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 COVID-19 (SARS CoV-2) pandemic has resulted in an unprecedented large number of hospital and intensive care unit (ICU) admissions, with patients requiring mechanical ventilation for prolonged periods of time. 1, 2 Our experience in the Mount Sinai Health System (MSHS) in New York City has been similar, with approximately 10% of all COVID-19 positive patients admitted to date requiring mechanical ventilation, a median duration of ongoing ventilatory support of 9.3 days, 26% mortality despite ventilatory support, and only 25% of patients were extubated successfully (data not shown). This equates to nearly 50% of intubated patients continuing to require ventilatory support. Although the MSHS currently has enough ventilators to meet demand, the slow but steady rise in the number of intubated patients requiring prolonged ventilation is concerning. As this pandemic now spreads throughout the country and around the globe, especially in developing countries, tens of thousands more such patients are expected, leading to even greater concern that there will be insufficient ventilators to meet demand. 3 The United States Public Health Service Commissioned Corps published a statement that a possible crisis standard of care strategy is the ventilation of two patients with a single mechanical ventilator. 4 The document described the challenges that must be overcome, and asserted that such a strategy should only be considered as an absolute last resort. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.