The ventilator should be put to pressure control mode, with a PIP (peak inspiratory pressure) set to the pressure needed for the lowest compliance in the circuit, meaning the highest PIP needed amongst all connected patients.
Since patients should not be able to trigger each other’s breaths, the system can only operate in mandatory ventilation mode. Modern ventilators lacking this option can be locked out, meaning the trigger threshold should be put beyond achievable values. Since mandatory ventilation is uncomfortable, patients would likely have to be paralysed.
Individual, effective PEEP is the sum of ventilator PEEP and PEEP set on the individual PEEP valves. See information on in-line PEEP valves.
Deleterious interactions between the patient’s circuits can be avoided in pressure control mode, but the pressure alarms of the ventilator have to be carefully set. E.g., when an inspiration tube becomes obstructed, the volume could be diverted to another patient’s circuit. A carefully set ‘pressure high alert’ will immediately make the ventilator release this too high pressure.
Likewise, the ‘low minute ventilation alarm’ should also be carefully set. This is important in case a disconnection happens in a part of the circuit behind a flow control valve that is strongly restricting the flow. In this case the disconnection alarm might not be triggered, but a carefully set low minute ventilation alarm will be.
The allowed tidal volume should be set to the maximum, or the alarm should be turned off.
BPM, FiO2 and I:E ratio can only be shared amongst all patients. PEEP can be set differentially for each patient using in-line, adjustable PEEP valves.
