Another low cost, simple ventilator from MIT

https://web.mit.edu/2.75/projects/DMD_2010_Al_Husseini.pdf

From one of the links Wayne provided:

"What are some possible risks of a ventilator?

A ventilator places a person at high risk for infections.

You might find a ventilator to be uncomfortable.

You might try to pull the tube.

To prevent this from happening, you might be given medicine to make you sleepy or your hands might be restrained. Some people who need a ventilator do not recover to their previous level of function.

You would need a lot of help. Most people on a ventilator need to be monitored in an intensive care unit or similar setting.

Some people can be cared for in a nursing home or in their own home if they have care from professionals for monitoring and maintenance. "

The FIA should get behind mas producing ventilators. Ship them to each automobile club member, such as AAA and the like.

The goodwill would be huge, and frankly much needed.

"For the record, if things go badly for me, I would rather have a functional vent than not be able to get access to a FDA approved vent."

I would want a functional vent used by people with some level of skill, experience and training people in a care setting that does not make the vent superfluous. So I guess my specs are different.

"The purpose of this thread is to develop something for use in an emergency situation, not something for used or sale on the open market in normal circumstances."

Sorry, I missed that post by the OP.

Right. When your emergency mask drops from the airplane cabin ceiling, you do not say "Not my brand" and refuse to put it on.

The group I posted about in post #10 is attempting to recreate this vent.

https://www.vortran.com/go2vent
https://www.youtube.com/watch?v=JRKIyEJAEhA&amp=&feature=emb_rel_pause

Last I read, as of the 16th, they have not been able to contact anyone at the company. As you would expect, things are hectic and there may be delay in their documentation.

"Right. When your emergency mask drops from the airplane cabin ceiling, you do not say "Not my brand" and refuse to put it on. "

Interesting analogy, but you are missing the point. What difference does it make if the airplane is made of string, balsa wood and cloth?

And the pilots only have previous experience flying paper airplanes?

And they were trying to fly this plane over the Himalayas?

Would you even get on that plane? Maybe yes.

Would you put your loved one on that plane? Maybe yes.

I envision that if things get that bad we'll have other much bigger issues.

ICU is a health care "setting." Populated with teams of trained people.

If that setting becomes like a wartime battlefield, there may be larger issues in play than the availability of a custom engineered and built vent.

We'll see. Well hopefully we won't.

I wonder if a simple lack of vents in Italy has contributed to their challenges... or whether the challenges are larger in scope.

Sure a vent is an important tool in ICU settings for patients with major respiratory issues.

What term did we use.... necessary but may not be sufficient.

Just like the sample collection cotton swabs in Rhode Island... there cannot be a "test" without a sample. But a test is also impossible without a way to get a sample to a lab. And no one will work (without being forced) in a lab without PPE, and so on.

I see this as a "system."

^ When there are not enough beds, respirators, health care workers, and they must choose between letting you live or die, you don't want to be "choosy".

You don't understand that this is not a drill. You can't be like the kid during fire drill who cries and wants to be carried. Normal "systems" and "settings" do not apply. Indeed, you are the one who is totally missing the important point.

Vortran Medical appears to have less than 50 employees.

I wonder about the supply chains involved in the manufacture of their products...

I wonder about the manufacturing location of partial and final assemblies...

About they are located 7.5 miles from the State of California Public Health HQ.

We'll see.

What about a modernized iron lung. You’d need a human sized tube and a bellows.

"When there are not enough beds, respirators, health care workers, and they must choose between letting you live or die, you don't want to be "choosy"."

Makes no sense. I would very very likely be incapacitated. So I could likely not be involved in "choosing."

But that is not the point. The points I make relate to the larger scope of what is necessary to keep people alive.

And of course as I have stated, giving prime consideration to the best places to focus resources with the highest likelihood of impact.

I envision if we ever get to a point here in the U.S. where folks are using cobbled together critical care equipment, there will be massive "civil unrest situations."

During the civil war, I reckon that they did a lot of amputations and a lot of casualties were due to disease and infections. A lot. In a lot of ways that is all they could do. And all they knew to do.

In this case, most if not all folks in jeopardy, and their loved ones will clearly know at some level the differences in likely outcomes between care settings (including equipment like vents) and caregivers that are part of our every day health care system, and those that are cobbled together and operated by laypeople.

So I can envision a scenario where people will fight hard, perhaps against each other for the former.

Anyway, I understand that in times like these it is leadership that helps guide impactful use of resources, including those that want to cobble and tinker.

Even during WW2 I am sure that some well-meaning folks eschewed working at the airplane factory and decided to try to design and build their own war planes.

We are all human.

Mahler - you seem to have some knowledge here.

What air volume is needed per aspiration, how much pressure is needed, how many aspirations per minute?

Help us out with this information. That would be far more useful than the tirade you are on. We get it, you would rather die waiting for a brand name vent that took years to get approval on. The rest of us want to built an improvised splint so we can walk out of the Bush with a broken leg because that could be the only option available.

^ Mahler, You WILL BE INCAPACITATED. You will not be able to choose. The healthcare workers will have to choose who lives or dies if the system is overwhelmed. Literally the choice seems to be, "let you die", or "try something else". That is why we see talented engineers even contemplating home-made ventilators. The issue is whether they let you die or not. The Agnelli family, owners of Ferrari, donated $10M USD to help do what? Buy more ventilators and medical equipment for those who are sick and dying. "Best practices" is a phrase that does not apply. It is meaningless when the "standard of care" threshold has been exceeded by a factor of more than 2. In these cases, by more than 4.

Do you ever leave the pot fields of Nor Cal long enough to watch or read about what is happening in Italy? That is what the USA is trying to avoid, that is the reason for this thread, and that is what everyone else is talking about. I guess you would be one of those who would be allowed to die while you wait for your chosen brand of medicine to show up.

As soon as you same I am waiting for a brand name you don't understand how healthcare or medicine works or the points I am trying to make.

I understand that I cannot teach you about this... all I can do is suggest a broader perspective.

You cannot walk out of the bush with a broken leg with just a safe and effective cobbled together ventilator.

You might even be better off spending your money on Alibaba immediately:

https://www.alibaba.com/trade/search?fsb=y&IndexArea=product_en&CatId=&SearchTex t=medical+ventilator

I doubt much, if any of the The Agnelli family's donation has been or will be spent on vents with unknown safety and efficacy (including things as simple as safe materials and QC) from Alibaba.

You can buy a pulse ox for probably $10, and that won't be designed and manufactured under the US CFR. And in a pinch that might be good enough compared to one from Tyco or Massimo that is sold into hospital settings.

But a vent is a different animal.

Much, more complicated... not necessarily in its composition, but often (perhaps usually) more critical in its application.

The original article on Instructable from Wayne's OP was uploaded in 2007 (!). The same author setup the blog above also. Regarding the published articles, I'm actually quite happy to learn that health authorities (as well as backyard mechanics) have had plans for the next big influenza pandemic. I never paid any attention to this before and I'm sure the vast majority of people didn't care either, otherwise we would always have had toilet paper shortage!

I hope so too, Won. Never mind the Hippie from Northern California.

There are plenty of places to read up on respiratory physiology, et cetera.

And of course for the basics (though my training is from 1983) I suggest starting with the hypothesis that Guyton is a good place to start.

I also suggest learning about the ICU setting as a system.

I think it is a great idea to think about these things, but like I said, I think it might be a better contribution for many to instead work in the airplane factory. In this case, one with a bivouac where workers are protected from infection.

And maybe, just maybe, take some junior pilots (like medical students pre-MD) and engage them. Wait, that is likely already happeneing.

This is from the UK I believe, based on the url. Putting out their requirements for a "Rapidly Manufactured Ventilation System (RMVS)"

https://www.britishchambers.org.uk/media/get/Specification%20For%20RMVS%20Challenge.pdf

Hippie? Cool!

I am a black man with an Ivy league education (advanced engineering) that has been involved with medical devices and capital equipment for a long time (engineering summer student 1978 - 1984 and on the business side immediately after engineering grad school 1985 to basically present).

Huge companies like GE healthcare, and start-ups. In two of those I worked with two of the three of inventors of pulse OX.

Was a pre-med in engineering grad school (where I focused on biomedical and electrical engineering) so elected to take all the pre-med orgo classes and a medical physiology class.

Most of my friends will find it funny that I have been labled a hippie on social media.

Oh and I am a pretty unapologetic capitalist.... perhaps headed toward venture capital next.

I am not a big believer in ad hominem in general nor do I generally participate in social media.

Big believer in cobbling and disruption in healthcare.

Here ya go:

"(The UK) Health department says NHS has 5,900 ventilators but could need as many as 20,000"

https://www.theguardian.com/business/2020/mar/16/vauxhall-owner-psa-car-shuts-european-plants-amid-coronavirus-fears

Nosotros veremos.

And some additional perspective:

https://www.bloomberg.com/news/articles/2020-03-17/johnson-s-ventilator-plan-puzzles-u-k-firms-wanting-to-help

As most folks know, manufacturing components for a proven design is different from coming up with a new design and bringing it through to production at scale in a relevant (that is impactful) time frame, regardless of regulatory framework and litigation environment.

BJ does not look to happy in that picture.

I think your friends would probably nod, knowingly, and ask if you threw the race card.

What do you think we are trying to do here??

Anyway. I can think of a few reasons why a vastly experienced Ivy leaguer such as yourself may not engage in a back-of-the-napkin pub discussion, which is all this is. While you try to distract/dissuade us, I'll continue while I wait for a real ventilator blueprint to land on my desk.

Back on topic. It wouldn't be hard to get a sense of my own need for air volume - just breath into a ziplock bag. I'm small, so use a large ziplock bag for normal people.

Collapsible water jugs for camping could be used as an air pump. Plenty of O2 left in the exhaled volume (maybe the pre-med engineer can confirm?). Pump it manually or figure out how to automate it.

Yet more perspective-- perhaps previously posted (P alliteration):

https://www.forbes.com/sites/baldwin/2020/03/14/ventilator-maker-we-can-ramp-up-production-five-fold/#11ba378e5e9a

Best perspective I have read thus far. Just a few days old. I wonder if more actual orders have been placed and/or some of these companies are ramping on their own dime and/or on spec.

And by the way, back of the napkin activity is something I highly value. But I try to start with the best specs I can. Like considering a vent as part of a setting with a variety of machines, disposables and professionals.

I always try to work with like minded disrupters whom have, at least some relevant experience.

For those serious about these vent efforts and related efforts to help with equipment and devices, these folks and others like them will perhaps be good contacts and/or pitch in:

https://innovation.sutterhealth.org/

I met the guy that runs the place last October and I know the couple that provided the funds. Michael Gaulke is a Porschephile and I have raced against him.

Remember, we are all in this together.

Sadly, we are not equipped nor qualified to design open-source ICU support staff :) Just doing what we can.

Since we are all in this together, can rich old people with connections in the industry buy their own ventilator and ICU "system" and share it with the rest?

So big boy, are you going to answer my questions or not?

What volume per ventilation?
What max pressure is needed?
How many ventilations per minute?

Don’t assume the rest of us here are stupid or incapable. I only have 33 ISSUED patents and am a professional engineer. One of my inventions is used worldwide and has brought in over $700M in revenue.

If you are going to keep posting in this thread, make yourself useful and answer the above questions (that is if you are the expert that you portrayed yourself to be).

I think Mike has clearly explained why I never wanted to work on vents.

I'm curious, does everyone realize that to be on a ventilator, the patient must be intubated? Having that tube down the throat is very unpleasant. Most patients are sedated, else they'll be yanking on it.

For long-term use ( meaning more than a week or so ), the patient gets a tracheotomy and the vent attaches there. No more tube, but the patient cannot speak. I won't even get into how they eat.

There's zero chance I'd allow anyone I know be intubated for "homemade" ventilator use.

CPAPs and Nebulizers are completely different.

Update.

https://www.theverge.com/2020/3/17/21184308/coronavirus-italy-medical-company-threatens-sue-3d-print-valves-treatments?fbclid=IwAR2jwaqav9bYc9gXazBL_wrKeuswMF PAxaOs78VLeru0UkGVbh1BCAAI6ZE

the thing about ventilators..
your pretty messed up if you need one..
and the longer your on it..
the less likely you will come of same..

Rika

unclebilly, you need a valium, is google disabled on your computer?

Maybe start with this.

https://www.merckmanuals.com/professional/critical-care-medicine/respiratory-failure-and-mechanical-ventilation/overview-of-mechanical-ventilation

Interesting development. I guess the medical companies still need to protect their IP and justify the cost of certification and salary for all the highly qualified engineer doctors, even in the time of Covid.

I did mention earlier that the method used to print those valves are by far not safe (we don't use SLS for parts that need to be food-safe, let alone medical grade). If they do get used, assuming it's not just hospitals trying to save $10999 per valve but for real reasons like scarcity, that only highlights how bad things are.

I like to tinker. And I am a physician with a little knowledge of ventilators. If you have "it" and are in dire straights, you will need to be on a ventilator with a knowledgeable respiratory therapist running the machine; that will be in a hospital, and not something that can be cobbled together to work (the respiratory therapist).

On the other hand, just tipping the scale for survivability when a ventilator is not available, a simple "ambu bag," esp one that can have oxygen supplementation might carry the day. These are easily available with masks, hoses, oral airways. So I really like the idea posted above
https://web.mit.edu/2.75/projects/DMD_2010_Al_Husseini.pdf

But we can do it more simply. Use an inexpensive automatic BP cuff to inflate and deflate the ambu bag- wrap the cuff around the bag, you get the idea- get one with wall outlet option- and rewire the start button to a programmable momentary switch to control the start/stop timing.

Good luck to all of you, my friends.

Charles

Related article with perspective from the UK dated March 17:

https://www.dailymail.co.uk/health/article-8121277/Calls-step-production-ventilators-coronavirus-pointless-without-additional-staff.html

Why cant you just play along with the topic of this thread.
It's just an open minded think about what can be done

It's not about why something can't be done.
Whether or not additional there is enough staff to man the vents is not relevant at this point.

If you don't like it, then go elsewhere to piss and moan

Kind reminder Mike, that the Daily Mail is THE prototypical tabloid. Nothing on it is worth quoting. For example: according to their "weather" section, the UK will experience any combination of snowmageddon, earthquakes, killer heatwave, flooding and drought in any given week, all year round.

Fair point about looking at the system and the need for people trained to use the machines. But do we have any idea where the shortage is currently? In 2 weeks' time? Next month? Next winter? Is it wrong to assume there is still room for more machines before we saturate the operators?

NOT pissing and moaning, thanks.

And I never said something cannot be done. What I encourage is to consider the bigger picture in one's efforts.

Efforts are one thing-- I interpreted Wayne's original post as related to an effort, not merely musings, or something in between.

Many folks all around the earth are thinking about what can be done with respect to ventilators. Many, many, many. Lots of evidence of that.

And I believe there is a huge potential benefit from that.

I disagree about whether personnel are relevant. If one is setting out on a "new design," it might be a good idea to consider the types of folks that will operate the design. This can be a part of disruptive thinking.

For example, can a new type of machine be created as a stop gap, and designed for a less skilled person that can be quickly trained to do just one thing? I doubt it, but it is likely a question worth asking.

If one is considering spending time and money to design and or manufacture, for example a new type of vent for some type of application beyond one's own "social circle," then it might be even more beneficial to consider the larger framework that may have an impact on the result of the efforts.

Those are some of my views.

Folks are free to express opinions, expert and otherwise.

Yes I know about the Daily Mail. That was not the point. The point is to consider the bigger picture. I encourage that.

I suspect that folks in public health around the globe do have some ideas where the shortages are (for example in Italy) and where they might be in the future.

The models are likely that good, and the folks involved are likely that smart.

I think it does make sense to consider having folks work on ideas for re-purposing old machines, perhaps converting related equipment, work on finding ways to expand manufacturing output of current designs and so on.

To me all of that makes a lot of sense.

I have not had time to look to see if there are estimates of the global manufacturing capacity for vents. I think it is likely folks in public health have done so. Just like they have likely looked at global supply, including emergency and military stockpiles.

I would guess that most companies in the space have execs that are 0.5 - 1.5 degrees removed from my professional network, given my age and business background, and that they and folks in their enterprises have been scrambling to figure out whatever they can do to increase capacity, change over production lines et cetera. Including tracking down necessary components and timelines. Engineers, product planners, manufacturing folks, global sourcing folks... all hands on deck.

I think in Italy it was just announced that med students in year 4 will not graduate but instead immediately be poured into service.

Some is good, more is better.

But in my opinion, it can often be helpful to consider the bigger picture.

I saw an HC administrative professional from Georgia interviewed on TV today. They have folks in conference rooms sewing gown cloth to create "overmasks" to try to make their short supply of N95 masks last longer.

He stated that they normally spend $0.58 per mask, and have a line on some in Mexico for $7 each and are likely to buy them.

see, e.g., https://www.cnn.com/videos/us/2020/03/18/georgia-hospital-sewing-masks-together-vpx.cnn/video/playlists/coronavirus/

Clinical and economic impact.

Ivy League Mike, you are not the one pissing and moaning.

This story is evolving. When I read the article yesterday, it said the volunteers who ended up recreating the valves were threatened to be sued when they asked for the blueprints so they could 3D print the valve. Not after they had done it. Now if you read the article, even that is being backtracked. They were denied the blueprints and told it would be illegal to reproduce the valve, but were NOT threatened.

YMMV

Yes it did get that desperate. Have your read any of the stories on what was/is happening in northern Italy? As of a few days ago, 10 had been used. And the OEM cost may not be what was stated.

Am I missing something? Who, in their right mind, would...
A- try and put a person on a homemade vent
and
B- allow anyone they know to be put on a homemade vent?

If you are one of the ones who would do this, please state it clearly. Of those, have you been on one, or have you visited patients that have been on one longer than 1 day?