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

However, the approach to vent splitting that has been most widely discussed is ill-suited to the specific challenges of the current COVID-19 pandemic. In the Neyman/Babcock/Beitler approach, multiple patients are attached in parallel to the same ventilator without any intervening valves. Therefore, all patients experience the same airway pressures throughout the respiratory cycle, and ventilator settings cannot be changed for one patient without changing the settings for all others. This approach can be widely used during a mass trauma, where many patients will have healthy lung parenchyma with largely similar ventilation requirements and a straightforward clinical course. COVID-19 patients, on the other hand, can rapidly develop ARDS, and so ventilator requirements can change quickly and in unpredictable ways. Hence, patients who initially are well matched on a single ventilator may no longer be well matched as the day progresses. If the COVID-19 pandemic becomes as widespread as is now feared, affecting hundreds of thousands of US patients, the increase in ICU ventilator production may not be sufficient to keep up with patient demand. This could lead, in turn, to wrenching decisions about which patients should receive ICU ventilator support -heretofore an unthinkable prospect in the modern era.