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The international pandemic of coronavirus disease 2019 (COVID-19) has caused unprecedented strain on healthcare systems worldwide and threatens to deplete the available supply of mechanical ventilators. In addition to ventilator allocation protocols, a potential way of addressing this problem is ventilator sharing, also termed split- or co-ventilation, a concept that has gained recent attention in anticipation of dire equipment shortages. Co-ventilation was initially proposed by Neyman and Irvin in 2006 as a method of increasing surge capacity needs during disasters resulting in mass casualty respiratory failure. They demonstrated the technical feasibility of using one ventilator on four mechanical lungs, and proposed use as a last resort only after depletion of ventilators and staff available for manual ventilation to temporarily bridge to the arrival of disaster relief.1 Similar circuits have since been used in both sheep models and more sophisticated mechanical lung models.2 3 Tonetti and colleagues describe a simple circuit which can be used to ventilate two patients with one ventilator and report on its use in mechanical lung models of differing compliance and resistance.4 While this report again demonstrates the technical feasibility of ventilating multiple patients with a single ventilator, there are many areas of caution to consider before widespread implementation of this technique in the current pandemic.
Tonetti and colleagues, as well as the protocol recently published by New York Presbyterian Hospital, have attempted to address many of the technical challenges of co-ventilation, although many still remain.4 5 Front and centre among these problems is the inability to titrate mechanical ventilation to the individual patient physiology. Close matching of ventilatory settings—such as minute ventilation, positive end-expiratory pressure and fraction of inspired oxygen—to patient characteristics such as pulmonary mechanics (static compliance, resistance); oxygen consumption and carbon dioxide production; acid-base balance; and haemodynamics—is necessary to optimise …
Footnotes
Contributors All authors contributed to the drafting, revision and final approval of the editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.