A process for daily checks when using anaesthetic machines to ventilate the lungs of COVID‐19 patients: the ‘domino switch’ technique

Greig, P. R.; Dixson, T.; McCorkell, S.

The COVID-19 pandemic has increased demand for ventilators. Anaesthetic machines offer an alternative, but these are not designed to run continuously. Our department uses Dräger Primus anaesthetic machines which require daily checks. Dräger company representatives have indicated that checks can be deferred for up to 72 h [1], but this might increase the risk of malfunctions. Checks take several minutes, so an alternative means of ventilation is required to cover this period, necessitating two circuit disconnections per patient. Each disconnection potentially generates an infectious aerosol, and risks tracheal tube displacement and lung derecruitment, even with precautions such as tracheal tube clamping. We concluded that multiple circuit disconnections were unsatisfactory and devised a process for daily checks with a single disconnection per patient. We call this process 'domino switching'.