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The fastest way to double our capacity of high-quality ventilators during a patient surge is to externally patch extra-tubing to existing ventilators so they ca

The fastest way to double our capacity of high-quality ventilators during a patient surge is to externally patch extra-tubing to existing ventilators so they can handle two patients instead of just one. This paper documents how it has been done successfully in an emergency: https://www.reddit.com/r/COVID19/comments/fijars/a_single_ventilator_for_multiple_simulated/ https://www.reddit.com/r/COVID19/comments/fijars/a_single_ve... Reddit thread yesterday with commentary from ventilator experts: https://www.reddit.com/r/COVID19/comments/fijars/a_single_ventilator_for_multiple_simulated/ https://www.reddit.com/r/COVID19/comments/fijars/a_single_ve... Summary: It's definitely feasible and works. Not as good as more full ventilators but in a shortage, probably much better than DIY vents but it requires hoses, Y-splitters, adapters, etc. Request: Make two-for-one emergency kits that adapt to fit popular ventilator models.

koheripbal 7y ago
The major problem here is cross patient contamination. Patients are literally inhaling virus laden exhales from the other patient. ...which aside from covid-19, might also contain other bacterial/viral co-infections.
- mrandish 7y ago
  That's addressed in detail by anesthesiologists, ICU docs and other ventilator operators in the linked Reddit thread. I'm not an expert but they indicate while not ideal it's NOT as bad as it seems and can be mitigated.
- fragmede 7y ago
  You're absolutely right. Cross-contamination is a huge issue. That doctors who would be well aware of the risk, are willing to run a ventilator in such a risky fashion should help everyone realize just how dire a given situation is/was. The linked paper dates back to 2006, and don't know if it's been done for the Covid-19 pandemic, though the situation in Italy sounds bad.
  - mrandish 7y ago
    I agree. My thought was such 2-for-1 kits would be strictly for very temporary, situational use in an emergency only. The idea of making kits in advance was simply that in such an emergency having staff scrounging adapters and tubes is it's own cost and have a kit that's ready and been at least a little bit thought through makes this a little more likely to succeed. I was also hopeful, as discussed in the Reddit thread by docs who know a lot more than I, that filters and optimal routing could help minimize cross-contamination. It also appears from papers released in the last few days that CV19 is most contagious just after developing significant symptoms but before progression and also that reinfection is looking very unlikely or impossible (they gave macaque monkeys CV19, let them get over it and they couldn't reinfect them despite trying to). The whole thing could be a dumb idea but the paper and discussion seemed relevant enough to bring to people's attention because a lot of engineers are talking about designing DIY ventilators which seems a lot harder and even at 'maker' speed may not arrive fast enough in volume should the very worst happen in some areas.
- SkyMarshal 7y ago
  If both patients have COVID19 then is cross-contamination the main concern? Seems the priority then is preventing them from dying due to incapacitated lungs.
mrandish 7y ago
I mis-linked. Here's the direct link to the paper: https://www.ncbi.nlm.nih.gov/m/pubmed/16885402/ https://www.ncbi.nlm.nih.gov/m/pubmed/16885402/
Herodotus38 7y ago
This would be a very Last resort. Aside from infection risks you are going to cause barotrauma which we know worsens mortality. In mass casualty or trauma events the pt needs stabilization and ventilation but the issue is usually not lung compliance, so this is somewhat better use. In ARDS lungs are not as compliant. Imagine two patients where one has less compliant lungs and you use one ventilator, how are you going to prevent the barotrauma, maybe try to match lung compliance? The paper you link also says this would be potentially useful in mass disaster for a limited time.

koheripbal 7y ago

The major problem here is cross patient contamination. Patients are literally inhaling virus laden exhales from the other patient. ...which aside from covid-19, might also contain other bacterial/viral co-infections.

mrandish 7y ago
That's addressed in detail by anesthesiologists, ICU docs and other ventilator operators in the linked Reddit thread. I'm not an expert but they indicate while not ideal it's NOT as bad as it seems and can be mitigated.
fragmede 7y ago
You're absolutely right. Cross-contamination is a huge issue. That doctors who would be well aware of the risk, are willing to run a ventilator in such a risky fashion should help everyone realize just how dire a given situation is/was. The linked paper dates back to 2006, and don't know if it's been done for the Covid-19 pandemic, though the situation in Italy sounds bad.
- mrandish 7y ago
  I agree. My thought was such 2-for-1 kits would be strictly for very temporary, situational use in an emergency only. The idea of making kits in advance was simply that in such an emergency having staff scrounging adapters and tubes is it's own cost and have a kit that's ready and been at least a little bit thought through makes this a little more likely to succeed. I was also hopeful, as discussed in the Reddit thread by docs who know a lot more than I, that filters and optimal routing could help minimize cross-contamination. It also appears from papers released in the last few days that CV19 is most contagious just after developing significant symptoms but before progression and also that reinfection is looking very unlikely or impossible (they gave macaque monkeys CV19, let them get over it and they couldn't reinfect them despite trying to). The whole thing could be a dumb idea but the paper and discussion seemed relevant enough to bring to people's attention because a lot of engineers are talking about designing DIY ventilators which seems a lot harder and even at 'maker' speed may not arrive fast enough in volume should the very worst happen in some areas.
SkyMarshal 7y ago
If both patients have COVID19 then is cross-contamination the main concern? Seems the priority then is preventing them from dying due to incapacitated lungs.

mrandish 7y ago

I mis-linked. Here's the direct link to the paper: https://www.ncbi.nlm.nih.gov/m/pubmed/16885402/ https://www.ncbi.nlm.nih.gov/m/pubmed/16885402/

Herodotus38 7y ago

This would be a very Last resort. Aside from infection risks you are going to cause barotrauma which we know worsens mortality. In mass casualty or trauma events the pt needs stabilization and ventilation but the issue is usually not lung compliance, so this is somewhat better use. In ARDS lungs are not as compliant. Imagine two patients where one has less compliant lungs and you use one ventilator, how are you going to prevent the barotrauma, maybe try to match lung compliance? The paper you link also says this would be potentially useful in mass disaster for a limited time.