Multiplex Ventilation: A Simulation-Based Study of Ventilating 2 Patients With a Single Ventilator.

The overwhelming demand for mechanical ventilators due to COVID-19 has stimulated interest in using one ventilator for multiple patients (ie, multiplex ventilation). Despite a plethora of information on the internet, there is little supporting evidence and no human studies. The risk of multiplex ventilation is that ventilation and PEEP effects are largely uncontrollable and depend on the difference between patients' resistance and compliance. It is not clear whether volume control ventilation or pressure control ventilation is safer or more effective. We designed a simulation-based study to allow complete control over the relevant variables to determine the effects of various degrees of resistance-compliance imbalance on tidal volume (V Two separate breathing simulators were ventilated with a ventilator using pressure control and volume control ventilation modes. Evidence-based lung models simulated a range of differences in resistance and compliance (6 pairs of simulated patients). Differences in V Depending on differences in resistance and compliance, differences in V These experiments confirmed the potential for markedly different ventilation and oxygenation for patients with uneven respiratory system impedances during multiplex ventilation. Three critical problems must be solved to minimize risk: (1) partitioning of inspiratory flow from the ventilator individually between the 2 patients, (2) measurement of V

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Mr Chatburn has disclosed relationships with IngMar Medical, and Vyaire Medical. Mr Branson has disclosed relationships with Mallinckrodt, Ventec Life Systems, and Zoll Medical Corporation. Dr Hatipoğlu has disclosed no conflicts of interest.