key: cord-0837762-316wscb8
authors: Greig, P. R.; Dixson, T.; McCorkell, S.
title: A process for daily checks when using anaesthetic machines to ventilate the lungs of COVID‐19 patients: the ‘domino switch’ technique
date: 2020-04-27
journal: Anaesthesia
DOI: 10.1111/anae.15098
sha: 53ef60448df65d14efd077dfe248b487145136d4
doc_id: 837762
cord_uid: 316wscb8

The COVID-19 pandemic has increased demand for ventilators. Anaesthetic machines offer an alternative, but these are not designed to run continuously. Our department uses Dräger Primus anaesthetic machines which require daily checks. Dräger company representatives have indicated that checks can be deferred for up to 72 h [1], but this might increase the risk of malfunctions. Checks take several minutes, so an alternative means of ventilation is required to cover this period, necessitating two circuit disconnections per patient. Each disconnection potentially generates an infectious aerosol, and risks tracheal tube displacement and lung derecruitment, even with precautions such as tracheal tube clamping. We concluded that multiple circuit disconnections were unsatisfactory and devised a process for daily checks with a single disconnection per patient. We call this process 'domino switching'.

The COVID-19 pandemic has increased demand for ventilators. Anaesthetic machines offer an alternative, but these are not designed to run continuously. Our department uses Dr€ ager Primus anaesthetic machines which require daily checks. Dr€ ager company representatives have indicated that checks can be deferred for up to 72 h [1] , but this might increase the risk of malfunctions. Checks take several minutes, so an alternative means of ventilation is required to cover this period, necessitating two circuit disconnections per patient. Each disconnection potentially generates an infectious aerosol, and risks tracheal tube displacement and lung derecruitment, even with precautions such as tracheal tube clamping. We concluded that multiple circuit disconnections were unsatisfactory and devised a process for daily checks with a single disconnection per patient. We call this process 'domino switching'.

The process requires one extra anaesthetic machine and depends on the breathing circuit of each machine being able to reach patients on either side of the device. 

COVID-19: usage of Dr€ ager anaesthesia devices for long term ventilation