Pressure-Regulated Ventilator Splitting (PReVentS): A COVID-19 Response Paradigm from Yale University

Micha Sam Brickman Raredon; Clark Fisher; Paul Heerdt; Ranjit Deshpande; Steven Nivison; Elaine Fajardo; Shamsuddin Akhtar; Thomas Raredon; Laura E. Niklason

-Pressure-control ventilation mode is optimal and assumed for this design -Pressure readouts on the ventilator screen reflect unmodified pressures delivered by the ventilator, and are not representative of what each patient is seeing -PIP and PEEP for each patient are obtained by adding/subtracting each patient's valve settings from displayed ventilator settings -see below -Tidal volume readout on the ventilator is total tidal volume for both patients -Additional monitors may be deployed in-line for each patient, to measure tidal volumes and airway pressures individually and in real time -FIO2 and respiratory rate are the same for both patients -Tidal volumes will differ for each patient, depending on PIP, PEEP and lung compliance -A short circuit from the ventilator outflow to ventilator inflow is necessary to avoid triggering of circuit occlusion alarm and to allow ventilator bias flow -Because of changes to the expected circuit, ventilator alarms will not always work as expected, and an alternate alarm strategy must be employed (see discussion below)