engineer, I know you probably can't answer this, but I'm confused by the following clipped out of that article.....
“I think we can come up with the beds and ventilators we need, and I think this country has the resources to do it,” Moktad said. “I know for instance that the same ventilator is being used on multiple patients."
I'm not a doctor, or nurse, or respiratory tech, etc. However, I do know that coming up with ideas on how to stretch already overburdened resources is not hooking up more than one person to a device that was designed for one patient, involving constant monitoring by both alarm systems and direct staff care.
Being put on a ventilator in the first place is an end game move. Putting multiple people on one?
This using one ventilator on multiple patients is a horrible idea. It could (and I believe would) result in more deaths, not fewer.
Plus, as referenced in that link, the meds need to be given while on the ventilator are in short supply.
Medications? Read knocking the patients ass out. In addition, they give the patient a paralytic so they stop breathing on their own.
I have no idea how many people are aware, but being put on a ventilator is a nasty business.
It isn't going to be someone telling you you're scheduled to be put on a vent tomorrow, or even that afternoon.
No, you go into acute distress, your o2 drops to where you can't think, and they do it.
Now, the family gets to decided what happens. In the meantime, the patient doesn't even know he's alive anymore.
Having 2 or more people hooked up like cows on a milking machine? Each one dependant on the weakest link of the group?
What a Hail Mary pass that is.
Joint Statement on Multiple Patients Per Ventilator
March 26, 2020: The Society of Critical Care Medicine (SCCM), American Association for
Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety
Foundation (ASPF), American Association of Critical‐Care Nurses (AACN), and American College
of Chest Physicians (CHEST) issue this consensus statement on the concept of placing multiple
patients on a single mechanical ventilator.
The above‐named organizations advise clinicians that sharing mechanical ventilators should not
be attempted because it cannot be done safely with current equipment.
The physiology of
patients with COVID‐19‐onset acute respiratory distress syndrome (ARDS) is complex. Even in
ideal circumstances, ventilating a single patient with ARDS and nonhomogenous lung disease is
difficult and is associated with a 40%‐60% mortality rate. Attempting to ventilate multiple
patients with COVID‐19, given the issues described here, could lead to poor outcomes and high
mortality rates for all patients cohorted.
In accordance with the exceedingly difficult, but not
uncommon, triage decisions often made in medical crises, it is better to purpose the ventilator
to the patient most likely to benefit than fail to prevent, or even cause, the demise of multiple
Background: The interest in ventilating multiple patients on one ventilator has been piqued by
those who would like to expand access to mechanical ventilators during the COVID‐19
pandemic. The first modern descriptions of multiple patients per ventilator were advanced by
Neyman et al in 20061 and Paladino et al in 2013.2 However, in each instance, Branson,
Rubinson, and others have cautioned against the use of this technique.3‐5 With current
equipment designed for a single patient, we recommend that clinicians do not attempt to
ventilate more than one patient with a single ventilator while any clinically proven, safe, and
reliable therapy remains available (ie, in a dire, temporary emergency).
Attempting to ventilate multiple patients would likely require arranging the patients in a spoke‐
like fashion around the ventilator as a central hub. This positioning moves the patients away
from the supplies of oxygen, air, and vacuum at the head of the bed. It also places the patients
in proximity to each other, allowing for transfer of organisms. Spacing the patients farther apart
would likely result in hypercarbia.
Spontaneous breathing by a single patient sensed by the ventilator would set the respiratory
frequency for all the other patients. The added circuit volume could preclude triggering.
Patients may also share gas between circuits in the absence of one‐way valves. Pendelluft
between patients is possible, resulting in both cross‐infection and over‐distension.
alarms can monitor only the total response of the patients’ respiratory systems as a whole. This
would hide changes occurring in only one patient. The reasons for avoiding ventilating multiple
patients with a single ventilator are numerous.
These reasons include:
Volumes would go to the most compliant lung segments.
Positive end‐expiratory pressure, which is of critical importance in these patients, would
be impossible to manage.
Monitoring patients and measuring pulmonary mechanics would be challenging, if not
Alarm monitoring and management would not be feasible.
Individualized management for clinical improvement or deterioration would be
In the case of a cardiac arrest, ventilation to all patients would need to be stopped to
allow the change to bag ventilation without aerosolizing the virus and exposing
healthcare workers. This circumstance also would alter breath delivery dynamics to the
The added circuit volume defeats the operational self‐test (the test fails). The clinician
would be required to operate the ventilator without a successful test, adding to errors
in the measurement.
Additional external monitoring would be required. The ventilator monitors the average
pressures and volumes.
Even if all patients connected to a single ventilator have the same clinical features at
initiation, they could deteriorate and recover at different rates, and distribution of gas
to each patient would be unequal and unmonitored. The sickest patient would get the
smallest tidal volume and the improving patient would get the largest tidal volume.
The greatest risks occur with sudden deterioration of a single patient (e.g.,
pneumothorax, kinked endotracheal tube), with the balance of ventilation distributed to
the other patients.
Finally, there are ethical issues. If the ventilator can be lifesaving for a single individual,
using it on more than one patient at a time risks life‐threatening treatment failure for all
1. Neyman G, Irvin CB. A single ventilator for multiple simulated patients to meet disaster
surge. Acad Emerg Med. 2006 Nov;13(11):1246‐1249.
2. Paladino L, Silverberg M, Charcaflieh JG, et al. Increasing ventilator surge capacity in
disasters: ventilation of four adult‐human‐sized sheep on a single ventilator with a
modified circuit. Resuscitation. 2008 Apr;77(1):121‐126.
3. Branson RD, Rubinson L. One ventilator, multiple patients: what the data really
supports. Resuscitation. 2008 Oct;79(1):171‐172; author reply 172‐173.
4. Branson RD, Rubinson L. A single ventilator for multiple simulated patients to meet
disaster surge. Acad Emerg Med. 2006 Dec;13(12):1352‐1353; author reply 1353‐1354.
5. Branson RD, Blakeman TC, Robinson BR, Johannigman JA. Use of a single ventilator to
support 4 patients: laboratory evaluation of a limited concept. Respir Care. 2012