Coronavirus Open Source Ventilator * Real-Time Monitoring System * - P2 Challenge
Bob Lawrence (VE1RLL)
Posts: 1,720
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."
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/
=============================================
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……."
***************************************************************************************************************************************************
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."
Comments
Tubular Posts: 3,870
2020-03-29 - 09:29:12 Flag
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
MR Conditional LTV® 1200 System
Operator’s Manual
https://www.aarc.org/wp-content/uploads/2014/11/19802-001-F-LTV-1200-and-1150-Ops-Manual.pdf
https://intl.vyaire.com/
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.
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 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.
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.
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 .
Our Formula One boys have risen to the challenge:
https://www.bbc.co.uk/news/health-52087002
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...
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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
Use existing cpap system as base, and mod them for O2 ?
https://en.wikipedia.org/wiki/Continuous_positive_airway_pressure
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.
Watch and follow Dr.Fauci!
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 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.