Coronavirus Open Source Ventilator * Real-Time Monitoring System * - P2 Challenge

Bob Lawrence (VE1RLL)Bob Lawrence (VE1RLL) Posts: 1,716
edited 2020-03-29 - 12:56:04 in Propeller 2
The problem is that even when there are enough ventilators , the Respiratory Therapist (RT) can only monitor 4 or 5 patients at a time: (according to this news Video @ 16:24)

The solution would be a Re-time monitoring system that could work via wifi and monitor and make automated measurements and adjustments . It could provide notifications and alarms when necessary, in real-time.

There are a few open source ventilator Projects however, they don't solve the problem of having a RT monitor in real-time.

THis seems like a good challenge for the P2 . :)

Here are a few links to a few open source Ventilator projects:

https://www.extremetech.com/extreme/308236-mit-develops-cheap-open-source-ventilator-for-coronavirus-treatment?fbclid=IwAR0bZ8DrB5Nsn0xoHX9dKsZLjRWWowEabkau7j17TPYPiQA7r_jWDRWd8mY

https://hackaday.com/2020/03/25/ventilators-101-what-they-do-and-how-they-work/

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https://hackaday.com/2020/03/25/ventilators-101-what-they-do-and-how-they-work/

From this comment (if it is correct) :

"Having been a Registered Respiratory Therapist for the past 28 years, this is not a DIY task. We don’t need to reinvent the wheel here. There are plenty of “old school” pieces of equipment that would fill the void here. The Bird Mark 7 and Puritan Bennette PR 2 are both perfectly capable of delivering Time Cycled, Pressure limited ventilation to a patient. There are other “plastic vents” made for transport that can be mass produced and rapidly deployed that work on the same principles as the afore mentioned machines. The problem is they do not have any kind of alarms or monitoring capabilities. This makes the use of them not possible because a nurse or RT would have to remain at the bedside 24/7. It would be better served if you could DIY something that could be put inline with these devices providing feed back on Rate, Tidal Volume, Minute ventilation, and Peak Pressure. Also provide Alarm Limits for High and Low Pressure, High and Low PEEP, High and Low Rate. With these things being able to monitor and alarm when needed it frees the nurses and RT’s to care for more than one patient at a time as we do with existing ventilators. Just my two cents here, but if you want to help? That’s what we need……."
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THis comment sums up the problem:

"The problem is they do not have any kind of alarms or monitoring capabilities. This makes the use of them not possible because a nurse or RT would have to remain at the bedside 24/7. It would be better served if you could DIY something that could be put inline with these devices providing feed back on Rate, Tidal Volume, Minute ventilation, and Peak Pressure."
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Comments

  • I pasted ]Tubular comment from the P2 ideas thread to this one to keep everything together:
    Bob there is a more detailed paper about a couple of earlier MIT prototypes here:-

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

    I believe they are related
    Tubular Posts: 3,870
    2020-03-29 - 09:29:12 Flag
  • I wonder if you could strap an accelerometer around somebody's chest and use the up down motion to gauge things like:
    Rate, Tidal Volume, Minute ventilation, and Peak Pressure. Also provide Alarm Limits for High and Low Pressure, High and Low PEEP, High and Low Rate.
    

    How far up and down is pressure. Rate of up down is rate, etc...
  • JRoarkJRoark Posts: 567
    edited 2020-03-29 - 15:58:38
    Rayman wrote: »
    I wonder if you could strap an accelerometer around somebody's chest and use the up down motion to gauge things like:

    Rate, Tidal Volume, Minute ventilation, and Peak Pressure. Also provide Alarm Limits for High and Low Pressure, High and Low PEEP, High and Low Rate.

    How far up and down is pressure. Rate of up down is rate, etc...

    I think the pressure needs to be measured directly from the airstream being applied to the patient, but chest displacement might work for volume. I was googling some of this and it looks like the upper end of the pressure being applied to the airway is about 15 inches of water. (Lower end is about 4 inches). Seems like a common high-res atmospheric baro sensor could be used here.

    Disclaimer: I am not a medical professional, and I have only fair google-fu. YMMV
  • pmrobertpmrobert Posts: 627
    edited 2020-03-29 - 20:34:53
    I have several decades of experience performing airway and respiratory support in the high acuity patient. Chest excursion won't work. You can actually have very dynamic chestwall excursions while moving no gas whatsoever - "silent chest", for a little while anyway. The specific defect associated with Covid-19 is progressive and is known as severe V/Q mismatch. Here's a not-overly complex link to a site that explains V/Q mismatch quite nicely. the devil is in the details with these very sick patients, there is a fairly complex approach to ventilating them in regards to setting pressures, rates, demand vs mandatory vent, PEEP (Positive End Exhalation Pressure, keeps the alveoli (very small air sacs where the gas exchange between the inspired gas and the blood happens) from collapsing but also has a whole raft of it's own complications, etc., etc. The pulmonary involvement is so severe that the use of ECMO is becoming very common, it didn't used to be. See https://uihc.org/health-topics/family-guide-ecmo for short explanation. Anyway please keep thinking outside the box!
  • While this a laudable challenge for the engineering community, the P2 is not the device to use. Why - because let's say you pass all the software and sensor hurdles, how many can you ship next week? 100, well that's not going to do much, better to use a MCU that you can ramp up production with existing stock.
  • @brucee
    , how many can you ship next week? 100,

    The problem with the Coronavirus will not be solved by anyone in weeks or months. It will most likely recycle in waves and take a year or 2, at least( we really have no idea how long). Also, it is most likely that as the virus adapts to it's environment , there will be other strains of the virus, or other contagious viruses on the loose in the future. The idea of a self monitoring and regulating system is for it to be more independent and free up limited resources(humans) as well as for them not to have to be so close to the pacient so often.

  • Even if "DIY monitoring and control" of ventilators wasn't a hot potato, the ESP32 or 8266 would be a much better product for a cheap and simple WiFi integrated gizmo.

    I'm pretty sure all the interfacing could be done in a single module, then you've only got 3 things to get certified: the module, the carrier board, and the software.

    The Espressif devices are available in bulk volumes and have been out there for some time, and they are dirt cheap.

    Given the complexities discussed in previous messages, I would strongly advocate applying your skills and energy elsewhere.
  • The need is now, and the P2 is still what we use to call "unobtainium". So yes if you have the skills and tools go ahead and join with hackaday or hackster.io to start some research. While I have a fully stocked lab here, I would need to order gas sensors, pressure sensors and probably other things, and it's not my area of expertise anyway.

    The needs of ventilators is great today, but 6 months from now, ventilators will be sitting gathering dust in some warehouse. I would hate to be a ventilator company, they are under huge pressure to ship as much as possible now, but the market will be saturated by the end of the year.

    The best thing we can all do now is, sit home, tinker in your lab and stay isolated. Stay well all.
  • We have the P1 available, no need to use P2 exclusively. Current equipment for sure has less powerful controllers. As pmrobert mentioned, it's not you just blow air into a lung. It might be useful to measure air flow or pressure fluctuations over the duration of a single breath, even monitoring the sound of the air flow may give information how easily the avioly are filled. If you inflate a latex glove with your mouth you can easily watch that the palm is filled with no effort while the fingers need much pressure to open. This might on a much lower level be similar in a lung.
  • This seems like it's probably overkill for a P2. Wouldn't the P1 be sufficient for this?
  • pmrobert wrote: »
    I have several decades of experience performing airway and respiratory support in the high acuity patient. Chest excursion won't work. You can actually have very dynamic chestwall excursions while moving no gas whatsoever - "silent chest", for a little while anyway. The specific defect associated with Covid-19 is progressive and is known as severe V/Q mismatch. Here's a not-overly complex link to a site that explains V/Q mismatch quite nicely. the devil is in the details with these very sick patients, there is a fairly complex approach to ventilating them in regards to setting pressures, rates, demand vs mandatory vent, PEEP (Positive End Exhalation Pressure, keeps the alveoli (very small air sacs where the gas exchange between the inspired gas and the blood happens) from collapsing but also has a whole raft of it's own complications, etc., etc. The pulmonary involvement is so severe that the use of ECMO is becoming very common, it didn't used to be. See https://uihc.org/health-topics/family-guide-ecmo for short explanation. Anyway please keep thinking outside the box!

    Wow, ECMO is pretty interesting. I've heard of covid-19 patients feeling like the ventilator is choking them, so they start to panic and have to be restrained. Not a good situation to be in. It's neat that a machine could take over the oxygenation process while the lungs and heart could relax to heal.
  • Totally agreeing with mprobert. I was going to see about designing a DIY vent - Just don't go there, it is fought with all kinds of medical and technical pitfalls. Major corporations have had disastrous manufacturing results, lost millions and have nothing to show for it. Spend you time on prevention stuff, please
  • I still think it's an interesting exercise. We may never cut a single line of actual code, but it's still educational... and if we're being honest here, most of us aren't going anywhere pressing at the moment. Lol!
  • cgracey wrote: »

    Wow, ECMO is pretty interesting. I've heard of covid-19 patients feeling like the ventilator is choking them, so they start to panic and have to be restrained. Not a good situation to be in. It's neat that a machine could take over the oxygenation process while the lungs and heart could relax to heal.

    Chip, by the time you get to ECMO the patient has been on the vent sedated and chemically paralyzed for quite some time and the blood gasses are continuing to spiral. Trust me, very few people on a vent are conscious - if they are conscious they're going to be "bucking the vent" due to the endotracheal tube down their mouth. It's REALLY uncomfortable. They're only brought up typically to make sure their brain is still alive or to extubate them (take out the tube when they are able to breath OK on their own). I also hope we're not running out of sedatives and paralytics as most of these are made overseas and the JIT inventory craze has led to minimal reserve when stuff goes upside down. I'm retired from the medical field but I'm getting reports from friends still in the profession that medication is running short, lots of drug substitutions going on that are suboptimal. ECMO is pretty much a heroic rescue effort when the cardiopulmonary system is unable to keep things remotely in a zone where you *might* survive when and if you improve.


  • @ JRoark
    I still think it's an interesting exercise. We may never cut a single line of actual code, but it's still educational... and if we're being honest here, most of us aren't going anywhere pressing at the moment. Lol!

    Exactly! and I know a hell of a lot more about all of this than I did when I woke up this morning. You never know when a good discussion will spark a new idea. If I should ever end up on a ventilator system, at least the I will have some idea about what the medical team is trying to do on my behalf. I'm over 60 with high blood pressure so that places me in the high risk category . :(


  • While soccer's Christiano Ronaldo is proudly showing off his new €8M Bugatti,

    Our Formula One boys have risen to the challenge:

    https://www.bbc.co.uk/news/health-52087002
  • From pmrobert again: "ECMO is pretty much a heroic rescue effort when the cardiopulmonary system is unable to keep things remotely in a zone where you *might* survive when and if you improve."
    Some of the medical reports from my doctor and nurse friends, the survival rate for someone on a vent is maybe 15 to 20 percent. Prevention, please...
  • As much as people carp about having to deal with the FDA for approval of medical devices, @pmrobert has given us a scratch 'n sniff overview of what goes on in a ventilator. Even designing an add-on to an old Bird or similar, that device would still have to be proven to work and be approved as a Medical Device. There are a lot of smart people on this forum, but without time and the $$$$$ to drive the device to approval, likely to not go far. Still will need many more RRTs than exist currently to make use of devices as they become available. Where do we get them?
    .
  • Medtronic open sourced one of their ventilators today
    https://hackaday.com/2020/03/30/professional-ventilator-design-open-sourced-today-by-medtronic/
    files are here
    https://www.dropbox.com/sh/xfrnlb5b7w35tt2/AADhLQ_94SKvsGOZjOHlgXy6a?dl=0

    There is also Gtech in the UK that got open sourced after not going ahead

    There's at least a couple of efforts here in AU too. I've learned a heap in the past week
  • My 5cent,

    Use existing cpap system as base, and mod them for O2 ?

    https://en.wikipedia.org/wiki/Continuous_positive_airway_pressure
  • Such a machine consists of different parts like electronics, which should be easily produced by the contract manufacturers that manufacture everything you want at high volume. Then there are moulded parts and molding machines are available in high quantities, just take a look how complex a vacuum cleaner is. What could be rare are the specific moulds. So moulds must be replicated by mould makers. If man is characterized by using tools, tools have to be made. Like assembly lines. Now is the time to seed, not to eat ;-) The faster the pandemic can be stopped, the faster we will find back to our normal live. Or we will change our habbits from percussion to sustain.
  • pmrobert wrote: »
    if they are conscious they're going to be "bucking the vent" due to the endotracheal tube down their mouth. It's REALLY uncomfortable.

    FWIW, I remember waking up with respirator tube down my throat. Thanks to warned about the respirator and thanks to still being relatively sedated, I didn't find I minded having the respirator in me. I recall thinking "oh good, I don't have to worry about breathing."
    Once I was more awake, the respirator was quickly removed but it wasn't a bad experience.
    I just thought I'd let you all know, the respirator doesn't have to unpleasant to the patient. Of course I had healthy (32 year old) lungs at the time so my experience doesn't completely apply to the discussion.
    This was almost 25 years ago when I had my heart transplant.


  • Duane Degn wrote: »
    pmrobert wrote: »
    if they are conscious they're going to be "bucking the vent" due to the endotracheal tube down their mouth. It's REALLY uncomfortable.

    FWIW, I remember waking up with respirator tube down my throat. Thanks to warned about the respirator and thanks to still being relatively sedated, I didn't find I minded having the respirator in me. I recall thinking "oh good, I don't have to worry about breathing."
    Once I was more awake, the respirator was quickly removed but it wasn't a bad experience.
    I just thought I'd let you all know, the respirator doesn't have to unpleasant to the patient. Of course I had healthy (32 year old) lungs at the time so my experience doesn't completely apply to the discussion.
    This was almost 25 years ago when I had my heart transplant.


    A heart transplant! That's a big operation. It's amazing how we have these machines that can bring us through things like that. After a bypass operation, my breathing was very shallow, at first, and it took maybe three weeks before I could lie flat in a bed and breathe easily. A Lazy Boy chair was my respirator, for a while.
  • ErNaErNa Posts: 1,460
    edited 2020-03-31 - 21:57:13
    Every life saved is a blessing to an individual. Statistics don't count than. But only one in eight survives a sudden cardiac arrest after resuscitation with a defibrillator. Corona victims that need intense care and a ventilator have about 50 percent a chance to survive. So we have just a chance to slow down the spread to minimize overload of the health system and hopefully to find some vaccine for those happy not to be the first.
    Watch and follow Dr.Fauci!
  • MIT is working on a simple ventilator https://e-vent.mit.edu, looks like perfect application for a Propeller chip.

  • I'm working on my own version of the BVM bag ventilator. I don't have any medical background but have learned a lot about the basic functions of the ventilator. Such as tidal volume, BPM (breaths per minute), lung pressure, spirometer, inhale, exhale ratio, etc. I believe total adult lung volume is 2 liters. I think I'm going with the Bs2 to start, maybe prop.
  • @cgracey said:
    After a bypass operation, my breathing was very shallow, at first, and it took maybe three weeks before I could lie flat in a bed and breathe easily. A Lazy Boy chair was my respirator, for a while.
    10^6! Amens! LazyBoy (with eject option), Netflix, Hulu and Amazon Prime made a great post op plan. Not sure if Polo was an FDA approved stimulant though.

    As to the MIT and other projects, it will be interesting to see what they come up with, and how the the FDA treats them. Can't imagine getting it approved without some testing, clinical trials etc. MIT may even have the money for that, but to actually produce, market and support it? These things will need field support (no way to get them to cheap throwaway status) which means paying a field force or contracting to a third party to maintain (These things are classified as life support, don't know how far CMMS will waive the maintenance requirements) and repair them either on site or depot level repair. Which of course means stocking parts and providing service training.

    Ok, so MIT realizes this and then figures the best way is to release as open source everything needed to actually manufacture the device, enter stage left, the.......FDA..... Remember in this or another thread my use of the term GMP? Whoever makes this device better have a lot of experience in medical device manufacturing or bringing a company into line with GMP so that they may actually get to the point of fully operational without the FDA either seizing the product, shutting them down or at the least operating under a consent decree (think regular proctoscopic examinations of the operation) because they ran afoul of some small seeming requirement that the FDA did not feel was so small. Oh, and the fines can be pretty stiff as well. Siemens spent most of the '90s under a consent decree and more recently, Philips was blocked from selling CT systems for while due to some "minor" violations.

    Making the next medical mouse trap is not for the small guys. If you have the next great device, best thing would be partner with someone like MIT or at least find a good IP firm and start licensing the heck out of it before the big guys grab it anyway. There are some pretty good comments on the hackaday thread about Medtronic and "opensource" release of one of there vents.
  • I suspect that in this circumstance, they would waive some strictures. We have way too many regulations for our own good. I wish they would waive a lot of food safety laws so that we could have lower-key places to eat. Where I live, there ought to be all kinds of roadside stands to eat locally grown foods, but by the time you jump through all the hoops, you've got the same uninteresting experience to offer as everyone else does, plus you're broke. Boring. Why even bother? That's why it's fun to go to Mexico or Thailand - more local food on a lower cost basis, more adventure. America is boring when it comes to eating.
  • Let me quote the "conclusions" chapter of the original Hackaday page:
    Ventilators, though, are a whole new beast with a complexity similar to life support in a spaceship, though different enough that asking a car company to make one is like asking a ventilator company to retool to make a car. Asking a car company to make PARTS to help with supply chain problems makes sense, though. See the requirements put out by the UK for a ventilator solution for a more thorough guide to what’s needed.

    My hope isn’t to discourage entirely; my hope is that this 101 will help guide a little so that effort isn’t wasted on solutions that can’t work. There’s an argument that “if there aren’t enough ventilators and patients are being turned away, I’d rather have a slim chance with a hacked solution than no chance with no solution. The reality is closer to “if there aren’t enough ventilators, a hacked solution will most likely do more damage than good, take up too much time from already strained health care resources, and could lead to death.” As the Hackaday community isn’t one for shying from a challenge, though, if you’re going to start somewhere, you should start with existing solutions that are close and in no short supply, like oxygen generators and BiPAPs and some kinds of ventilators, and look into how they could be modified without bypassing the safety mechanisms built into them, rather than start from scratch. As a community, we can and should help whenever possible. Let’s do it alongside the guidance of trained health professionals who have the skills to navigate the needs and the risks of assisted breathing.

    I totally agree with the statement that developping a new ventilator from scratch makes no sense. Even if it's possible to build the required mechanics and electronics quite easily such a machine needs a lot of testing to get it right. To keep somebody alive for half an hour, for example in an ambulance, until you arrive at the hospital, you can work with a very simple solution and ignore the requirement to warm up and humidify the air. But corona patients need assisted breathing for at least 7 days. If only a single parameter is slightly wrong you risk making things worse. Do you really want to test your creation on live humans and risk their death? There are strict regulations for approval of life supporting devices and there is a reason!

    If you really want a challange to support fighting the virus how about building an automated PCR/DNA tester? Testing capacity is one of the biggest problem to effectively prevent infection. Increasing the available test capacity would probably save more lives (per invested $) than increasing the number of ventilators. Prevention is better than treatment. The tester works similar to some kind of robot or CNC machine and could be build out of 3D printer components. And it's no critical live supporting device.
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