Pressure-Regulated Ventilator Splitting for Disaster Relief: Design, Testing, and Clinical Experience

The coronavirus disease 2019 (COVID-19) pandemic has revealed that even the best-resourced hospitals may lack sufficient ventilators to support patients under surge conditions. During a pandemic or mass trauma, an affordable, low-maintenance, off-the-shelf device that would allow health care teams to rapidly expand their ventilator capacity could prove lifesaving, but only if it can be safely integrated into a complex and rapidly changing clinical environment. Here, we define an approach to safe ventilator sharing that prioritizes predictable and independent care of patients sharing a ventilator. Subsequently, we detail the design and testing of a ventilator-splitting circuit that follows this approach and describe our clinical experience with this circuit during the COVID-19 pandemic. This circuit was able to provide individualized and titratable ventilatory support with individualized positive end-expiratory pressure (PEEP) to 2 critically ill patients at the same time, while insulating each patient from changes in the other's condition. We share insights from our experience using this technology in the intensive care unit and outline recommendations for future clinical applications.

Origin of the hook effect in extrinsic photoconductors

The response of extrinsic photoconductors to a step change in incident photon flux has long been known to exhibit a sharp transient feature, particularly at higher signal levels, known as the hook effect. We demonstrate experimentally and theoretically that the hook effect can be due to reduced illumination adjacent to the injecting contact. This nonuniformity can be produced by the transverse illumination of the detector that is common for far-infrared Ge:Ga devices. The hook effect has been demonstrated to be either present or absent in the same Ge:Ga photoconductor, at comparable signal size, depending on the nature of the contact illumination. Numerical finite-difference calculations of the transient response support this explanation and produce features that replicate the experimental results.