Design of a flow modulation device to facilitate individualized ventilation in a shared ventilator setup

Stiers, M., Vercauteren, J., Schepens, T. et al. Design of a flow modulation device to facilitate individualized ventilation in a shared ventilator setup. J Clin Monit Comput 38, 679–690 (2024). https://doi.org/10.1007/s10877-024-01138-1

Summary of "Design of a Flow Modulation Device to Facilitate Individualized Ventilation in a Shared Ventilator Setup"

Abstract

This study addresses the need for increased ventilator capacity during surge scenarios by developing a prototype device that adjusts patient-specific flow in a shared ventilator setup. The device aims to deliver predictable tidal volumes (VT) with minimal additional monitoring and workload. Tested in vitro, the device demonstrated linear correlation between VT and valve opening, consistent performance across various lung conditions, and a unique ventilation profile. This flow modulator supports individualized ventilation for each patient in a shared ventilator setup, enhancing surge capacity without requiring patient matching.

Background

The COVID-19 pandemic highlighted the reality of ventilator shortages, spurring research into shared ventilation systems. Traditional shared ventilation systems required patients to have similar respiratory mechanics, limiting dynamic management. The new concept of Individualized Shared Ventilation (ISV) allows individualized control over VT, PEEP, and FiO2 for each patient. The development of a flow modulator to titrate VT in a shared ventilator setup addresses this need, ensuring predictable and accurate ventilation without extensive patient matching.

Methods ISV Bench Setup

The ISV bench setup involved a Dr?ger Savina 300 ICU ventilator in pressure-control mode, connected to two artificial test lungs simulating healthy and ARDS conditions. The flow modulator device was tested to evaluate its performance in delivering individualized VTs.

Prototype Design and Development

The prototype aimed to meet design criteria for predictable and accurate VT regulation, ease of independent operation, and scalability. Various designs were 3D-printed and tested, with the final design selected based on its linear response and manufacturability.

Bench Tests

1. VT and Airway Pressure as a Function of Valve Opening:
2. Pressure Drop and Flow Across the Prototyped Device:
3. PV Loop and ISV Breath Profiles:

Results

The prototype demonstrated a linear relationship between valve opening and VT across different inspiratory pressures and lung conditions. The device provided predictable and titratable VTs, with minimal impact on the contralateral circuit. The unique ventilation profile supported individualized ventilation.

Discussion

The flow modulator device effectively individualizes VTs in a shared ventilator setup, enabling safe and predictable ventilation without patient matching. The device's performance was consistent across different lung conditions and inspiratory pressures, suggesting its potential for clinical application during ventilator surge capacity scenarios.

Performance and Limitations

The device showed high predictability and independence in VT delivery. However, further evaluation is needed for additional PEEP modulation, different ventilator settings, and more sophisticated lung simulations. Separate respiratory system monitoring is essential for patient safety, but the device's performance and clinical protocols could reduce the need for advanced monitoring.

Conclusions

The flow modulator device addresses the unmet medical need for ventilator surge capacity solutions. Its development supports individualized ventilation in shared ventilator setups, enhancing clinical protocols for surge scenarios.

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Watch the following video on "Developing a ventilator sharing device for emergencies" by Institute for Manufacturing (IfM), University of Cambridge

Discussion Questions

1. How can the flow modulator device improve patient outcomes in ventilator surge capacity scenarios?
2. What are the potential challenges in implementing the flow modulator device in clinical settings, and how can they be addressed?
3. How does the unique ventilation profile of the flow modulator device compare to traditional pressure-controlled ventilation, and what implications does this have for clinical practice?

Javier Amador-Casta?eda, BHS, RRT, FCCM

Interprofessional Critical Care Network (ICCN)

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