As the COVID-19 pandemic continues to spread across the United States and the world, ventilator shortages have emerged as a major concern. With many COVID-19 patients requiring breathing assistance, a shortage of ventilators could mean the difference between life and death. Considering many U.S. states lack the number of ventilators required to support all those who need them, many healthcare professionals have started developing and advocating for ventilator sharing methods, where one device can simultaneously help multiple patients (1). One of the most prominent use cases of ventilator sharing in the U.S. is at the New York-Presbyterian/Columbia University Medical Center, where multiple patients were assigned one ventilator at the height of New York’s COVID-19 outbreak (2) (3).
For patients with severe cases of COVID-19, ventilators help facilitate the flow of oxygen through the lungs. At first glance, the act of setting up ventilator sharing systems – particularly through using relatively inexpensive adaptors – is more than feasible (2). Moreover, recent studies show that ventilator sharing for short periods of time is certainly a viable option (3) (4). One study from the journal Anesthesiology highlights that flow control valves can allow one ventilator to simultaneously help patients with varying lung complications (3). Another study from the American Journal of Respiratory and Critical Care Medicine further emphasizes the success of ventilator sharing, although researchers caution that coventilation is only recommended for up to two days (4).
Yet the mechanics of a ventilator are far more complex than inserting a tube down a patient’s throat and flipping a switch to ensure proper breathing. As such, it is crucial to realize that ventilator sharing is not a silver bullet to the issue of ventilator shortages; indeed, it only provides hospitals with a temporary reprieve. One outstanding issue with ventilator sharing is the intended individualized nature of ventilators, which are designed to steadily regulate the direction, pressure, and flow of oxygen for one person. However, connecting two or more people to one ventilator means there must be some level of standardization in terms of the amount of air pressure needed by each patient. As a result, doctors must pair patients for ventilators on a case-by-case basis or risk oxygen delivery imbalances, which might have disastrous consequences (2) (5).
All in all, coventilation remains a hotly debated topic in the medical community. Those who advocate for ventilator sharing point to the successful examples of coventilation, both in experimental settings and in the field. On the other hand, those against ventilator sharing stress that doing so can incur many risks; aside from the need for individual calibration, ventilator sharing can also result in cross-contamination between patients and remains a relative novelty in the medical world (2). While COVID-19 has led to an influx of new research surrounding the topic, there is still much that is unknown about the long-term safety and viability of ventilator sharing (2) (5) (6).
While some remain skeptical about coventilation, the life-saving benefits of ventilator sharing are undeniable. As the COVID-19 pandemic continues to move through the U.S. and many hospitals face ventilator shortages, coventilation emerges as one way to maximize the amount of patients receiving ventilatory assistance. Although it is yet to be seen if ventilator sharing is a sustainable practice, the ongoing pandemic all but necessities that coventilation will continue into the near future.
References
(1) Columbia University. (2020, April 1). Columbia Develops Ventilator-Sharing Protocol for Covid-19 Patients. Columbia University Irving Medical Center. Retrieved July 18, 2020, from https://www.cuimc.columbia.edu/news/columbia-develops-ventilator-sharing-protocol-covid-19-patients
(2) Greenberg, Alissa. (2020, May 12). Covid-19 patients sharing ventilators is possible – but not ideal. PBS. Retrieved July 18, 2020, from https://www.pbs.org/wgbh/nova/article/covid19-ventilators-sharing-safe/
(3) Joseph, Saumya. (2020, June 10). Short-term ventilator sharing may be viable for COVID-19 patients: study. Reuters. Retrieved July 18, 2020, from https://www.reuters.com/article/us-health-coronavirus-ventilators/short-term-ventilator-sharing-may-be-viable-for-covid-19-patients-study-idUSKBN23H3H8
(4) Levin M., Shah A., Shah R., et al. (2020). Differential Ventilation Using Flow Control Valves as a Potential Bridge to Full Ventilatory support during the COVID-19 Crisis: From Bench to Bedside. Anesthesiology, 1-13. https://doi.org/10.1097/ALN.0000000000003473
(5) Hermann J., Fonseca de Cruz A., Hawley M., et al. (2020). Shared Ventilation in the Era of COVID-19: A Theoretical Consideration of the Dangers and Potential Solutions. Respiratory Care, 65(7). https://doi.org/10.4187/respcare.07919
(6) Rosenthal, Brian. (2020, March 26). ‘The Other Option is Death’: New York Starts Sharing of Ventilators. The New York Times. Retrieved July 19, 2020, from https://www.nytimes.com/2020/03/26/health/coronavirus-ventilator-sharing.html