猴塞雷

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科学赐予人类相信真理的力量

研究提供了希望,因为世界与COVID-19呼吸机短缺斗争

研究提供了希望,因为世界与COVID-19呼吸机短缺斗争

Researchers+from+The+Royal+Women%26rsquo%3bs+Hospital%2c+Melbourne%2c+Monash+University+and+the+Alfred+Hospital%2c+Melbourne%2c+have+achieved+a+world-first+breakthrough+in+ventilator+splitting.%0aFor+the+first+time%2c+researchers+tested%2c+in+a+simulated+environment%2c+the+potential+to+ventilate+two+lungs+of+different+compliances+from+a+single+ventilator+using+only+commonly+available+hospital+equipment.%0aThe+authors+do+not+condone+the+practice+of+ventilator+splitting+and+say+the+findings+must+be+applied+with+caution.%0aThe+COVID-19+pandemic+has+led+to+a+worldwide+shortage+of+ventilators.%0a%0aA+world-first+breakthrough+by+Australian+researchers+in+ventilator+splitting+could+help+hospitals+under+severe+stress+as+the+number+of+critical+COVID-19+cases+continues+to+rise.%0aFor+the+first+time%2c+researchers+have+successfully+tested%2c+in+a+simulated+environment%2c+the+potential+to+ventilate+two+lungs+of+different+compliances+from+a+single+ventilator.%0aWhile+the+authors+do+not+condone+the+practice+of+ventilator+splitting+and+say+the+findings+must+be+interpreted+and+applied+with+caution%2c+the+experiments+demonstrate+the+hope+of+simultaneously+ventilating+two+test+lungs+of+different+compliances+%26mdash%3b+using+only+standard+hospital+equipment+%26mdash%3b+and+modify+the+pressure%2c+flow+and+volume+of+air+in+each+lung%2c+in+case+of+extreme+emergencies.%0aThe+COVID-19+pandemic+has+led+to+a+worldwide+shortage+of+ventilators.+The+worst+affected+parts+of+the+globe+are+already+experiencing+serious+shortages+of+ventilators%2c+which+are+needed+desperately+to+treat+the+failing+lungs+of+seriously+ill+COVID-19+patients.%0aThe+study%2c+published+in+the+international+journal+Anaesthesia%2c+is+led+by+Dr.+Alexander+Clarke+from+the+Department+of+Anaesthesia+at+The+Royal+Women%26rsquo%3bs+Hospital+in+Melbourne%2c+and+Dr.+Shaun+Gregory+from+the+Department+of+Mechanical+and+Aerospace+Engineering+at+Monash+University.%0aDr.+Andrew+Stephens+and+Dr.+Sam+Liao+(Faculty+of+Engineering%2c+Monash+University)+and+Dr.+Timothy+Byrne+(Department+of+Intensive+Care+and+Hyperbaric+Medicine%2c+Alfred+Hospital%2c+Melbourne)+supported+this+investigation.%0a%26ldquo%3bPatients+with+COVID-19+may+develop+progressive+viral+pneumonitis+leading+to+severe+respiratory+failure.+The+combination+of+unprecedented+disease+burden+and+global+supply+chain+disruption+has+resulted+in+worldwide+shortages+of+medical+equipment%2c%26rdquo%3b+Dr+Clarke+said.%0a%26ldquo%3bDespite+our+advances+in+the+practical+application+of+ventilator+splitting%2c+the+practice+is+unregulated+and+under+tested.+But+as+the+COVID-19+pandemic+continues+to+grow%2c+some+countries%2c+like+the+USA%2c+may+consider+ventilator+splitting+on+compassionate+grounds.+The+United+States+of+America+Food+and+Drug+Administration+has+passed+emergency+use+authorization+for+the+splitting+of+ventilators.%0a%26ldquo%3bWhile+ventilator+splitting+has%2c+at+face+value%2c+validity+in+addressing+ventilator+shortages%2c+we+agree+that+on+sober+reflection%2c+it+is+a+solution+that+needs+to+be+weighed+up+carefully+as+it+may+cause+more+harm+than+good.%26rdquo%3b%0aThe+basic+principle+of+ventilator+splitting+is+simple+%26mdash%3b+two+or+more+patients+are+connected+to+one+ventilator+and+both+are+exposed+to+the+same+circuit+dynamics.%0aThis+presents+many+challenges+including+ventilator+and+patient+synchronicity+%26mdash%3b+ventilation+requirements+are+different+for+a+100kg+male+and+a+50kg+female%2c+cross-infection+from+inter-patient+gas+exchange%2c+oxygen+concentration%2c+and+the+lack+of+monitoring+for+inpidual+tidal+volume%2c+flow%2c+and+pressure.+Irregularly+pressurized+air+supply+can+kill+patients.%0aTo+counter+this%2c+researchers+connected+a+flow+restrictor+apparatus%2c+which+consisted+of+a+Hoffman+clamp+and+tracheal+tube%2c+to+the+inspiratory+limb+of+the+ventilator+to+the+high+compliance+test+lungs.%0aThe+breathing+circuit+ran+from+the+humidifier+to+a+hospital-commodity+Y-connector+splitter.+From+the+splitter%2c+two+identical+limbs+were+created%2c+simulating+the+ventilation+of+two+pairs+of+patient+lungs.+The+resistance+was+modified+to+achieve+end-tidal+volumes+of+500ml+%26plusmn%3b+20mL.%0aThe+addition+of+the+flow+restrictor+was+critical+to+the+way+this+setup+works+%26mdash%3b+without+the+restrictor%2c+the+researchers+weren%26rsquo%3bt+able+to+control+air+flow+to+each+simulated+patient%2c+Dr.+Gregory+said.%0aWhile+the+research+findings+are+exciting+for+crisis+and+trauma+medicine%2c+Dr.+Gregory+says+they+need+to+be+interpreted+and+applied+with+caution.%0a%26ldquo%3bOur+experiment+has+demonstrated+that+in+order+to+deliver+a+safe+tidal+volume+and+airway+pressure%2c+a+resistance+mechanism+is+required+on+at+least+one+inspiratory+limb+of+the+circuit.+One+way+of+achieving+this+is+through+the+use+of+a+tracheal+tube+and+Hoffman+clamp+%26mdash%3b+common%2c+practical+items+found+in+hospitals%2c%26rdquo%3b+Dr.+Gregory+said.%0a%26ldquo%3bWhile+the+discovery+is+promising%2c+the+use+of+this+method+in+the+clinical+context+has+not+been+validated+and+we+don%26rsquo%3bt+recommend+its+wider+use+without+further+trials.+We+are+hopeful+of+one+day+being+able+to+get+great+surety+with+this+approach+to+ventilator+splitting+so+we+can+help+save+lives+in+dire+cases+of+emergency.%26rdquo%3b%0aReference%3a+%26ldquo%3bCoping+with+COVID%26%238208%3b19%3a+ventilator+splitting+with+differential+driving+pressures+using+standard+hospital+equipment%26rdquo%3b+by+A.L.+Clarke%2c+A.F.+Stephens%2c+S.+Liao%2c+T.J.+Byrne+and+S.D.+Gregory%2c+9+April+2020%2c+Anaesthesia.%0aDOI%3a+10.1111%2fanae.15078%0aThe+study%2c+titled%3a+%26lsquo%3bVentilator+splitting+with+differential+driving+pressures+using+commodity+hospital+equipment%26rsquo%3b+was+led+by+Dr.+Alexander+Clarke+(Department+of+Anaesthesia%2c+The+Royal+Women%26rsquo%3bs+Hospital%2c+Victoria)+and+Dr.+Shaun+Gregory+(Faculty+of+Engineering%2c+Monash+University)%2c+in+collaboration+with+Dr.+Andrew+Stephens+and+Dr.+Sam+Liao+(Faculty+of+Engineering%2c+Monash+University)+and+Dr.+Timothy+Byrne+(Department+of+Intensive+Care+and+Hyperbaric+Medicine%2c+Alfred+Hospital%2c+Melbourne)%2c+with+additional+support+from+Dr.+Daniel+Duke+(Faculty+of+Engineering%2c+Monash+University)+and+Professor+David+Tuxen+(Alfred+Hospital%2c+Melbourne).

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