Irie T, Downey RJ, Fischer GW. Regulating inspiratory pressure to individualise tidal volumes in a simulated two-patient, one-ventilator system. Br J Anaesth 2020; 125:e366-e368. [PMID: 32718725 PMCID: PMC7324329 DOI: 10.1016/j.bja.2020.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Grant H Chen
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samuel Hellman
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Takeshi Irie
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Downey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gregory W Fischer
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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45
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Supporting more than one patient with a single mechanical ventilator: useful last resort or unjustifiable risk? Br J Anaesth 2020; 125:247-250. [PMID: 32536443 PMCID: PMC7262535 DOI: 10.1016/j.bja.2020.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 11/21/2022] Open
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46
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Stawicki SP, Jeanmonod R, Miller AC, Paladino L, Gaieski DF, Yaffee AQ, De Wulf A, Grover J, Papadimos TJ, Bloem C, Galwankar SC, Chauhan V, Firstenberg MS, Di Somma S, Jeanmonod D, Garg SM, Tucci V, Anderson HL, Fatimah L, Worlton TJ, Dubhashi SP, Glaze KS, Sinha S, Opara IN, Yellapu V, Kelkar D, El-Menyar A, Krishnan V, Venkataramanaiah S, Leyfman Y, Saoud Al Thani HA, WB Nanayakkara P, Nanda S, Cioè-Peña E, Sardesai I, Chandra S, Munasinghe A, Dutta V, Dal Ponte ST, Izurieta R, Asensio JA, Garg M. The 2019-2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper. J Glob Infect Dis 2020; 12:47-93. [PMID: 32773996 PMCID: PMC7384689 DOI: 10.4103/jgid.jgid_86_20] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a "new normal" are discussed in this article.
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Affiliation(s)
- Stanislaw P Stawicki
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA,Address for correspondence: Dr. Stanislaw P Stawicki, Department of Research and Innovation, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, Pennsylvania, USA. E-mail:
| | - Rebecca Jeanmonod
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Andrew C Miller
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Lorenzo Paladino
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - David F Gaieski
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Anna Q Yaffee
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Annelies De Wulf
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Joydeep Grover
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Thomas J. Papadimos
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Christina Bloem
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Sagar C Galwankar
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vivek Chauhan
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Michael S. Firstenberg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Salvatore Di Somma
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Donald Jeanmonod
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Sona M Garg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Veronica Tucci
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Harry L Anderson
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Lateef Fatimah
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Tamara J Worlton
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | | | - Krystal S Glaze
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Sagar Sinha
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Ijeoma Nnodim Opara
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Vikas Yellapu
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Dhanashree Kelkar
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Ayman El-Menyar
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vimal Krishnan
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - S Venkataramanaiah
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Yan Leyfman
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | | | | | - Sudip Nanda
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Eric Cioè-Peña
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Indrani Sardesai
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Shruti Chandra
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Aruna Munasinghe
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vibha Dutta
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Silvana Teixeira Dal Ponte
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Ricardo Izurieta
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Juan A Asensio
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Manish Garg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
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47
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Jian Z, Zhang L, Jin L, Lan W, Zhang W, Gao G. Rab5 regulates the proliferation, migration and invasion of glioma cells via cyclin E. Oncol Lett 2020; 20:1055-1062. [PMID: 32724343 PMCID: PMC7377158 DOI: 10.3892/ol.2020.11660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/29/2020] [Indexed: 12/23/2022] Open
Abstract
Glioma is the most common and lethal type of primary brain tumor, with a high mortality and recurrence rate. Rab5, which serves as a classic ontogenetic gene, is highly expressed in various types of tumor, including lung cancer, hepatocellular carcinoma and ovarian cancer. However, the exact role and the underlying mechanism of Rab5 in glioma remain unknown. Herein, the role of Rab5 in the tumorigenesis and metastasis of glioma cells was investigated. The upregulation of Rab5 in glioma tissues and cells was observed. The expression of Rab5 was positively associated with proliferation, migration and invasion of glioma cells. Moreover, Rab5 was involved in the cell cycle of glioma cells via the regulation of cyclin E. Data presented in the present study suggest Rab5 as a potential novel diagnostic and prognosis marker of glioma.
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Affiliation(s)
- Zhao Jian
- Department of Neurosurgery, Cangzhou People's Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Lianglong Zhang
- Department of Neurosurgery, Cangzhou People's Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Liang Jin
- Department of Neurosurgery, Cangzhou People's Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Weitu Lan
- Department of Neurosurgery, Cangzhou People's Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Wei Zhang
- Department of Neurosurgery, Cangzhou People's Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Guiyan Gao
- Department of Neurosurgery, Cangzhou People's Hospital, Cangzhou, Hebei 061000, P.R. China
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48
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Lotz C, Notz Q, Kranke P, Kredel M, Meybohm P. Unconventional approaches to mechanical ventilation-step-by-step through the COVID-19 crisis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:233. [PMID: 32423431 PMCID: PMC7233673 DOI: 10.1186/s13054-020-02954-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/07/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Christopher Lotz
- Department of Anesthesiology and Critical Care, University Hospital of Wuerzburg, University Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Quirin Notz
- Department of Anesthesiology and Critical Care, University Hospital of Wuerzburg, University Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Peter Kranke
- Department of Anesthesiology and Critical Care, University Hospital of Wuerzburg, University Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Markus Kredel
- Department of Anesthesiology and Critical Care, University Hospital of Wuerzburg, University Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Patrick Meybohm
- Department of Anesthesiology and Critical Care, University Hospital of Wuerzburg, University Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
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49
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Frazer JS, Shard A, Herdman J. Involvement of the open-source community in combating the worldwide COVID-19 pandemic: a review. J Med Eng Technol 2020; 44:169-176. [PMID: 32401550 DOI: 10.1080/03091902.2020.1757772] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The ongoing COVID-19 pandemic is unprecedented in the modern age both due to its scale and its disruption to daily life throughout the world. Widespread social isolation and restrictions in the age of modern communicative technology, coupled with some early successes for makers, have united the open-source community towards a common goal in a way not previously seen. Local hospitals and care facilities are turning to makers to print essential consumable parts, such as simple visors, while in the hardest hit areas, critical pieces of medical technology are being fabricated. While important and effective innovations are appearing almost daily, there are also some worrying trends towards hobbyists attempting manufacture of complex medical devices with little understanding of the clinical or scientific rationale behind their design. The nature of the open-source community, an area of intensive innovation, fluidity, and experimentation, jars with the exacting standards of medical device regulation. Here, we review the involvement of rapid prototyping and the open-source community in the key areas of personal protective equipment (PPE), diagnostics, critical care technology, and information acquisition and sharing, highlighting where makers and hackers have clashed with medical device regulations, and areas where the system has worked well to facilitate change.
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Affiliation(s)
- John Scott Frazer
- Somerville College, University of Oxford, Oxford, UK.,Buckinghamshire Healthcare, NHS Trust, Aylesbury, UK
| | - Amelia Shard
- Buckinghamshire Healthcare, NHS Trust, Aylesbury, UK
| | - James Herdman
- Buckinghamshire Healthcare, NHS Trust, Aylesbury, UK
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50
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Rodríguez-Villar S. Sharing a single ventilator ("In vitro"). Med Intensiva 2020; 44:514-516. [PMID: 32493646 PMCID: PMC7211698 DOI: 10.1016/j.medin.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Sancho Rodríguez-Villar
- Department of Critical Care, King's College Hospital NHS Trust Foundation. London, United Kingdom; Honorary Senior Clinical Lecturer in the GKT School of Medical Education, Faculty of Life Sciences & Medicine at King's College London. London, United Kingdom.
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