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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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Achanta S, Gentile MA, Euliano NR. Development and evaluation of a mechanical ventilator-sharing system. Front Med (Lausanne) 2024; 11:1356769. [PMID: 38435386 PMCID: PMC10905385 DOI: 10.3389/fmed.2024.1356769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Background During the COVID-19 pandemic surge in the hospitalization of critically ill patients and the global demand for mechanical ventilators, alternative strategies for device sharing were explored. We developed and assessed the performance of a system for shared ventilation that uses clinically available components to individualize tidal volumes under a variety of clinically relevant conditions. The feasibility of remote monitoring of ventilators was also assessed. Methods By using existing resources and off-the-shelf components, a ventilator-sharing system (VSS) that ventilates 2 patients simultaneously with a single device, and a ventilator monitoring system (VMS) that remotely monitors pulmonary mechanics were developed. The feasibility and effectiveness of VSS and VMS were evaluated in benchtop testing using 2 test lungs on a single ventilator, and then performance was assessed in translational swine models of normal and impaired lung function. Results In benchtop testing, VSS and VMS delivered the set individualized parameters with minimal % errors in test lungs under pressure- and volume-regulated ventilation modes, suggesting the highest precision and accuracy. In animal studies, the VSS and VMS successfully delivered the individualized mechanical ventilation parameters within clinically acceptable limits. Further, we found no statistically significant difference between the target and measured values. Conclusion The VSS adequately ventilated 2 test lungs or animals with variable lung conditions. The VMS accurately displayed mechanical ventilation settings, parameters, and alarms. Both of these systems could be rapidly assembled for scaling up to ventilate several critically ill patients in a pandemic or mass casualty disaster situations by leveraging off-the-shelf and custom 3D printed components.
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Affiliation(s)
- Satyanarayana Achanta
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
| | - Michael A. Gentile
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
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Abstract
COVID-19 resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic of respiratory failure previously unencountered. Early in the pandemic, concentrated infections in high-density population cities threatened to overwhelm health systems, and ventilator shortages were predicted. An early proposed solution was the use of shared ventilation, or the use of a single ventilator to support ≥ 2 patients. Spurred by ill-conceived social media posts, the idea spread in the lay press. Prior to 2020, there were 7 publications on this topic. A year later, more than 40 publications have addressed the technical details for shared ventilation, clinical experience with shared ventilation, as well as the numerous limitations and ethics of the technique. This is a review of the literature regarding shared ventilation from peer-reviewed articles published in 2020.
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Affiliation(s)
- Richard D Branson
- Department of Surgery, Division of Trauma & Critical Care, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, Ohio.
| | - Dario Rodriquez
- Division of Trauma/Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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Combined Ventilation of Two Subjects with a Single Mechanical Ventilator Using a New Medical Device: An In Vitro Study. Anesthesiol Res Pract 2021; 2021:6691591. [PMID: 33628233 PMCID: PMC7896537 DOI: 10.1155/2021/6691591] [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: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The SARS-CoV-2 pandemic has created a sudden lack of ventilators. DuplicARⓇ is a novel device that allows simultaneous and independent ventilation of two subjects with a single ventilator. The aims of this study are (a) to determine the efficacy of DuplicARⓇ to independently regulate the peak and positive-end expiratory pressures in each subject, both under pressure-controlled ventilation and volume-controlled ventilation and (b) to determine the ventilation mode in which DuplicARⓇ presents the best performance and safety. Materials and Methods Two test lungs are connected to a single ventilator using DuplicARⓇ. Three experimental stages are established: (1) two identical subjects, (2) two subjects with the same weight but different lung compliance, and (3) two subjects with different weights and lung compliances. In each stage, the test lungs are ventilated in two ventilation modes. The positive-end expiratory pressure requirements are increased successively in one of the subjects. The goal is to achieve a tidal volume of 7 ml/kg for each subject in all different stages through manipulation of the ventilator and the DuplicARⓇ controllers. Results DuplicARⓇ allows adequate ventilation of two subjects with different weights and/or lung compliances and/or PEEP requirements. This is achieved by adjusting the total tidal volume for both subjects (in volume-controlled ventilation) or the highest peak pressure needed (in pressure-controlled ventilation) along with the basal positive-end expiratory pressure on the ventilator and simultaneously manipulating the DuplicARⓇ controllers to decrease the tidal volume or the peak pressure in the subject that needs less and/or to increase the positive-end expiratory pressure in the subject that needs more. While ventilatory goals can be achieved in any of the ventilation modes, DuplicARⓇ performs better in pressure-controlled ventilation, as changes experienced in the variables of one subject do not modify the other one. Conclusions DuplicARⓇ is an effective tool to manage the peak inspiratory pressure and the positive-end expiratory pressure independently in two subjects connected to a single ventilator. The driving pressure can be adjusted to meet the requirements of subjects with different weights and lung compliances. Pressure-controlled ventilation has advantages over volume-controlled ventilation and is therefore the recommended ventilation mode.
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