Insights about this potential last resort ventilation strategy
Multiplex ventilation (MpV) is the practice of ventilating more than one patient at a time with a single ventilator. Understanding this technique is especially germane during the COVID-19 pandemic, which has created a greater demand for ventilators in some healthcare centers. MpV can be a lifesaving technique, but there are several modifications to consider to maximize its efficacy and minimize risk for patients.
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Umur Hatipoğlu, MD, Medical Director for Respiratory Medicine, and Robert Chatburn, MHHS, RRT-NPS, FAARC, Enterprise Research Manager for Respiratory Care, both at Cleveland Clinic’s Respiratory Institute, host an instructional video that demonstrates potential use and considerations of MpV in a clinical setting.
“The technique becomes relevant when there’s a surge in the demand for mechanical ventilators, and there are less machines than patients in need. In response to the COVID-19 pandemic, several different methods of providing mechanical ventilation from two to nine patients have been disseminated on the Internet. Almost all of these circuit designs focus on splitting flow with off-the-shelf respiratory y-connectors applied at the inspiratory and expiratory ports of the ventilator,” explains Dr. Hatipoglu. “Valves, typically those used in water flow applications, have been suggested in some designs for regulating tidal volume distribution between patients. Some of these techniques employ 3D-printed connectors that either provide a fixed flow split or a variable flow diversion between patients.”
Dr. Hatipoglu then explains the goals of ventilation in patients with ARDS and how MpV can be safely implemented for patients. “There are three critical issues that need to be addressed to minimize risk to patients from multiplex ventilation. The first is partitioning of the volume delivered by the ventilator to each subject… Second is the issue of measuring tidal volume delivered to each patient. And a third issue is the provision of individualized PEEP [positive end-expiratory pressure].”
Watch as Dr. Hatipoglu explains how to address these issues.
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