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 use of this crisis-driven modification of the ventilator breathing circuit was done with the knowledge and agreement of the Program for the Protection of Human Subjects at the Icahn School of Medicine at Mount Sinai. Four patients with acute respiratory failure due to COVID-19 who had already been on mechanical ventilation with sedation and paralysis for 1-12 days, and expected to require continued prolonged ventilatory care, were identified. The patients were required to have similar minute ventilation, PEEP, and fraction of inspired oxygen (FiO 2 ) requirements. Informed Consent and Permission for Emergency Procedure with an Unapproved Article was obtained from the legally authorized representative of both patients prior to beginning the study. The patients were moved into the same room in an intensive care unit and connected to full physiologic monitoring. Each patient was placed on pressure control ventilation with the same respiratory rate, PEEP, and FiO 2 . The driving pressure of each patient's ventilator was adjusted to achieve a tidal volume of 4-6 ml/kg of IBW. The patients were then observed for a period of 20 minutes to ensure they were hemodynamically stable, and a baseline arterial gas sample was taken. Simultaneously, the split ventilation circuit including flow control valves was All rights reserved. No reuse allowed without permission.