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

The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.04.14.20053587 doi: medRxiv preprint requires prolonged sedation and paralysis, although many COVID patients require paralysis for optimal ventilation. Third, if one patient in the pair decompensates there may be a significant increase in ventilatory requirement requiring them to be separated emergently from the split circuit and connected to an independent means of ventilation (e.g., Ambu bag). Fourth, even with B/V filters it is possible that bacterial super-infection could be spread between patients. However likely to be small and would likely be appropriate in a crisis standard of care." 14 Fifth, it will not be possible to wean patients from controlled ventilation while they are on the split circuit. This is a known limitation and we do not expect weaning to be attempted while patients are sharing a ventilator. Finally, our design adds an additional layer of complexity with which not many clinicians will be familiar, thus introducing possible use error that could cause significant harm.