Challenge to Pelican Engineering -> Let's design and build an open-source Ventilator!

[rusnak]

Originally Posted by Tobra

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

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.

[93nav]

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.

Originally Posted by DonDavis

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?

[Captain Ahab Jr]

Originally Posted by Tobra

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

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

[RWebb]

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

[DonDavis]

Originally Posted by 93nav

Vent and maybe die. Do not vent and die.

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.

Originally Posted by Captain Ahab Jr

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

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?

[Mahler9th]

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.

[Mahler9th]

"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.

[Mahler9th]

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.

[RWebb]

Originally Posted by RWebb

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

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.

[RWebb]

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.

[Mahler9th]

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.

[93nav]

"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.

[Mahler9th]

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

[Mahler9th]

Boom:

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

Effort confluence.

[RWebb]

tres bon

[Mahler9th]

We are all in this together

[HardDrive]

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.

[James Brown]

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.

also needed is a patent airway device, this is a King airway a "blind" inserted secure airway.



also a O2 supply would be nice but this system works on room air. Something along these lines would be a start.

[pwd72s]

https://www.autoblog.com/2020/03/18/coronavirus-ford-gm-could-build-ventilators/

[Mahler9th]

"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.