Skip to main content

Letter to the Editor in response to “COVID-19: desperate times call for desperate measures”

We have read with attention the commentary from von Düring et al. questioning our research letter on safe doubling of ventilator capacity recently published in Critical Care [1]. Our publication starts with a quote of our own: “The best way to ventilate two patients on a single ventilator is simply not to do it,” and we believe that unfortunately, von Düring et al. took this as the conclusion of the report.

In fact, we argue for the idea of ventilating two patients with a single ventilator, not against. This is a serious misunderstanding of our work proposing a safe way to ventilate two patients at once, so as von Düring et al. note, a second life can be saved.

We proposed a safe, innovative method based on a simple in-series (one-after-the-other) breathing circuit (Fig. 1). It directly addresses the limitations of shared, in-parallel (both-together) breathing listed in the SCCM statement [2]. It permits individual PEEP settings and driving pressures, and volume-controlled or pressure-controlled ventilation of patients with different lung compliance, because each patient breathes separately.

Fig. 1
figure 1

In-series breathing setup and concept [1]

While we agree with von Düring et al. when they say “The objective of ventilator sharing is to save a second life by buying time to find a second ventilator” [3], but we believe it is practically incompatible with their suggestion of reserving it for patients with the same gender, similar IBW and lung mechanics, who are sedated and paralyzed. When ICU clinicians are faced with a decision to ventilate two patients at once, or deny care to one, they will not start analyzing all of their patients’ lung mechanics to find the matching pairs. Our in-series approach obviates this need.

So yes, we believe our in-series setup is a safe last resort proposal for last resorts, rather than a desperate measure.

Availability of data and materials

Not applicable


  1. Chase JG, Chiew YS, Lambermont B, Morimont P, Shaw GM, Desaive T. Safe doubling of ventilator capacity: a last resort proposal for last resorts. Crit Care. 2020;24:1–4.

    Article  Google Scholar 

  2. SCCM, C.C. Archives, A.A. iCritical Care, C.C. Blog, S. Connect, S. App, and C.O. Demand, Consensus Statement on Multiple Patients Per Ventilator. 2020. SCCM Website ( Accessed 15 June 2020. .

  3. von Düring S, Primmaz S, Bendjelid K. COVID-19: desperate times call for desperate measures. Crit Care. 2020;24(1):1–2.

    Article  Google Scholar 

Download references





Author information

Authors and Affiliations



JGC and TD developed the idea and led the writing. YSC, BL, PM, and GMS provided additional input and contributions to the development and writing. All authors read and approved the manuscript.

Corresponding author

Correspondence to Thomas Desaive.

Ethics declarations

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

No competing interests

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chase, J.G., Chiew, YS., Lambermont, B. et al. Letter to the Editor in response to “COVID-19: desperate times call for desperate measures”. Crit Care 24, 415 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: