Shared Ventilation: Toward Safer Ventilator Splitting in Resource Emergencies

Shortages of mechanical ventilators during the COVID-19 pandemic have prompted clear messaging about the hazards of ventilating multiple patients with a single ventilator.    Nonetheless, some hospitals are forced to undertake the practice. A protocol using pressure control ventilation for well-matched patients under deep sedation and neuromuscular blockade    and novel solutions for some limitations of ventilator splitting have been published. These recommendations mitigate some concerns about ventilator settings and monitoring.    Adequate matching of ventilator parameters (driving pressure, respiratory rate, and positive end-expiratory pressure [PEEP]) and continuous or frequent monitoring for each individual patient (oxygen saturation measured by pulse oximetry, end-tidal carbon dioxide, pH, and PCO 2 ) are complimented by monitoring of shared ventilator parameters ( e.g. , driving pressure, PEEP, total tidal volume [V T ], and dynamic compliance), with alarms set for deviations from initial values.