A Safe, Sterile Approach to Sharing Single Intubation Type Ventilators with Multiple Patients

The upcoming tsunami of infected COVID-19 patients needing intubation and breathing support provided by ventilators is well documented. There are many highly incompetent and dangerous methods being offered as potential solutions by medical doctors by creating a mechanical manifold using readily available "T-Tubes" to share a single common tidal pulmonary respiration (air source) between two, four even up to nine patients with using a single Intensive Care Unit (ICU), Critical Care Unit (CCU) or surgical patient intubation ventilator.

For a brief explanation of what a ventilator does and the dangers these inherent risks are commonly associated with these assisted breathing FDA Approved medical devices see the following brief introduction. Please take notice of infections, O2 toxicity and harmful pressure levels.

Any mechanical solution to create a manifold or hub to share out one ventilator between multiple patients that does not address dual-flow, inhale and exhale, cross-contamination by viral or biological pathogens a comorbid patient may introduce into the shared air may create a medical condition where the cure is more dangerous than the disease. Additionally, these individual spokes from a common hub or manifold individually need to be able to adjust the tidal air flow for each patient.

The following proposal addresses these three critical issues that are not addressed by the simple "T-Tube" type proposed by some highly irresponsible medical doctors.

The three issues that need to be managed are: (1.) preventing all possible single source air transported cross-contamination, (2.) Maintaining a constantly sterile water seal without the use of chemicals or other noxious substances, (3.) Being able to adjust and control tidal air pressure volumes to each individual patient.

Nothing in the following recommendation requires any type special or high tech equipment. All these materials may be found in a high school or college chemistry or biology lab. And most certainly at any medical facility small, medium or large size.

Bill of Materials to Construct and Deploy a Self-Sanitizing, using UV light to activate H2O to create small and highly sterilizing amounts of O3 (ozone) to kill all known viral and biological pathogens, Pneumatic Troughs (water seal) and airway tubing with a simple inline plastic ball joint valve to control tidal air pressure where very accurate and simple fluid filled medical air pressure gauges can monitor patient inspiration and expiration air pressure in the breathing tubes to and from the intubated medical patient attached to the ventilator.

First the "Self Sanitizing Water Seal" will use UV light to liberate highly sanitizing O3 (ozone) from the static saline solution or distilled water in the pneumatic trough (water seal).

Secondly, the pneumatic trough (water seal) isolating each additional patient from the common intubation air source provided by the ventilator. Here are examples of the diverse array of pneumatic troughs (water seals) that may be successfully employed. In a pinch, as any competent combat thoracic surgeon can attest sealed large sterile pickle jars may also be used as pneumatic troughs (water seals).

Here, for the pneumatic troughs glass or metal is preferred so as not to become subjected to the degrading effects of the sanitizing O3 (ozone) that tends to break down non-medical grade plastics in long term usage. Since only a very small amount of O3 (ozone) is needed to completely sanitize any air or solution by direct contact. The excess O3 (ozone) will be vented away by an open-loop positive or negative air pressure circuit. Or, if designed, may be easily disperse to ambient air for dilution to non-toxic O2 (ozone) levels after the sterilization of viral and biological pathogen contamination stage of the water/air seal is allowed to function.

A critical medical parameter to control with any intubated patient on a respirator is tidal air pressure. Here, each patient's breathing tube(s) may have a simple plastic ball joint valve that are readily available in the hospital or easily acquired from medical tubing suppliers.

A simple device, located at the ball joint valve controlling airflow, called a "Burette" can simply and accurate measure the hydrostatic air pressure being received by each patient.

IN SUMMARY: Cross contamination is not acceptable in any shared single source intubated ventilator system. Additionally, the lack of individual air pressure control to each intubated patient is equally unacceptable. The following outline of a self-sterilizing pneumatic trough (water seal) using UV light and the liberation of O3 from H2O as a continuous odorless chemical free sanitizing agent that is known effective against all viral and biological pathogens. And simple inline ball valve air pressure control to each individual patient with real time endpoint air pressure monitoring by use of medical grade "Burretes" may be a safe and flexible way to share a single intubation type ventilator between multiple patients. Do no harm. Do know harm.

ABOUT THE AUTHOR: David Walker is formally with the US Navy Medical Corps and is trained in Biological, Chemical and Nuclear medical treatment. Additionally, David has completed graduate and post graduate level work in Biochemistry at Boston College where he worked with Dr. Robert White and recombinant retroviruses. Additionally, David has electronic hardware design experience with The Hewlett-Packard Medical Products Division FDA Approved "Merlin Bedside Monitoring System" and its modular systems approach to bedside patient monitoring in the wards, ICU and CCU units - specifically the IMC DM-60M printer sharing module that allowed multiple "HP Merlin Bedside Patient Monitors" send data to printers in mission critical, life support, medical applications.