Please correct me if I'm wrong, but earlier he wrote that he thinks it's "cool" to be called Hippie Ivy League Black Mike.

Being quoted back your own words is a B I T C H.

Vent and maybe die. Do not vent and die. Take your choice.

All the groups I have seen that are attempting to create a basic vent envision it being used in a medical setting.

Agree 100% ^^^^ please keep posting Mike, you are a voice of reason :)

I was reminded by my wife that I spent 2 days on a ventilator while packed in ice during an induced coma after I'd died so I have ventilator experience but still know nothing ;)

Still think its a great idea but one in practice with the timescales involved just wouldn't work

If ever there was the perfect example of a 'little knowledge is dangerous' then a crowd funded built ventilator would be it :(

Would it not be simpler/quicker/safer to pool ventilators world wide and ship them to the hot spots along with instructors to train local medical staff. Japan, South Korea will have plenty of ventilators and they won't be in high demand

Please be sure and update your Living Will to include that option.
I would take my chances staying off the homemade option rather than have my lungs deflated...or worse.

And I’d love to see this “medical setting” using a homemade vent.

That’s a logistical nightmare. Devices must go through the facility checkin procedure and added to the asset list. Then checked out by either the vendor, or qualified Service Engineers. That could take a few days to pull together.
After that, Trainers are often times backlogged for weeks.

I just find this whole discussion about as silly as can be.

During my hospital in-house days, a terribly ill patient was placed on a vent. Docs prob knew he wouldn’t make it. And he didn’t. Had zero to do with the vent, but because he was on it when he expired, that unit was removed from service pending investigation.

No one, and I mean no one, will be willy-nilly placed on a vent in any hospital anyplace.

What’s next? Vodka anesthesia machines? I mean, why not? Uncle Marv drinks till he’s out and the children draw unicorns on his face all the time. Next day he’s fine.
What’s the big whoop?

Our legal system may make it difficult to conceive that many HCPs would take chances with equipment and supplies without special public health emergency indemnification protections.

Same may be true when it comes to "choosing which ones to prioritize" in a peacetime setting. A war on a virus may already be legally different from a conventional war like WW1.

I am pretty sure that public health officials and government lawyers are all over this.

"https://www.washingtonpost.com/health/2020/03/18/ventilator-shortage-hospital-icu-coronavirus/"

Thanks Rwebb. I knew it was a matter of time before folks started reporting on this aspect.

The question is "who pays," and no one raises their hands. Likely a little overly simplistic, but one must consider capitation, et cetera.

Just last Fall I met the leader of a local system's innovation activity-- may have mentioned that in this thread or another thread. He was on a panel on the future of healthcare.

After the panel discussion I introduced myself to him and we almost instantly agreed that there are perhaps increasing challenges at the intersections between capitalism and healthcare. Then we kind of winked at one another.

We don't have a single payer system... so it might make sense to consider the insurance companies and CMS (Medicaid and Medicare Services) in the economic equation.

My classmate used to run United Healthcare, and now she runs Anthem.

I bet they have a lot of planning and modeling going on. Clinical and financial.

I have never worked with her, but my experience with her from ~40 years ago, and at a wedding about 10 years ago, makes me hypothesize that she is likely a great leader.

All of this is very, very complex.

conflicting information...


Ventilator manufacturer Hamilton Medical Inc. said it has received hundreds of orders and requests within the past few weeks.

"It is more than we can currently provide," said Kathrin Elsner, team leader of MarCom Ventilators at Hamilton Medical.

I suspect this will push the US to single-payer - at least for some types of things, but people will tend to turn policy discussions into political ones, so that's all I'll say here.

I think some of those orders may be coming from overseas. Of course all of these companies have to be very, very careful about what they disclose to public. Especially those that are publicly traded.

SEC laws may not be likely to be relaxed in situations like this.

Yes Rwebb, yes I have been thinkin' 'bout that. Don't want to however.

Very complex and fluid situation.

"Irish project for easy-to-assemble Covid-19 ventilators bears fruit"


https://www.irishtimes.com/business/health-pharma/irish-project-for-easy-to-assemble-covid-19-ventilators-bears-fruit-1.4205999

No real technical details though.

Boom.

Related Forbes article:

https://www.forbes.com/sites/alexandrasternlicht/2020/03/18/theres-a-shortage-of-ventilators-for-coronavirus-patients-so-this-international-group-invented-an-open-source-alternative-thats-being-tested-next-week/#1b185723ba01

Quote:

"Gui Calavanti started the Open Source Ventilator project on Facebook on March 11. It has since been worked on by more than 300 doctors, engineers, designers, nurses and venture capitalists.

Cavalcanti’s primary role is CEO and cofounder of Breeze Automation, which designs low-cost robots for extreme environments like deep sea and outer space."

Breeze Automation is in the local "network." Came out of Otherlab like Roam Robotics, a company I visited last Fall. Likely some relationship... couldn't disclose that.

Roam has military, medical and consumer opportunities and I got to meet the CEO and COO during my visit. Bright fellas. I was introduced to them by one of their venture investors.

I would surmise that there are a lot of efforts like this underway-- thanks to 93nav for posting and to Mr. Cavalcanti, et al for jumpin' in.

And...

where there is one there are likely others...

and

some is good, more are better

Boom:

https://www.facebook.com/groups/670932227050506/

Effort confluence.

tres bon

We are all in this together

My wife is a physician, anesthesiologist who knows a bit about ventilation and airways.

I'm a software engineers, avid 3D printer, experienced with microcontrollers, blah, blah, blah.

We have a bit of time on our hands, so my wife and I really talked this thing through.

Mike is trying to drive the discussion towards introducing a device into our existing system, a product that would go through testing, approvals, etc. A welcome voice of reality, but missing the point. This is about the engineering exercise.

The original question: Could you build an open source ventilator.

The Harddrive engineering teams answer: For some limited functions of what a ventilator does, yes. But the machine could pose a very real threat to the patient if not calibrated correctly, and this gets back to the a VERY valid point: Without health care professionals trained on using the device, who understand its settings, it is unlikely to be of much good.

A ventilator is not a crude device that robotically pushes air in out. Simply pushing air in and out is not issue. A person can be 'breathing', but if the level of lung function has decreased to the point that air is not making it deep enough into the lungs to exchange oxygen, the mechanical action is irrelevant.

The magic in a ventilator is that you can dial in a specific pressure that will create enough force to reach the alveoli, yet not so much that you burst the person lungs. Could you 3D print a valve of sufficient quality to maintain a specific pressure? Yes, but 3D printing is done in plastic or resin. So even after you calibrate a valve, is it going to be accurate for 1000 cycles? 100,000? Unlikely.

Another strike against the homemade ventilator: Sensing a patient's breathing. If a person has simply stopped breathing, and the device can breath 100% for them, that is a simpler exercise. But what if the patient is still breathing, and you want to augment their natural breathing pattern. Could you build the sensors to detect a persons respiration. Yeah, sure, but let's get real here, are you going to leave a $10 arduino controller and a $2 crude mechanical sensor with someones life in their hands? No.

Conclusion: From a raw engineering perspective, can this be done: Yes. Can this be done in a way that anyone would actually stake the lives of their loved one on: Only in very, very desperate circumstances, and the potential for harm to the patient, or simply being ineffective is quite high without a person intimately familiar with both the medical problem and the engineering.

this is a version of a ventilator, a bag valve mask. kept many a patient alive on the way to the hospital and at the hospital waiting for rooms. Simple to operate and control.
http://forums.pelicanparts.com/uploa...1584582514.jpg
also needed is a patent airway device, this is a King airway a "blind" inserted secure airway.

http://forums.pelicanparts.com/uploa...1584582681.jpg
http://forums.pelicanparts.com/uploa...1584582681.jpg
also a O2 supply would be nice but this system works on room air. Something along these lines would be a start.

Ford And G.M. to build ventilators?
 

"Mike is trying to drive the discussion towards introducing a device into our existing system, a product that would go through testing, approvals, etc."

That is not quite right.

I think I have been pretty consistent... I encourage folks to consider the bigger picture. That is the point. It might be helpful to understand that there IS a system.

I have 40+ years of experience watching the "system" evolve. I have been to FDA hearings. I have had a product get a PMA (a form of FDA approval) and wind up on every major evening news station and in every major newspaper. (The Secretary of Health and Human Services issued a press release heralding the approval as a major step forward in the diabetes space... the stock shot up but I could not participate).

I have seen large businesses shut down and yellow taped due to FDA intervention to protect the public health.

I have seen many, many companies in tech like Apple think that the med device world is easy, only to re-budget and refocus efforts after meeting extensively with FDA and coming to a higher level understanding. Companies like Apple and Google are some of the largest employers of technical talent in the emerging new world of med tech.

For this situation, I think some of what is needed will come through the "system," and some will come through processes carefully modified to take on risks versus rewards. I am pretty sure that this is already happening with testing-- evaluation of samples collected from patients. I think that labs have been allowed to start helping in a "strategically relaxed" modified system.

(When I think about that, I think about Theranos. What a mess that was.)


I think Roche recently got an approval in a day.

I think the situation calls for these kinds if steps, and I think that informed and experienced folks are working really, really hard to find ways of assessing risk versus reward.

I believe that some, perhaps many or most efforts will have a better chance of positive impact if the system is at least partially understood. Of course not only the regulatory system, but also the healthcare delivery system associated with the ICU and ICU-like environment that is apparently required in this situation.

And of course, there are laws in place, and I reckon in some instances new laws might be required, and those might take more time to get through than product development in our system of government. Even in these circumstances. But I have not studied that aspect.

I think the term "ventilator" is giving some people trouble.

What we are discussing is assisted respiration in all different possible forms.

Cool, Ford, GM and perhaps others chippin' in.

Building assemblies and sub-assemblies for existing designs can make a lot of sense if that fits in to the larger picture.

Building B25's in a broader range of ways may be a great place for folks to help, as compared to to working in small groups to come up with a different war plane design.

I think it makes sense to consider tools that HCP's say they need.

And to consider the setting and other relevant specs and variables. And fast, fast, fast.

Last data point.

Plastic laid down with a 3D printer are riddled with both marco and micro level imperfections. The rapid cooling process that occurs as the material sets up ensures microscopic cracks in the material that would be impossible to sanitize without an autoclave. Translation: 3D printed parts would be throw away. You would not be able to reuse any part of a 3D printed vent without risk of infecting the next patient.

Good point. Not without some sort of a disposable liner.
There are mountains of one-use plastic medical-grade wa$te created each day.

Hospitals have huge central-air systems that are supposed to be filtered and sterile.
-What if there was a way to boost mainline pressure and hook up cycling nodes to vents?
-Calibrating supply pressure timing to the patients breathing rhythm would be the tricky part.
-There would have to be check valves to prevent spores from traveling upstream. (Perhaps in the replaceable mask/tube.)

https://www.foxnews.com/politics/pence-says-admin-has-identified-tens-of-thousands-of-ventilators-that-can-be-converted-to-treat-coronavirus-patients

As we learned during the early stages of WWII:
when the government helps instead of hinders or just gets the heck out of the way, there is no limit to what this country can achieve in a very short time.

From the BBC website,

Coronavirus: Formula 1 teams are to help in supply of ventilators

Formula 1 teams are working with government and health authorities to increase the supply of ventilators during the coronavirus crisis.

Ventilators are a device used to help supply more air to patients with breathing difficulties, one of the effects of severe coronavirus symptoms.

The majority of F1 teams are aiming to work out ways to use their engineering facilities to boost production.

F1 said the aim was to "provide as much help and assistance as we can".

A spokesman said: "The F1 community is engaged in discussions with all the relevant stakeholders regarding this issue and we will provide further details in due course."

A number of teams have applied-technologies divisions that could directly feed into the national production capacity of ventilators in the UK and Italy, particularly McLaren, Red Bull, Williams, Mercedes and Ferrari.

But all teams have advanced manufacturing capability that could potentially be used to make complex devices such as this, and as many will help as can.

The idea is to increase the supply of the existing design of ventilators rather than try to come up with a new approach.

The UK is estimated to need an extra 20,000 ventilators to deal with the crisis as it develops over the coming months.

It is hoped that an approach can be agreed within the next week that will help teams feed into capacity as quickly as possible, to boost the capability of health services to deal with increasing numbers of patients with breathing difficulties.

The move follows the Agnelli family which controls Ferrari and Fiat donating €10m (£9.3m) to the Italian government to help deal with the coronavirus emergency at a national level, as well as buying 150 extra ventilators and providing a fleet of cars to distribute food and medicine.

There must be sensors of a sort in CPAP machines. My CPAP knows when I exhale and reduces pressure. If I hold my breath the machine does nothing for a second or two, then increases pressure.

Yes they have sensors. And a lot of electric components.

I am pretty sure that folks are continuing to work hard to source things necessary to expand capacity to build existing designs that are known to work (that is to be safe and effective) and the operation of which is familiar to trained and experienced personnel.

Thanks for the update, Captain.

It's clear this thread is not where I or anybody can make a difference. As to my team, I'm on standby while another engineering group whose day job is closer to this sort of thing chips away at it.

Good luck to you all and keep yourself and others safe. And don't forget to be kind.

Why don't we just copy what the Italian guys did with their 3D printers? Just a much grander scale. Upload the files on the internet, tell the patent holder, "thanks" the US government will take care of you. and let the MASSES create them in the homes, apartments. What am I missing?

EDIT: OK, nevermind. that is just the connecting VALVE. Got it.

Musk just said Tesla will be helping with this

Hospitals have sophisticated HVAC systems but none are "sterile". HEPA filtration on certain systems, OR's and other invasive spaces specifically, provide high air quality but not to the filtered extent needed to attach to a ventilator. Many OR's have additional filtration at the diffuser. Hospital are required to meet a minimum air change per hour in each space, though each space type differs. Long story to say i don't believe central systems can be used in this situation at the patient level.

Soon he will be calling someone a "Pedo Guy"

There are numerous groups across the world attempting to design, create, manufacture etc items to be used in the fight against the corona virus. Complicated ventilators to simple masks. What I have noticed is that they most need project managers. So if you are good at that, look around for a group.

Thanks, but no need. I don't have a hero complex. Perfectly happy to leave it to the capable hands of my teammates.

First prototypes are expected by the weekend, in collaboration with University College London.

The government asks for ventilators, F1 teams deliver ventilators. Let someone else worry about the regulations, although we tend to be quite good at that too as a group.

https://www.bbc.com/sport/formula1/51975690

Edit: reading it again, it sounds a bit $hit. What I meant is, I know what I'm good at, and I offered that both here (mostly as a brain exercise) and at work (for real). Evidently, this is not what's needed right now. Too many engineers and "inventor" types don't know when to bow out. Lead, follow or get out of the way - I know which one I'm doing.

F1 cars are complex machines operated in extreme circumstances where life versus death can be on the line, and I would surmise that nearly every F1 team, and possibly teams in junior professional formulas have operational experience and practices very much like businesses that work in regulated industries like aircraft and medical device/equipment manufacturing.

Manufacturing components, sub-systems and even complete systems based on existing designs I would surmise would be right in their wheelhouses.

I would also surmise that their design talents could also be helpful, but perhaps less impactful.

And I would also hypothesize that they might have some realistic limits in terms of manufacturing output. But anything is better than nothing.

I think it is possible that many/most existing vent manufacturers operating in governments that engage in capitalism have historically had at least some ongoing efforts to simplify designs and/or improve manufacturing yields and lower manufacturing costs.

If this is true, hopefully there is still fruit hanging low enough to help in these extreme circumstances.