A better way of connecting multiple patients to a single ventilator

  • All the proposed components are readily available in hospitals, can be bought in medical supply or plumbing stores, and some can even be 3D printed as a back up plan,
  • the setup contains no added electronics or software and should be easy to understand and implement for experienced caretakers,
  • still, the setup allows the caretaker to monitor and finetune the pressure for each patient individually.
  • The setup has also been tested for over 48h on test lungs, and it has been replicated by an independent testing facility.

Overview of the proposed Differential Multiventilation setup

Schematic representation

Movie of the setup with test lungs

A movie by Dr. Mergeay, hospital Geel, explaining the individualized split ventilation setup.

How to obtain the components and set up the circuit

  • 2 splitters for 2 patients, 6 splitters for 4 patients.
  • 1 one-way valve per patient. For certain types of ventilators, 2 one-way valves per patient, one for expiration and one for inspiration, are advisable. See ‘Effects of adding one-way valves in the inspiration circuits’.
  • 1 flow control valve per patient.
  • 1 pressure transducer per patient.
  • 1 HMEF filter per patient.
  • Optional: 1 PEEP valve per patient.
  • Optional: 1 capnogram per patient.
  • Connectors with Luer ports, if additional ports are needed.
  • 1 HEPA filter per patient.
Instruction video for the use of flow control valves (early version of the circuit).
Image of the disposable pressure transducer connected through the Luer port connector.

Ventilator Settings

Patient Matching

How it works

Advantages and disadvantages

  • The pressure curve for each patient can be monitored.
  • The pressure can be adjusted for each patient. Patients do not have to be matched in compliance (but they do have to share some parameters such as BPM, oxygen enrichment, I:E ratio and possibly PEEP if no extra PEEP valves are added).
  • No deleterious interactions between patient’s circuits are possible if the alarms are carefully set.
  • The system retains the high-pressure alarms of the ventilator.
  • A disconnection signal can be ensured if carefully setting the low minute ventilation alarm.
  • Consists of relatively cheap, easy to obtain or produce components.
  • Does not contain electronics (apart from connection to monitor) or components that are difficult to install.
  • Could be set up in advance, with closed control valves, and patients could be connected as needed.
  • Only possible/safe in pressure control mode.
  • Patients should not be able to trigger (each other’s) breaths. Modern ventilators lacking this option can be locked out, i.e., the trigger threshold should be put beyond achievable values. Since this is uncomfortable, patients would likely have to be sedated.
  • Parameters such as BPM, I:E ratio, FIO2 can only be shared. PEEP could be adjusted through individual PEEP valves, otherwise this also has to be shared.
  • In case an alarm goes off at the ventilator, it might not be immediately clear which patient triggered it.
  • O2 and CO2 measurements at the ventilator are not reliable. But individual capnograms can be connected on the filters proximal to the patients.
  • Possible auto-PEEP.
  • Possible hypercapnea.
  • Increased dead space through possible longer length of cables, splitters etc. This might induce auto-PEEP and hypercapnea as mentioned above, but it could also change the temperature of the airflow etc.
  • Possible need to reconfigure the complete network when a patient with compliance lower than the current lowest compliance is added (since set pressure or PIP should then be increased).
  • Still contains one component that is not commonly found in a hospital, the flow control valve.

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PhD researcher in artificial and biological intelligence at VUB, MIT and Tufts. Studied physics and AI. Volunteering as a coordinator during COVID-19 crisis.

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Hannah Pinson

Hannah Pinson

PhD researcher in artificial and biological intelligence at VUB, MIT and Tufts. Studied physics and AI. Volunteering as a coordinator during COVID-19 crisis.

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