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

Here, we propose a circuit design that allows a provider to individualize and independently adjust the inspiratory pressures, tidal volumes, and positive end-expiratory pressures (PEEP) delivered to multiple patients sharing a single ventilator. The method described in this report, the Pressure-Regulated Ventilator Splitting protocol, or PReVentS protocol, relies upon currently available and cheaply mass-produced parts that require no special expertise for assembly. The PReVentS ventilator splitting device, and associated guidelines for use, could allow for patient management using the well-established and familiar principles of pressurecontrolled ventilation. The PReVentS method could allow for improved care of multiple patients with different disease courses who are forced to share the same ventilator if no better option exists. This method has been tested thus far only in the laboratory with mock lungs, and has not yet been deployed in animals or in patients. However, given the novelty and potential utility of this approach, we deemed it appropriate to provide this information to the broader critical care community at the present time.