Multiple patients on a single ventilator
The American Society of Anesthesiologists (ASA) advises clinicians that sharing mechanical ventilators should not be attempted because it cannot be done safely with current equipment. With current equipment designed for a single patient, ASA recommends that clinicians do not attempt to ventilate more than one patient with a single ventilator while any clinically proven, safe, and reliable therapy remains available (i.e., in a dire, temporary emergency).

Attempting to ventilate multiple patients would likely require arranging the patients in a spoke-like fashion around the ventilator as a central hub. This positioning moves the patients away from the supplies of oxygen, air, and vacuum at the head of the bed. It also places the patients in proximity to each other, allowing for the transfer of organisms. Spacing the patients farther apart would likely result in hypercarbia.

Spontaneous breathing by a single patient sensed by the ventilator would set the respiratory frequency for all the other patients. The added circuit volume could preclude triggering. Patients may also share gas between circuits in the absence of one‐way valves. Pendelluft between patients is possible, resulting in both cross‐infection and over‐distension. Setting alarms can monitor only the total response of the patients’ respiratory systems as a whole. This would hide changes occurring in only one patient.

The reasons for avoiding ventilating multiple patients with a single ventilator include.

-- Volumes would go to the most compliant lung segments.
Positive end‐expiratory pressure would be impossible to manage.
-- Monitoring patients and measuring pulmonary mechanics would be challenging.
-- Alarm monitoring and management would not be feasible.
Individualized management for clinical improvement or deterioration would be impossible.
-- In the case of a cardiac arrest, ventilation to all patients would need to be stopped that would alter breath delivery dynamics to the other patients.
-- Different Patients could deteriorate and recover at different rates, and the distribution of gas to each patient would be unequal and unmonitored.
-- Finally, there are ethical issues. If the ventilator can be lifesaving for a single individual, using it on more than one patient at a time risks life‐threatening treatment failure for all of them.

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