Canadian Anesthetist Rigged A Ventilator To Treat More Than One Patient

Dr Alain Gauthier, an anesthetist at the Perth and Smiths Falls District Hospital in Ontario, tested a modification that was first done in 2017 by Las Vegas emergency physician Dr. Kevin Menes, when he was faced with a shortage of ventilators after the 2017 mass shooting.

Gauthier, who also has a Phd in respiratory physiology, first learned about the ventilator adaptation by watching a YouTube video put out by emergency physician, Dr. Charlene Irvin Babcock, in Detroit.

ottawacitizen.com...

Here's the video:

The hack, done by Dr. Alain Gauthier of Perth, is not perfect, he warns. But it has the potential to save lives as Ontario begins to see more severe COVID-19 cases. And that could prevent the kind of worst-case scenario seen in Italy in which doctors were forced to decide who would get a ventilator and who would die.

There are risks associated with this ventilator modification.

“We are planning for the worst-case scenario, having to put two people or four people on one ventilator.”

Gauthier acknowledges it is a “crazy plan,” but says the hospital has to prepare for the possibility now and not ten days from now.

Since the ventilator will be used “off-label” Gauthier said it could only be modified with permission of family members. But even with risks, it might be better than the alternative.

“The option is you have to decide which of the two is going to get a ventilator and which is going to be sacrificed. Or you can say we can give both people somewhat of a chance.”

From his tests, Gauthier believes the system will work, but only with selective patients — those who are about the same size, in similar medical condition and with similar lung mechanics.

ottawacitizen.com...

Since the US is need of more ventilators, I hope other hospitals, especially rural ones, decide to look into this modification, especially as Covid-19 cases continue to grow across the nation. Kudos to both Dr. Babcock and Dr. Gauthier!

All ventilator makers should send out fit kits with the adapters. Now!

a reply to: Identified

Seconded

As noted in the article it could work, but there are drawbacks.

as noted same size patient in weight and degree of lung injury, same lung compliance, same needs for settings like PEEP, Volume, PIP, FiO2 etc. I also am curious how they got around the flow sensors and the overall flow. Modern ICU can move a fair amount of air, but two times for an adult patient?

I get that this is an extreme measure

a reply to: shawmanfromny

If you average the tidal volume to twice, and splice the patient delivery tubing, than it is possible.

The problem lies with positive end exspiratory pressures (PEEP) and how it might differentiate between the two patients.

Not something I'd ever recommend, but crafty non-the-less.



HA.

Just read the post above.

a reply to: DBCowboy

I hear you, but there would be an upper limit to how much Tidal Volume it could generate breath to breath depending on the size of a patient. I don't know what that is however so it may be possible.

I also forgot that if there is any leak in the cuff that would also wreak havoc on the flow sensing etc.

FWIW I think you would have more upside from perhaps pressing non bedside staff into duty. You can train a child to give breaths with a self inflating bag equipped with a pressure limiter and a peep valve. Its not going to be as optimal as a vent but you could help more people that way.

a reply to: FredT

I can't imagine the alarms this unit would generate.

They must have done an over-ride of everything and placed it in a manual mode.

I had to flag just for your 'sig'

a reply to: DBCowboy

It's why I chose Draeger units for my hospital.

Some other manufacturers do have an over-ride, with error alarms that will still ventilate.

I never wanted respiratory techs to even have that option.

Too many opportunities for incorrect/damaging vents.

originally posted by: DBCowboy
a reply to: FredT

I can't imagine the alarms this unit would generate.

They must have done an over-ride of everything and placed it in a manual mode.

This is peds mind you but you can silence alarms for 2 minutes and set the parameters pretty wide, but they never can be turned off lol. For this you would have an RCP or RN in pretty close proximity.

You also would have to paralyze the patients (Vecuronium / Roc etc) as they would have to be coordinated in terms of respiratory rates.

a reply to: shawmanfromny

Thank you sooooo much for making this thread. That is a brilliant rig job! I am going to share this as far and as widely as possible, because I know we will run out of ventilators at my hospital, and probably at all the other hospitals in central Illinois at some point too. Lives will be saved from you posting this. Nobody can thank you enough!

I realize it isn't a perfect thing, but it sure could prolong the time between now and when we need to start deciding who lives and who dies for lack of ventilators.

a reply to: Fowlerstoad

I agree but as I said above it would be a very narrow group of patients you could do this with as they would have to have nearly the exact same:

Size
Weight
similar degree of lung injury
Exact settings: depending on mode PEEP, PIP, I:E ratio, Rates, FiO2 requirements
Similar Lung Compliance
Exact same ETT size
Both patterns would need to be chemically paralyzed to make sure one did not cough thus causing a spike in pressures in he other one and to ensure the same rate

a reply to: DBCowboy

Dragers are good units. We use them at our Children's Hospital in the ICU's. For transport we use the Hamilton which is pretty kick ass for a transport vent. It also has an MRI friendly version which means we don't have to push a large machine down the hallway

Yeah nothing gets me more mad that to see a new nurse silence and alarm then just leave the room. Even 2 minutes in an ICU is an eternity

a reply to: FredT

Draegers are my go-to because you can't cheat the system.

If there's failure or a miscalibration in the PM, some will still allow a vent.

GE and Draeger units will not let you leave service mode until everything passes within specs.

TO add, Draegers have Service Connect which downloads the settings to the mainframe at Draeger so your data is always stored and backed up.

I wonder would a CPAP/APAP machine with oxygen line help some of these pneumonia patients rather than needing a full ventilator?

Here is an abstract from Italy in 2018.

Study Abstract