{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T01:07:20Z","timestamp":1755220040329,"version":"3.43.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The concept of ventilating multiple patients concurrently using a single ventilator has been proposed as a solution when the demand for ventilators surpasses the available supply. While the practicality of this approach has been established, a thorough evaluation of the risks involved has yet to be comprehensively addressed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Two circuits, a simple one (circuit-1) and another with an adjustable resistance valve (circuit-2), were evaluated within an experimental framework utilizing two computer-controlled lung simulators (TestChest and ASL 5000). These simulators were ventilated by an ICU (intensive care unit) ventilator (Servo-u) employing various ventilation modes (volume- and pressure-controlled ventilation). The study was conducted under differing respiratory conditions, characterized by low compliance (20 ml\/cmH<jats:sub>2<\/jats:sub>O) as well as normal-high compliance (100 ml\/cmH<jats:sub>2<\/jats:sub>O), in order to ascertain the applied tidal volume (VT), pressures, and the resultant mechanical power (MP).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Circuit-1: The applied VT, pressures, and MP differed significantly between the two simulators, as well as in relation to ventilation mode, compliance, and respiratory rate (RR) (p\u2009&lt;\u20090.001); the differences were most pronounced in settings with differing compliance levels. Circuit-2: Differences in VT, pressures, and MP were observed between simulators concerning valve settings (p\u2009&lt;\u20090.001). The VT demonstrated a negative correlation, with volumes derived from valve closure spanning from 50 to 100 ml across all settings. In the design of circuit-2, MP exceeded the 12 J\/min threshold in both lung simulators at elevated RR and could only be decreased through valve closure followed by a consequential hypoventilation in one simulator.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The simultaneous ventilation of two patients using a single ventilator is technically viable, yet it presents considerable risks. Even with the integration of an adjustable resistance valve to accommodate varying lung complexit<jats:strike>i<\/jats:strike>es, the likelihood of unilateral hypoventilation and elevated mechanical stress remains high.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0328813","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T17:38:20Z","timestamp":1754588300000},"page":"e0328813","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["1-4-2: Evaluation of applied mechanical power to individual lungs in a simulator-based setting of one ventilator for two patients"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4935-3240","authenticated-orcid":true,"given":"Lars-Olav","family":"Harnisch","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Czock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew A.","family":"Levin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Wieditz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3416-4727","authenticated-orcid":true,"given":"Leif","family":"Saager","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konrad","family":"Meissner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Onnen","family":"Moerer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"issue":"11","key":"pone.0328813.ref001","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/j.arbr.2020.06.011","article-title":"Mechanical risks of ventilator sharing in the COVID-19 era: a simulation-based study","volume":"56","author":"M Angulo","year":"2020","journal-title":"Arch Bronconeumol (Engl Ed)"},{"issue":"7","key":"pone.0328813.ref002","doi-asserted-by":"crossref","first-page":"932","DOI":"10.4187\/respcare.07919","article-title":"Shared ventilation in the era of COVID-19: a theoretical consideration of the dangers and potential solutions","volume":"65","author":"J Herrmann","year":"2020","journal-title":"Respir Care"},{"issue":"4","key":"pone.0328813.ref003","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1097\/ALN.0000000000003473","article-title":"Differential ventilation using flow control valves as a potential bridge to full ventilatory support during the COVID-19 crisis","volume":"133","author":"MA Levin","year":"2020","journal-title":"Anesthesiology"},{"issue":"4","key":"pone.0328813.ref004","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1164\/rccm.202006-2438ED","article-title":"Ventilator sharing during shortages. a Siren\u2019s song?","volume":"202","author":"J Mancebo","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"pone.0328813.ref005","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1186\/s13054-020-03248-z","article-title":"Successful ventilation of two animals with a single ventilator: individualized shared ventilator setup in an in vivo model","volume":"24","author":"M Stiers","year":"2020","journal-title":"Crit Care"},{"issue":"6","key":"pone.0328813.ref006","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1136\/thoraxjnl-2020-214895","article-title":"One ventilator for two patients: feasibility and considerations of a last resort solution in case of equipment shortage","volume":"75","author":"T Tonetti","year":"2020","journal-title":"Thorax"},{"key":"pone.0328813.ref007","volume-title":"Joint statement on multiple patients per ventilator","author":"Medicine SoCC, Medicine SoCC, Care AAfR, Anesthesiologists ASo, Foundation APS, Nurses AAoC-C","year":"2020"},{"issue":"5","key":"pone.0328813.ref008","article-title":"Personalized ventilation to multiple patients using a single ventilator: description and proof of concept","volume":"2","author":"JS Han","year":"2020","journal-title":"Crit Care Explor"},{"issue":"8","key":"pone.0328813.ref009","doi-asserted-by":"crossref","first-page":"200585","DOI":"10.1098\/rsos.200585","article-title":"A simulated single ventilator\/dual patient ventilation strategy for acute respiratory distress syndrome during the COVID-19 pandemic","volume":"7","author":"JA Sol\u00eds-Lemus","year":"2020","journal-title":"R Soc Open Sci"},{"issue":"4","key":"pone.0328813.ref010","first-page":"705","article-title":"Improvised automatic lung ventilation for unanticipated emergencies","volume":"22","author":"DD Sommer","year":"1994","journal-title":"Crit Care Med"},{"issue":"3","key":"pone.0328813.ref011","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1163\/15685570052062576","article-title":"Artificial ventilation of the lungs for emergencies","volume":"10","author":"M Darowski","year":"2000","journal-title":"Front Med Biol Eng"},{"issue":"11","key":"pone.0328813.ref012","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1197\/j.aem.2006.05.009","article-title":"A single ventilator for multiple simulated patients to meet disaster surge","volume":"13","author":"G Neyman","year":"2006","journal-title":"Acad Emerg Med"},{"issue":"1","key":"pone.0328813.ref013","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.resuscitation.2007.10.016","article-title":"Increasing ventilator surge capacity in disasters: ventilation of four adult-human-sized sheep on a single ventilator with a modified circuit","volume":"77","author":"L Paladino","year":"2008","journal-title":"Resuscitation"},{"issue":"2","key":"pone.0328813.ref014","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/BF01686056","article-title":"A selective ventilation distribution circuit (S.V.D.C)","volume":"5","author":"JM Cavanilles","year":"1979","journal-title":"Intensive Care Med"},{"issue":"3","key":"pone.0328813.ref015","doi-asserted-by":"crossref","first-page":"399","DOI":"10.4187\/respcare.01236","article-title":"Use of a single ventilator to support 4 patients: laboratory evaluation of a limited concept","volume":"57","author":"RD Branson","year":"2012","journal-title":"Respir Care"},{"issue":"12","key":"pone.0328813.ref016","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1197\/j.aem.2006.10.002","article-title":"A single ventilator for multiple simulated patients to meet disaster surge","volume":"13","author":"RD Branson","year":"2006","journal-title":"Acad Emerg Med"},{"issue":"7","key":"pone.0328813.ref017","doi-asserted-by":"crossref","first-page":"547","DOI":"10.3390\/membranes11070547","article-title":"Sharing mechanical ventilator: in vitro evaluation of circuit cross-flows and patient interactions","volume":"11","author":"SM Colombo","year":"2021","journal-title":"Membranes (Basel)"},{"issue":"1","key":"pone.0328813.ref018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0245578","article-title":"Simultaneous ventilation in the Covid-19 pandemic. A bench study","volume":"16","author":"C Gu\u00e9rin","year":"2021","journal-title":"PLoS One"},{"issue":"4","key":"pone.0328813.ref019","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1164\/rccm.202005-1586LE","article-title":"Ventilator sharing during an acute shortage caused by the COVID-19 pandemic","volume":"202","author":"JR Beitler","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"pone.0328813.ref020","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1097\/ALN.0000000000003410","article-title":"Shared ventilation: toward safer ventilator splitting in resource emergencies","volume":"133","author":"AD Cherry","year":"2020","journal-title":"Anesthesiology"},{"issue":"1","key":"pone.0328813.ref021","article-title":"Implementing shared ventilation must be scientific and ethical, or it risks harm","volume":"125","author":"DC Cook","year":"2020","journal-title":"Br J Anaesth"},{"issue":"7","key":"pone.0328813.ref022","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.4187\/respcare.08140","article-title":"Ventilator sharing: the good, the bad, and the ugly","volume":"65","author":"DR Hess","year":"2020","journal-title":"Respir Care"},{"issue":"50","key":"pone.0328813.ref023","first-page":"840","article-title":"Mechanical ventilation and extracorporeal membrane oxygena tion in acute respiratory insufficiency","volume":"115","author":"F Fichtner","year":"2018","journal-title":"Dtsch Arztebl Int"},{"issue":"1","key":"pone.0328813.ref024","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1186\/s13054-017-1750-x","article-title":"The future of mechanical ventilation: lessons from the present and the past","volume":"21","author":"L Gattinoni","year":"2017","journal-title":"Crit Care"},{"issue":"1","key":"pone.0328813.ref025","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.resuscitation.2008.04.033","article-title":"One ventilator multiple patients--what the data really supports","volume":"79","author":"RD Branson","year":"2008","journal-title":"Resuscitation"},{"issue":"10","key":"pone.0328813.ref026","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1007\/s00134-016-4505-2","article-title":"Ventilator-related causes of lung injury: the mechanical power","volume":"42","author":"L Gattinoni","year":"2016","journal-title":"Intensive Care Med"},{"issue":"5","key":"pone.0328813.ref027","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1097\/ALN.0000000000001056","article-title":"Mechanical power and development of ventilator-induced lung injury","volume":"124","author":"M Cressoni","year":"2016","journal-title":"Anesthesiology"},{"key":"pone.0328813.ref028","unstructured":"Chen M, Shah A, Shah R, Zhou G, Kane E, Burnett G, et al. Mount Sinai health system emergency ventilator sharing protocol and instructions for use; 2020. Available from: https:\/\/docs.google.com\/document\/d\/1eFxzKmt__0sbYAjFNiQxVRCuIv-a65mbs4QHzIu_1i0\/edit"},{"issue":"1","key":"pone.0328813.ref029","first-page":"43","article-title":"The Hering-Breuer reflex during artificial respiration in the rabbit. IV. The influence on the lung volume in different states of inflation","volume":"338","author":"M Fallert","year":"1972","journal-title":"Pflugers Arch"},{"issue":"9","key":"pone.0328813.ref030","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1164\/rccm.202006-2452LE","article-title":"Ventilator sharing using volume-controlled ventilation during the COVID-19 pandemic","volume":"202","author":"A Milner","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"9","key":"pone.0328813.ref031","article-title":"Inline positive end-expiratory pressure valves: the essential component of individualized split ventilator circuits","volume":"2","author":"S Roy","year":"2020","journal-title":"Crit Care Explor"},{"issue":"5","key":"pone.0328813.ref032","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s00134-015-4200-8","article-title":"The \u201cbaby lung\u201d became an adult","volume":"42","author":"L Gattinoni","year":"2016","journal-title":"Intensive Care Med"},{"issue":"7","key":"pone.0328813.ref033","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1111\/anae.15078","article-title":"Coping with COVID-19: ventilator splitting with differential driving pressures using standard hospital equipment","volume":"75","author":"AL Clarke","year":"2020","journal-title":"Anaesthesia"},{"issue":"4","key":"pone.0328813.ref034","article-title":"Regulating inspiratory pressure to individualise tidal volumes in a simulated two-patient, one-ventilator system","volume":"125","author":"GH Chen","year":"2020","journal-title":"Br J Anaesth"},{"issue":"6","key":"pone.0328813.ref035","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1109\/MCSE.2020.3024062","article-title":"Cloud computing for COVID-19: lessons learned from massively parallel models of ventilator splitting","volume":"22","author":"M Kaplan","year":"2020","journal-title":"Comput Sci Eng"},{"issue":"6","key":"pone.0328813.ref036","doi-asserted-by":"crossref","DOI":"10.14814\/phy2.15225","article-title":"Mechanical power thresholds during mechanical ventilation: an experimental study","volume":"10","author":"F Romitti","year":"2022","journal-title":"Physiol Rep"},{"issue":"11","key":"pone.0328813.ref037","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1007\/s00134-018-5375-6","article-title":"Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts","volume":"44","author":"A Serpa Neto","year":"2018","journal-title":"Intensive Care Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328813","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T17:38:25Z","timestamp":1754588305000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328813"}},"subtitle":[],"editor":[{"given":"Silvia","family":"Fiorelli","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":37,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0328813","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]}}}