Differential ventilation using flow control valves as a potential bridge to full ventilatory support during the COVID-19 crisis

Matthew Levin; Martin D Chen; Anjan Shah; Ronak Shah; George Zhou; Erica Kane; Garrett Burnett; Shams Ranginwala; Jonathan Madek; Christopher Gidiscin; Chang Park; Daniel Katz; Benjamin Salter; Roopa Kohli-Seth; James B Eisenkraft; Suzan Uysal; Michael McCarry; Andrew B Leibowitz; David L Reich

Using a rapid bench-to-bedside approach, we developed a split ventilation circuit that utilizes custom manufactured flow control valves to deliver differential ventilation to two patients connected to a single ventilator. While other groups have proposed similar solutions, we believe that this is the first study to test this technique of using individual flow control valves during shared ventilation in human subjects. 7 Our study validates that this approach to split ventilation is effective and safe in a small series of COVID-19 patients who differed significantly in size and lung compliance. Both pairs of patients tolerated one hour of shared ventilation with no adverse effects and were alive as of the time of writing. This study demonstrates this technique as a potential bridge to full ventilatory support.