DIY ventilation plan

A simple ‘do it yourself ’ breathing circuit, using accessories available in intensive care, can be used to ventilate two critically ill patients at once, should clinicians be faced with equipment shortages, say researchers.

But although technically feasible, it isn’t clear if the pros of split ventilation outweigh the cons, and the approach is fraught with ethical issues, so this circuit should only be used as a last resort, say critical care and respiratory disease doctors in linked opinion pieces..

Prompted by the rapid rise in Covid-19 cases in the Lombardy region of Italy, and the prospect of a ventilator shortage, Italian doctors assembled and tested a simple, easily built breathing circuit on two ‘pretend’ patients..

The circuit comprised routine and readily accessible tubing and accessories found in intensive care and operating theatres..

The 15-hour tests confirmed that it would be technically feasible to use the circuit to ventilate two patients at the same time..

What’s more, the technique is safer for staff than manual bag ventilation and avoids the constant need for a ‘human ventilator’ to work the bag, so freeing up staff, say the researchers who published their work in the online journal Thorax..

But the tests also showed that the level of ventilation provided wasn’t evenly distributed when lung function and capacity differed between the two ‘patients.’.

It should therefore only be used as a last resort, caution the researchers, because of the need to closely match the physiology of both patients, and the impossibility of being able to monitor separately changes in each patient’s respiratory response.

The idea of ventilator sharing isn’t new, explain Drs Steven Pearson, Jesse Hall, and William Parker. It was first suggested in 2006.