My name is Jeff Guy and this is ICRounds.

Welcome back to ICRounds as we continue talking about different therapeutic approaches and the management of the COVID patient.

One of the conversations that started early in the COVID pandemic was the consideration that there could be circumstances or areas in the pandemic

where there was a greater number of patients needing mechanical ventilators than there

were actual mechanical ventilators. This opens up the conversations about crisis standards of care

and allocation of resources and triage, but it also started the conversation and circulation

of notions on social media and on the internet and on YouTube

of putting multiple patients on a single mechanical ventilator.

Now on the surface, this seems like a rather simplistic solution to a very bad problem.

All you would need to do is take a plastic adapter, a splitter, and put it on the

inspiratory outlet and the expatory inlet of a mechanical ventilator and attach your circuits to this.

And boom, I can multiply the impact of that one mechanical ventilator rather than ventilating

just a single patient. Maybe now I can mechanically ventilate two patients or four patients.

What it doesn't take into consideration is that ARDS, as we've talked about in previous podcasts,

the mechanical ventilation done in the absence of significant detail to an individual patient can actually make the disease

process worse. Relative to this idea of splitting mechanical ventilators, I don't want to say

it's the right thing or the wrong thing. I will say that it is a thing that requires significant

consideration. It requires a significant understanding of how to

manage a patient on a mechanical ventilator, the physiological impact, sharing multiple patients on a

ventilator, and a significant understanding of technically how to set up a mechanical ventilator.

Now, one of the initial papers that considered splitting a ventilator

for multiple patients was described by Nyman and Babcock in 2006. The author simply added

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