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Zieliński K, Lisowska B, Siewruk K, Sady M, Ferenc K, Barwijuk M, Olszewski J, Anusz K, Jabłoński A, Gajewska M, Okrzeja P, Michnikowski M, Pijanowska DG, Pluta K, Remiszewska E, Darowski M, Zabielski R, Liebert A, Kramek-Romanowska K, Stecka A, Kozarski M, Pasledni R, Gajewski Z, Ładyżyński P. Automatic air volume control system for ventilation of two patients using a single ventilator: a large animal model study. Sci Rep 2022; 12:22591. [PMID: 36585425 PMCID: PMC9801355 DOI: 10.1038/s41598-022-26922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
The COVID-19 pandemic outbreak led to a global ventilator shortage. Hence, various strategies for using a single ventilator to support multiple patients have been considered. A device called Ventil previously validated for independent lung ventilation was used in this study to evaluate its usability for shared ventilation. We performed experiments with a total number of 16 animals. Eight pairs of pigs were ventilated by a ventilator or anesthetic machine and by Ventil for up to 27 h. In one experiment, 200 ml of saline was introduced to one subject's lungs to reduce their compliance. The experiments were analyzed in terms of arterial blood gases and respiratory parameters. In addition to the animal study, we performed a series of laboratory experiments with artificial lungs (ALs). The resistance and compliance of one AL (affected) were altered, while the tidal volume (TV) and peak pressure (Ppeak) in the second (unaffected) AL were analyzed. In addition, to assess the risk of transmission of pathogens between AL respiratory tracts, laboratory tests were performed using phantoms of virus particles. The physiological level of analyzed parameters in ventilated animals was maintained, except for CO2 tension, for which a permissive hypercapnia was indicated. Experiments did not lead to injuries in the animal's lungs except for one subject, as indicated by CT scan analysis. In laboratory experiments, changes in TV and Ppeak in the unaffected AL were less than 11%, except for 2 cases where the TV change was 20%. No cross-contamination was found in simulations of pathogen transmission. We conclude that ventilation using Ventil can be considered safe in patients undergoing deep sedation without spontaneous breathing efforts.
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Affiliation(s)
- Krzysztof Zieliński
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Barbara Lisowska
- Department of Anesthesiology and Intensive Medical Care, National Geriatrics, Rheumatology and Rehabilitation Institute, Warsaw, Poland
| | - Katarzyna Siewruk
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Maria Sady
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Karolina Ferenc
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Maciej Barwijuk
- grid.13339.3b0000000113287408I Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Olszewski
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Krzysztof Anusz
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Artur Jabłoński
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Magdalena Gajewska
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13339.3b0000000113287408Medical University of Warsaw, Warsaw, Poland
| | - Piotr Okrzeja
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Marcin Michnikowski
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Dorota G. Pijanowska
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Krzysztof Pluta
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Elżbieta Remiszewska
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Marek Darowski
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Romuald Zabielski
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Adam Liebert
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Katarzyna Kramek-Romanowska
- grid.1035.70000000099214842Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Anna Stecka
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Maciej Kozarski
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Raman Pasledni
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
| | - Zdzisław Gajewski
- grid.13276.310000 0001 1955 7966Veterinary Research Center, Center for Biomedical Research and Research Center for Regenerative Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland ,grid.13276.310000 0001 1955 7966Center of Translational Medicine, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Piotr Ładyżyński
- grid.413454.30000 0001 1958 0162Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena Str. 02109, Warsaw, Poland
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Garcia Eijo PM, D’Adamo J, Bianchetti A, Duriez T, Cabaleiro JM, Irrazabal C, Otero P, Artana G. Exhalatory dynamic interactions between patients connected to a shared ventilation device. PLoS One 2021; 16:e0250672. [PMID: 33945551 PMCID: PMC8096090 DOI: 10.1371/journal.pone.0250672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
In this work a shared pressure-controlled ventilation device for two patients is considered. By the use of different valves incorporated to the circuit, the device enables the restriction of possible cross contamination and the individualization of tidal volumes, driving pressures, and positive end expiratory pressure PEEP. Possible interactions in the expiratory dynamics of different pairs of patients are evaluated in terms of the characteristic exhalatory times. These characteristic times can not be easily established using simple linear lumped element models. For this purpose, a 1D model using the Hydraulic and Mechanical libraries in Matlab Simulink was developed. In this sense, experiments accompany this study to validate the model and characterize the different valves of the circuit. Our results show that connecting two patients in parallel to a ventilator always resulted in delays of time during the exhalation. The size of this effect depends on different parameters associated with the patients, the circuit and the ventilator. The dynamics of the exhalation of both patients is determined by the ratios between patients exhalatory resistances, compliances, driving pressures and PEEPs. Adverse effects on exhalations became less noticeable when respiratory parameters of both patients were similar, flow resistances of valves added to the circuit were negligible, and when the ventilator exhalatory valve resistance was also negligible. The asymmetries of driving pressures, compliances or resistances exacerbated the possibility of auto-PEEP and the increase in relaxation times became greater in one patient than in the other. In contrast, exhalatory dynamics were less sensitive to the ratio of PEEP imposed to the patients.
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Affiliation(s)
- Pedro M. Garcia Eijo
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Juan D’Adamo
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Arturo Bianchetti
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Thomas Duriez
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Juan M. Cabaleiro
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Célica Irrazabal
- División Terapia Intensiva del Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Otero
- Cátedra de Anestesiología y Algiología, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Artana
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
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Kelley KC, Kamler J, Garg M, Stawicki SP. Answering the Challenge of COVID-19 Pandemic Through Innovation and Ingenuity. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:859-873. [PMID: 33973216 DOI: 10.1007/978-3-030-63761-3_48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has created a maelstrom of challenges affecting virtually every aspect of global healthcare system. Critical hospital capacity issues, depleted ventilator and personal protective equipment stockpiles, severely strained supply chains, profound economic slowdown, and the tremendous human cost all culminated in what is questionably one of the most profound challenges that humanity faced in decades, if not centuries. Effective global response to the current pandemic will require innovation and ingenuity. This chapter discusses various creative approaches and ideas that arose in response to COVID-19, as well as some of the most impactful future trends that emerged as a result. Among the many topics discussed herein are telemedicine, blockchain technology, artificial intelligence, stereolithography, and distance learning.
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Affiliation(s)
- Kathryn Clare Kelley
- Department of Surgery, University Campus, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jonathan Kamler
- Departments of Emergency Medicine, NewYork-Presbyterian Health System, New York City, NY, USA
| | - Manish Garg
- Departments of Emergency Medicine, Weill Cornell Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, USA
| | - Stanislaw P Stawicki
- Department of Surgery, University Campus, St. Luke's University Health Network, Bethlehem, PA, USA.
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Kowalczyk M, Sawulski S, Dąbrowski W, Grzycka-Kowalczyk L, Kotlińska-Hasiec E, Wrońska-Sewruk A, Florek A, Rutyna R. Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study. PLoS One 2017; 12:e0184537. [PMID: 28910340 PMCID: PMC5598983 DOI: 10.1371/journal.pone.0184537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 08/24/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device's utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position. MATERIALS AND METHODS 69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance. RESULTS Our results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position. CONCLUSIONS We report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.
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Affiliation(s)
- Michał Kowalczyk
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
- * E-mail:
| | - Sławomir Sawulski
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Wojciech Dąbrowski
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Luiza Grzycka-Kowalczyk
- 1st Department of Radiology and Nuclear Medicine, Medical University of Lublin, Lublin, Poland
| | - Edyta Kotlińska-Hasiec
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Wrońska-Sewruk
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Artur Florek
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Rafał Rutyna
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
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Abstract
Objectives To determine if a ventilator available in an emergency department could quickly be modified to provide ventilation for four adults simultaneously. Methods Using lung simulators, readily available plastic tubing, and ventilators (840 Series Ventilator; Puritan‐Bennett), human lung simulators were added in parallel until the ventilator was ventilating the equivalent of four adults. Data collected included peak pressure, positive end‐expiratory pressure, total tidal volume, and total minute ventilation. Any obvious asymmetry in the delivery of gas to the lung simulators was also documented. The ventilator was run for almost 12 consecutive hours (5.5 hours of pressure control and more than six hours of volume control). Results Using readily available plastic tubing set up to minimize dead space volume, the four lung simulators were easily ventilated for 12 hours using one ventilator. In pressure control (set at 25 mm H2O), the mean tidal volume was 1,884 mL (approximately 471 mL/lung simulator) with an average minute ventilation of 30.2 L/min (or 7.5 L/min/lung simulator). In volume control (set at 2 L), the mean peak pressure was 28 cm H2O and the minute ventilation was 32.5 L/min total (8.1 L/min/lung simulator). Conclusions A single ventilator may be quickly modified to ventilate four simulated adults for a limited time. The volumes delivered in this simulation should be able to sustain four 70‐kg individuals. While further study is necessary, this pilot study suggests significant potential for the expanded use of a single ventilator during cases of disaster surge involving multiple casualties with respiratory failure.
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Affiliation(s)
- Greg Neyman
- Department of Emergency Medicine, St. John Hospital and Medical Center, 22101 Moross Road, Detroit, MI 48236, USA.
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