PROJECT HIGHLIGHTS

Governance Organization

MSU – Mount Sinai Hospital – University Health Network Academic Medical Organization

Project Title

Individualized Automatic Lung Ventilation of Multiple Patients using Single ventilator

Project Highlights

The system has now been tested in an animal model. The system was used to simultaneously co-ventilate two pigs of significantly different sizes (34 kg and 69 kg). We were able to demonstrate that tidal volume, FiO2 and PEEP can be independently controlled for each subject and acid-base balance can be independently adjusted for each. In addition we demonstrated that sudden disconnection or obstruction of one circuit has no significant effect on the ventilation delivered to the co-ventilated subject. Manuscript for the study is currently undergoing final revisions.

Abstract of the MS is below. This will be the final publication of the results from this project.

Project respository is available at https://github.com/tgh-apil/Cerberus-Multivent .

[Abstract]

In crises such as the COVD-19 pandemic local surges of critically ill patients may overwhelm availability of critical care technology such as ventilators. Ventilator splitting, that is distributing the tidal volume from a single ventilator among more than one patient, has been proposed as one short-term solution. However, the requirement for such methods to accommodate individual lung compliance, tidal volume, PEEP and inspired oxygen levels, have led to a consensus statement from expert professional associations led by the Society of Critical Care Medicine, strongly discouraging the use of simple ventilator splitting.

Nevertheless, the risk of widespread transient ventilator shortages has to be addressed. Storage of stock-piled ventilators reserved for emergency use is not feasible on a global scale due to cost and logistic challenges of storage and maintenance. In 1994 Sommer et al. proposed a ventilator splitting circuit that potentially addresses the concerns raised regarding the safety of simple splitting techniques. We previously modified and bench validated this system which consists of a series of secondary ventilator circuits for each patient, connected to a primary circuit driven by a single ventilator. The advantage of this “bag in a box” approach is that FiO2, tidal volume and PEEP can be independently adjusted for each co-ventilated patient irrespective of differences in lung compliances. Only the same respiratory rate is required for all connected patients.

In this study we sought to evaluate the system’s safety and efficacy in an in-vivo swine model. Specifically, we evaluated 1) the ability of the system to adequately ventilate two animals of significantly different sizes and 2) the ability to simultaneously correct respiratory acid-base imbalances in two different animals while being ventilated on the same circuit.

Theme

Methods of Risk Reduction and Mitigation

Primary Project Lead for Contact

Azad Mashari

Email

azad.mashari@uhn.ca

Secondary Project Lead for Contact

Joe Fisher

Email

joe.fisher@utoronto.ca

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