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

Split ventilation was then initiated by clamping the ETT of each patient, disconnecting them from their individual ventilators, and quickly connecting the split circuit. The flow control valve of the patient with the lower driving pressure was quickly throttled down to almost full close, and then slowly opened to achieve similar tidal volumes to the patient's baseline value. The patients were closely monitored with an intensivist and anesthesiologist at bedside. Thirty minutes after going on the shared circuit, an arterial blood gas was drawn from each patient and the flows to each patient adjusted as needed. After sixty minutes, another arterial blood gas was drawn. At this point, the patients were disconnected from the split circuit by clamping their ETT and reconnected to their individual ventilators. The patients were closely monitored for an additional one hour after termination of the study, in order to ensure that they were stable and had returned to their baseline respiratory status.