Improvised automatic lung ventilation for unanticipated emergencies.

OBJECTIVES: To design an improvised circuit that can be used to extend the capability of a single ventilator to ventilate two or more patients and that can be assembled from readily available parts in times of unanticipated emergency. DESIGN: Research and development, followed by technical analysis and evaluation. SETTING: Biomedical laboratory. MEASUREMENTS AND MAIN RESULTS: We describe two circuits that can be assembled from readily available inexpensive components to function as improvised ventilators. One circuit requires only a central mushroom valve driver and an additional source of fresh gas for each patient. The other circuit is configured as a number of secondary circuits in parallel, connected to a single ventilator. We constructed and tested the circuits using mechanical lung simulators. The secondary circuit configuration was more efficient in terms of fresh gas usage, but was more complex regarding operation and trouble-shooting. CONCLUSIONS: These two improvised circuits can extend the capability of a standard volume-cycled ventilator to provide automatic ventilation of the lungs in times of disaster.

Carinal resection with two high-frequency jet ventilation delivery systems.

A 76-yr-old man underwent carinal resection for squamous cell carcinoma through the right posterolateral thoracotomy approach. Ventilation was maintained by the use of two high-frequency jet ventilators, each attached to a separate catheter during the time of resection and reconstruction of the tracheal carina. These catheters were introduced through the endotracheal tube and positioned into the left and right main bronchi at the beginning of the tracheal resection. Then, conventional ventilation was replaced by high-frequency jet ventilation (HFJV) with different ventilatory variables for each lung. During two-lung jet ventilation there was good oxygenation, normocapnia and no cardiovascular complications. The principle advantage of using two separate high-frequency ventilators is that it allows for maximum ventilatory efficiency with lungs of different compliance.