title: Increasing ventilator surge capacity in disasters: ventilation of four adult-human-sized sheep on a single ventilator with a modified circuit.
abstract: OBJECTIVE
  Recent manmade and natural disasters have focused attention on the need to provide care to large groups of patients. Clinicians, ethicists, and public health officials have been particularly concerned about mechanical ventilator surge capacity and have suggested stock-piling ventilators, rationing, and providing manual ventilation. These possible solutions are complex and variously limited by legal, monetary, physical, and human capital restraints. We conducted a study to determine if a single mechanical ventilator can adequately ventilate four adult-human-sized sheep for 12h.
  
  
  METHODS
  We utilized a four-limbed ventilator circuit connected in parallel. Four 70-kg sheep were intubated, sedated, administered neuromuscular blockade and placed on a single ventilator for 12h. The initial ventilator settings were: synchronized intermittent mandatory ventilation with 100% oxygen at 16 breaths/min and tidal volume of 6 ml/kg combined sheep weight. Arterial blood gas, heart rate, and mean arterial pressure measurements were obtained from all four sheep at time zero and at pre-determined times over the course of 12h.
  
  
  RESULTS
  The ventilator and modified circuit successfully oxygenated and ventilated the four sheep for 12h. All sheep remained hemodynamically stable.
  
  
  CONCLUSIONS
  It is possible to ventilate four adult-human-sized sheep on a single ventilator for at least 12h. This technique has the potential to improve disaster preparedness by expanding local ventilator surge capacity until emergency supplies can be delivered from central stockpiles. Further research should be conducted on ventilating individuals with different lung compliances and on potential microbial cross-contamination.
authors.affiliation: Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States. LorenzoPaladino@yahoo.com
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Paladino
authors.forename: Mark
authors.initials: M
authors.lastname: Silverberg
authors.forename: Jean G
authors.initials: JG
authors.lastname: Charchaflieh
authors.forename: Julie K
authors.initials: JK
authors.lastname: Eason
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Wright
authors.forename: Nicholas
authors.initials: N
authors.lastname: Palamidessi
authors.forename: Bonnie
authors.initials: B
authors.lastname: Arquilla
authors.forename: Richard
authors.initials: R
authors.lastname: Sinert
authors.forename: Seth
authors.initials: S
authors.lastname: Manoach
mesh_terms: D000818:Animals; D004190:Disasters; D004867:Equipment Design; D005260:Female; D012131:Respiratory Insufficiency / Q000628:therapy*; D034561:Sheep, Domestic; D012122:Ventilators, Mechanical / Q000600:supply & distribution*