Dataset Information

Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept.

ABSTRACT:

Objectives

To design and test a ventilator circuit that can be used for ventilation of two or more patients with a single ventilator, while allowing individualization of tidal volume, fractional concentration of oxygen, and positive end-expiratory pressure to each patient, irrespective of the other patient's respiratory system mechanics.

Design

Description and proof of concept studies.

Settings

Respiratory therapy laboratory.

Subjects

Ventilation of mechanical test lungs.

Interventions

Following a previously advocated design, we used components readily available in our hospital to assemble two "bag-in-a-box" breathing circuits. Each patient circuit consisted of a flexible bag in a rigid container connected via one-way valve to a test lung, along with an inline positive end-expiratory pressure valve, connected to the ventilator's expiratory limb. Compressed gas fills the bags during "patient" exhalation. During inspiration, gas from the ventilator, in pressure control mode, enters the containers and displaces gas from the bags to the test lungs. We varied tidal volume, "respiratory system" compliance, and positive end-expiratory pressure in one lung and observed the effect on the tidal volume of the other.

Measurements and main results

We were able to obtain different tidal volume, dynamic driving pressure, and positive end-expiratory pressure in the two lungs under widely different compliances in both lungs. Complete obstruction, or disconnection at the circuit connection to one test lung, had minimal effect (< 5% on average) on the ventilation to the co-ventilated lung.

Conclusions

A secondary circuit "bag-in-the-box" system enables individualized ventilation of two lungs overcoming many of the concerns of ventilating more than one patient with a single ventilator.

SUBMITTER: Han JS

PROVIDER: S-EPMC7259561 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept.

Han Jay S JS Mashari Azad A Singh Devin D Dianti Jose J Goligher Ewan E Long Michael M Ng William W Wasowicz Marcin M Preiss David D Vesely Alex A Kacmarek Robert R Keshavjee Shaf S Brochard Laurent L Fisher Joseph A JA Slutsky Arthur S AS

Critical care explorations 20200506 5

<h4>Objectives</h4>To design and test a ventilator circuit that can be used for ventilation of two or more patients with a single ventilator, while allowing individualization of tidal volume, fractional concentration of oxygen, and positive end-expiratory pressure to each patient, irrespective of the other patient's respiratory system mechanics.<h4>Design</h4>Description and proof of concept studies.<h4>Settings</h4>Respiratory therapy laboratory.<h4>Subjects</h4>Ventilation of mechanical test l ...[more]

PMID: 32671348

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Project description:BackgroundMechanical ventilation is a common therapy in operating rooms and intensive care units. When ill-adapted, it can lead to ventilator-induced lung injury (VILI), which is associated with poor outcomes. Excessive regional pulmonary strain is thought to be a major mechanism responsible for VILI. Scarce bedside methods exist to measure regional pulmonary strain. We propose a novel way to measure regional pleural strain using ultrasound elastography. The objective of this study was to assess the feasibility and reliability of pleural strain measurement by ultrasound elastography and to determine if elastography parameters would correlate with varying tidal volumes.MethodsA single-blind randomized crossover proof of concept study was conducted July to October 2017 at a tertiary care referral center. Ten patients requiring general anesthesia for elective surgery were recruited. After induction, patients received tidal volumes of 6, 8, 10, and 12 mL.kg-1 in random order, while pleural ultrasound cineloops were acquired at 4 standardized locations. Ultrasound radiofrequency speckle tracking allowed computing various pleural translation, strain and shear components. We screened 6 elastography parameters (lateral translation, lateral absolute translation, lateral strain, lateral absolute strain, lateral absolute shear and Von Mises Strain) to identify those with the best dose-response with tidal volumes using linear mixed effect models. Goodness-of-fit was assessed by the coefficient of determination. Intraobserver, interobserver and test-retest reliability were calculated using intraclass correlation coefficients.ResultsAnalysis was possible in 90.7% of ultrasound cineloops. Lateral absolute shear, lateral absolute strain and Von Mises strain varied significantly with tidal volume and offered the best dose-responses and data modeling fits. Point estimates for intraobserver reliability measures were excellent for all 3 parameters (0.94, 0.94, and 0.93, respectively). Point estimates for interobserver (0.84, 0.83, and 0.77, respectively) and test-retest (0.85, 0.82, and 0.76, respectively) reliability measures were good.ConclusionStrain imaging is feasible and reproducible. Future studies will have to investigate the clinical relevance of this novel imaging modality.Clinical trial registrationwww.Clinicaltrials.gov, identifier NCT03092557.

Dataset Information

Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept.

Objectives

Design

Settings

Subjects

Interventions

Measurements and main results

Conclusions

Publications

Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept.

Similar Datasets

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