• Micha Sam Brickman Raredon, Clark Fisher, Paul M Heerdt, Robert B Schonberger, Alyssa Nargi, Steven Nivison, Elaine Fajardo, Ranjit Deshpande, Shamsuddin Akhtar, Allison M Greaney, Joseph Belter, Thomas Raredon, Joseph Zinter, Andrew McKee, Mark Michalski, Pavlina Baevova, and Laura E Niklason.
• From the Department of Biomedical Engineering, Yale University, New Haven, Connecticut.
• Anesth. Analg. 2022 May 1; 134 (5): 109411051094-1105.

AbstractThe 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.Copyright © 2021 International Anesthesia Research Society.

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