Novel Inspiratory Pressure Device to Double Mechanical Ventilator Capacity for Treating COVID-19 Patients: MSK Octopus

Novel Inspiratory Pressure Device to Double Mechanical Ventilator Capacity for Treating COVID-19 Patients: MSK Octopus

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Lead Contacts

Samuel Hellman, PhD
Medical Physics
Memorial Sloan Kettering Cancer Center

Grant Chen, MD
Anesthesiology & Critical Care Medicine
Memorial Sloan Kettering Cancer Center

For more information contact

OctopusVent@mskcc.org

A group of anesthesiologists and biomedical engineers at MSK have developed a novel system that will allow two intubated COVID-19 patients to be simultaneously supported by one mechanical ventilator.

Crucially, the system includes an adjustable pressure regulator added at the inspiratory limb of each patient’s breathing circuit and provides the clinician the ability to independently set the tidal volume for each patient. Additionally, a third flow circuit with a breathing bag is added to the system to allow pressure-equalization and maintain total system flow. The extra circuit allows the ventilator to maintain sufficient flow using elevated pressure while independently down-regulating each patient’s pressure.

One of the critical problems with utilizing a single ventilator for multiple patients during prolonged ventilation has been the inability to compensate for variability in the patients’ size, weight and pulmonary compliances.

Prolonged periods of mechanical ventilation are required when dealing with the COVID-19 population, and our inability to individualize each patient’s tidal volume will eventually lead to ventilator induced lung injury (VILI) and thus jeopardize the survival of both patients. For this reason, numerous national societies have warned against the use of splitting one ventilator for multiple patients.

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But this innovative set-up can potentially double the number of ventilators available by superseding the imprecise science used to overcome these variations.

Since we have not yet experienced a ventilator shortage at MSK we have only used the MSK Octopus on test-lungs.

Our invention is intended to be a short-term fix to address the serious lack of ventilators currently being faced as a consequence of the COVID-19 pandemic. It is only for use after hospital administration has approved and acknowledged the unique ethical considerations in a crisis situation such as this.

Contributors

Samuel Hellman, PhD – MSK Medical Physics

Gregory W. Fischer, MD, FASA, Chairman, Anesthesiology and Critical Care Medicine

Robert J Downey, MD – MSK Thoracic Service, Department of Surgery

Grant Chen, MD, Anesthesiology and Critical Care Medicine

Takeshi Irie, MD, PhD, Anesthesiology and Critical Care Medicine

Paul Booth, MS – MSK Biomedical Engineering

Jud Ramaker, MD – MSK Volunteer Retired Technical Supervisor - Respiratory Care Service

MSKCC COVID-19 Innovations Team

References

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Neyman G, Irvin CB. A single ventilator for multiple simulated patients to meet disaster surge. Acad Emerg Med. 2006 Nov;13(11):1246-9.

Paladino L, Silverberg M, Charchaflieh JG, Eason JK, Wright BJ, Palamidessi N, Arquilla B, Sinert R, Manoach S. 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):121-6. doi: 10.1016/j.resuscitation.2007.10.016.

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Joint Statement on Multiple Patients per Ventilator; American College of Chest Physicians, Society of Critical Care Medicine, American Association for Respiratory Care, American Society of Anesthesiologists, Anesthesia Patient Safety Foundation, American Association of Critical-Care Nurses, and American College of Chest Physicians; Chest. March 26, 2020.

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