A 64-year-old patient with cardiac failure and a fever arrived to the ER intubated for ventilator failure.

The patient was disconnected 16 times in the first 24 hours after arriving to the hospital:

  • Sent for a chest CT – 4 Disconnections
  • Transferred from the ER to the ICU – 2 Disconnections)
  • Sent to the Cath Lab – 4 Disconnections
  • Transitioned from dry circuit to heated wire – 1 Disconnection
  • MDI adapter placed in line – 1 Disconnection
  • Nebulized Tobramycin placed in line – 1 Disconnection
  • Expiratory filter changed daily due to delivery of Tobramycin – 2 Disconnections
  • Nitric Oxide placed in line – 1 Disconnection

Circuit disconnects are often thought of as brief or infrequent, however, with each disconnect, the patient’s lungs are put at risk for injury from collapse and re-expansion. In addition, the clinician is exposed to airborne pathogens with every disconnect.


A 2018 study published in the American Journal of Respiratory and Critical Care Management concluded abrupt deflation after sustained inflation can cause acute lung injury.[1]

Every disconnect has the potential to undo the progress that has already been made to heal the patient’s lungs, causing barotrauma, volutrauma and Ventilator Induced Lung Injury. These conditions, in turn, can cause long-term respiratory disability, recurring pulmonary infections, multi-organ failure as well as an increase in morbidity and mortality.[2]

Keeping the PEEP is key to protecting patients’ lungs.


The Mechanical and Aerospace Engineering Department at Carleton University recently reviewed the current standard procedures for patient transport with a three-circuit disconnection. The study found a leakage of 25% to 46% of particles emanating (such as bacteria) or delivered aerosols to the patient (such as pharmaceuticals) were dispersed in the room within a 5-inch area in which the clinical staff is exposed.[3]

Even when a ventilator is put on standby during a disconnection, there is still passive exhalation from the patient that can expose staff to airborne contaminants. It is clear that keeping the circuit closed can protect staff and enhance infection control.

THE SOLUTION: The FLUSSO BY PASS ADAPTER = Safer Circuit Disconnects

The Flusso By Pass Adapter facilitates the disconnection of the patient from the mechanical ventilator during a circuit change, HME change, or for transport. Flusso allows the patient’s PEEP to be maintained and reduces exhaled aerosols during a ventilator circuit disconnect, enhancing patient and staff safety.

The Flusso By Pass Adapter features proprietary Swing Valve Technology™, a patient port, by pass port, a ventilator port, a tethered cap and an integrated swivel to reduce torque. When the ventilator port is in use, the by pass port is sealed and when the by pass port is in use, the ventilator port is sealed. The innovative swing valve is designed to redirect the gas flow without interruption of positive pressure ventilation to the patient. The Flusso has standard ISO connections, adds minimal dead space and works with all modes of ventilation.

Use the Flusso By Pass Adapter for the following procedures

  • Implementation / removal of MDI into circuit
  • Implementation / removal of nebulizer into circuit
  • Change expiratory filter on the ventilation
  • Change humidity systems (i.e. wet to dry)
  • Implementation / removal of Aerogen SVN
  • Implementation / removal of nitric oxide
  • Manually bagging for delivery of inhaled medications
  • Ventilator circuit change
  • Change HME
  • Change ventilator
  • Add ETCO2 monitoring adapter
  • Patient proning
  • Patient transport
  • Move IV lines to opposite side of patient

The Flusso By Pass Adapter is on Premier Contract Number PP-DS-743 and Vizient Contract Number DM0170.