A Simple Method to Estimate Flow Restriction for Dual Ventilation of Dissimilar Patients: The BathRC Model

With large numbers of COVID-19 patients requiring mechanical ventilation and ventilators possibly being in short supply, in extremis two patients may have to share one ventilator. This possibility has been discussed for at least two decades, and careful matching of patient ventilation requirements is necessary. However, with a large range of lung compliance and other characteristics, which may also vary with time, good matching is difficult to achieve. Adjusting the impedance of the flow path between ventilator and patient gives the opportunity to control the airway pressure and hence flow and volume individually for each patient. Several groups are now investigating this, in particular the addition of a flow restrictor in the inspiration tube for the patient who is more compliant, or requires a lower tidal volume. We show that a simple linear resistance-compliance model, termed the BathRC model, of the ventilator tubing system and lung allows direct calculation of the relationships between pressures, volumes, and required flow restriction. The BathRC model was experimentally validated using a GE Aisys CS2 ventilator connected to two test lungs. The pressure-flow relationships for two restrictors were experimentally determined, and despite the need to approximate them with a linear resistance characteristic, their effect in the breathing circuit is accurately predicted by the simple model. The BathRC model is freely available for download and also has been implemented online; this tool is provided to demonstrate that flow restriction can be readily estimated.