So I did a site search, and don't think this has been covered already.
I would not describe myself in an engineer in the least, but those of you here with a 3D printer and home tooling might be interested to see you could be part of the fight back;
https://gitlab.com/TrevorSmale/OSV-OpenLung
Is the link to keep an eye on while they test it..
Interested in your thoughts?
Everything I've read indicates all the regulations around medical equipment (at least in this country) precludes even other manufacturers making them and even if they could it still doesn't help with the long time it takes to test them (a 10% failure rate on equipment used in critical care probably isn't a good idea...)
So can't see home-made versions ever being used unless we see the NHS collapse (which isn't going to happen).
If/when Covid-19 really hits African countries (that have no internal medical equipment manufacturing capability) then maybe governments there will put out a mass appeal for this sort of thing though (especially as the developed countries with existing outbreaks will already be hoarding/trying to monopolise regulated supply)
Having worked with open source and Free software for the last 15 years or so, I've become jaded to it after having one too many valid bug reports closed with a sarcastic comment and a WONTFIX status from some package maintainer that probably hasn't got his first pube yet.
Then something like this comes along to remind you that there are some truly great people in the open source world willing to give their hard work away gratis. Props.
You would think if the government really wanted these things they could have bought/ordered them from the suppliers in this country literally months ago.
They haven't done so, so one has to assume that Matt Hancock is totally relaxed and happy about the number of ventilators currently available.
I think it is a great idea as I read the other day that the only manufacturer in the UK make about 150 a year and they think they would increase their capacity to 250 or so, but they were a tiny company. I appreciate that there are loads of medical regulations but when it a case of life or death they these things can be waved. they did so with ebola and the testing of vaccines when people pointed out that the patients were going to die anyway. All the current manufactures seem to think that its not possible for others to pick up production but I bet as the Chinese come back on line they will be producing ventilators by the 10000's. They are the kings of contract and volume production. Just look at how they switched factories from make iPhones to face masks almost overnight.
I think it's absolutely bonkers.
Ventilators are (high-risk) Class IIb medical devices.
(The next category up is class III - heart valves, that sort of things).
Obviously every part must be tested and its performance guaranteed. There is no way a random item off the web is going to pass muster. They are wasting everyone's time.
Notified bodies (BSI is one you may have heard of) have to approve these devices, currently under MEDDEV, and they are swamped at the moment as the law changes in a month or two with MDR coming in. Bonkers.
What's the survival rate for people on ventilators with covid19?
This is an ITU ventilator. £20'000 or so of reliable, triple tested, regularly serviced, sophisticated equipment.
Someone like me has to operate and trust the equipment they are given to use, and be assured that it will be reliable, and be able to cope with ventilating people with severe lung disease.
It's like the difference between a steam powered rocket and an Apollo mission.
Having been involved in the design and manufacture of medical equipment its absolutely bonkers and the notion that different sectors can simply re-tool to produce them just really shows how little politicians and civil servants know about manufacturing.
All that would be realistically feasible is to work with existing manufacturers to increase capacity e.g. the procurement of more components from existing manufacturers and increase their assembly and test capability under their existing quality assurance / certification arrangements
Can't I just switch the pipe on my workshop dust extractor to make it blow instead of suck? I know MDF and chipboard particles aren't to good for you but we all have to make sacrifices.
But can one co scale up fast enough to meet global demand while every country in the world will be fighting for supply over the next 12 months?
This looks more feasible for the UK from Meggitt / Nissan / McLaren:
https://www.pesmedia.com/covid-19-meggitt-nissan-mclaren-ventilator-manufacturing-190320/
I heard that one proposal was to make ventilators based on much older designs. I understand that it would not be possible to rapidly reproduce ones like the pictures above but ventilators have apparently been made since the 1950s. It must be possible to produce something older more quickly. I get that it wouldn’t be as effective but if it would save lives.....
I get that there are regulations and standards and there's clearly not a call to just chuck them all out, but somewhere compromises have to be made. If it comes to it, I'd take my chance with a lower certification / lower spec model than be left to die in a hospital corridor.
One of the other issues they have is that 3D printers are often great for prototyping shapes but the spec of the plastics they use are not robust enough for routine use and / or sterilisation between users.
All this is fixable however, given time, people and money. The supply of people and money is virtually unlimited, I believe (in spite of the evidence of the few bog roll bandits) that we can pull together in this one. Time - is running out.
I have used a 50s/ 60s bleese ( I think) ventilator when I worked in ITU in the early 80s. Very primative machine.
I think there is a basic disconnect in understanding - something like that open source gadget could be better than nothing - but only just. Its just a way of mechanically pumping a bag - not a proper ventilator that has multi functions.
But - If my dad at 85 with damaged lungs gets cv he would not be admitted to ITU ( given reasonable priority setting) I would happily attempt to save his life with one of those gadgets. a 5% chance is better than zero!
Wouldn't it be easier to write to your MP and ask why the UK government aren't participating in the EU procurement scheme?
I bet as the Chinese come back on line they will be producing ventilators by the 10000’s. They are the kings of contract and volume production.
China can do that because they have the full manufacturing chain, including designers, product engineers, manufacturing engineers, component suppliers, delivery, QC, assembly etc, etc. So the Chinese will already have most of the things required to manufacture almost anything. They just need to reorder how they use those resources.
Obama asked Steve Jobs how much more it would cost to make the iPhone in the USA. Jobs replied that it wasn't just assembly cost; the complex chain of different functions you need to engineer and manufacture consumer goods on that scale had largely moved to China.
https://www.cnet.com/news/a-tale-of-apple-the-iphone-and-overseas-manufacturing/
I'd guess the most effective way to get ventilators fast would be to raise as much money as possible and throw it at established Chinese manufacturers.
Given the choice of no ventilator or two footballs joined with some garden hose, connected to a Camping Gaz regulator and a J cylinder of welding oxygen, I would choose the Heath Robinson Mk1 over nothing.
If the brown stuff does hit the whirly thing we need all patients and their families to sign away any right to sue because mistakes will be made by people and equipment whilst trying their level best to save lives under extreme stress.
Its 20 years since I was nursing and maybe things have changed, but ventilating someone usually also entails:
-intubating them
-doing their bloods regularly to check for acidosis, etc
-IV fluids/parenteral feeding if its long term
-catheterisation
-regular obs
-supportive therapies such as inotropes in the event of impending multi-organ failure
etc.
TJ and others are far fresher on this stuff than me so could comment in a far more up to date way, but how would any of this be achievable at home to someone without all of the above, and the knowledge to use it all safely?
My 93 year old dad is in a care home. They've contacted all the families to ask what we want to happen if they get CV when all the hospitals are full and the ventilators are gone.
The choice is go to hospital an die alone in agony on a trolley in a corridor outside A&E or stay in the home where they will have an isolation unit and a big box of morphine to keep them "comfortable".
The company I work for is already working to produce parts for ventilators. Clearly we're not engineering them ourselves...merely making available the additional manufacturing capacity needed for existing manufacturers to increase production, so we're making parts to their specifications as we have the necessary equipment and machine tools that they need.
codybrennan - I am more out of date on ITU than you. IIRC those things apart from the enteral nutrition are usually monitoring the condition of the patient in relation to the disease rather than the ventilation
Intubation is of course needed. How practical at home - not really for those of us with little knowledge like me but if my dad was going to die anyway I would have a shot. a 1% chance is perhaps better than a zero chance.
I'd need somone to intubate him - I cannot do that but I could monitor him and ensure he was getting the high o2 etc. Maybe thats just hero fantasy from me - I do not know but given my dads age and condition he would not get into ITU ( despite being fit and active) so if its a choice of let him die or have a go I would like to have a go.
As I say tho - maybe just hero fantasy.
I applaud the idea, but it's pie in the sky. ITU ventilators are sophisticated things, and by all accounts these patients are going to be critically hypoxic and difficult to ventilate - this won't be able to touch the sides. I'm an ITU doctor btw, so I know a little on the subject.
I think all the Medical Regs etc will go out the window. We're only a few weeks away from having people dieing in corridors for lack of ventilators in the UK (Italy is already there), so it will be simply that anything is better than nothing. There's no way the existing supply chain can cope, the current order backlog, for 'proper' machines is decades worth of production.
The medical regs probably will go out the window, problem is people with wet lungs with a bad ventilator will just die. It will either pop their lungs or simply won't be able to ventilate them effectively. A modern ITU vent has all the settings it has because we have learnt how bad for your lungs being ventilated is, putting a sick person on a crap vent is next to pointless. I'm concerned that those patients vented on anaesthetic machines will probably do really badly and that's a thousand times better than a self inflating bag and an electric strap.
The medical regs probably will go out the window, problem is people with wet lungs with a bad ventilator will just die. It will either pop their lungs or simply won’t be able to ventilate them effectively. A modern ITU vent has all the settings it has because we have learnt how bad for your lungs being ventilated is, putting a sick person on a crap vent is next to pointless
This.
those patients vented on anaesthetic machines will probably do really badly
Not this.
Our anaesthetic machines are basically the same ventilators with a couple of extras; I'd be happy using theatre vents in this scenario.
The issue will centre around staff with the appropriate training.
I guess that depends on your anaesthetic machines, ours are nowhere near as good as our ITU vents when you have a severely hypoxic patient.
Medtronic have announced they are doubling ventilator production.
Production is based in Galway, Ireland so thank god we are still part of the EU. Oh wait.
For the US, peak ventilator demand is forecast for Oct on, and they'll need a lot of them:
What’s the survival rate for people on ventilators with covid19
Thisn't is quite the answer.
In China the cv19 death rate was between 1-2% overall. Near to 1%. But in Wuhan it was more like 5%. This was because in Wuhan the medical services were over whelmed and people weren't treated. So that is roughly a factor 3 difference for chances if you get the treatment you need
No medical training. Numbers from memory from a summary of a WHO report.
But we have signed a deal with the private hospitals which means 1200 more ventilators. That's from memory from the BBC news
Link to summary of WHO report
Not as dramatic as a DIY ventilator, but spotted yesterday that AP Diving (who make valves and suchlike for SCUBA diving) have rushed out an adapter valve that enables ordinary SCUBA diving air cylinders that have been oxygen-cleaned to be converted for use as an oxygen cylinder . . . apparently because there could be a shortage of gas cylinders to run the ventilators. Available here.
Well, necessity being the mother of invention and all that, it seems a doctor in northern Italy went ahead and did it, based on a Decathlon diving mask.
The idea first occurred to Renato Favero, a former chief doctor from the province of Brescia.
To remedy the shortage of equipment in hospitals, the Isinnova company is working to transform Decathlon brand diving masks into respirators. The civil protection of the province of Brescia, in the north of the country, has already ordered 500.
"We analyzed the doctor's proposal and concluded that the Decathlon Easybreath mask was the one that best suited our requirements. Decathlon replied that they had tens of thousands in store. Then we 3D printed the necessary connections between the mask and the standard hospital tubes."
The prototype was tested in a hospital, and once its functioning validated, the civil protection of Brescia ordered 500 Decathlon masks
To all the medical professionals saying how proper ventilators are expensive machines with skilled operators and you cannot make them on the cheap: What would you rather we did?
I wouldn't shoot the messengers, especially when they are working hard to keep people alive.
What would you rather we did?
What you need to understand is that ventilating a human being is a complex, delicate, difficult thing to do. It's one important part of being able to keep someone alive while they fight off the disease. Using a suboptimal ventilator requires a skilled operator, requires more attention, more experience, more skill, more time...
All of which are in very, very short supply.
People have seized on this as an answer to the problem; it's really not. Respiratory failure of this kind is a complicated thing to treat. I'm trying to think of an analogy and this is a clumsy one but... imagine you had to had to write a program to display the progress of the virus and people were suggesting that a you could do it with a calculator and a television.
Ventilating people is easy in theory, in practice not actually so; you need to be able to ventilate them reliably for a week or two, then step things down to wean them from the ventilator, as well as keeping them alive in between.
So are we more short of skilled doctors than ventilators?
The government have now produced a specification for a basic ventilator. Now thats something realistic to work with. Its much more complex that the gadet in the OP but much simpler than the standard vents.
~so - all you armchair engineers - this is the spec to work with. Build one and I will be forever in your debt. make parts for a workable vent - then you are a hero.
So are we more short of skilled doctors than ventilators?
I think its the skilled nurses and techs that will be more of an issue. The docs with the skills are in short supply but they can spread themselves thin. The patient on the vent needs a skilled operator 1 to 1 24/7
So are we more short of skilled doctors than ventilators?
If you put someone on a ventilator you need to look after them.
For 24 hours a day.
For 7 or 14 or 28 days and nights.
ITU nurses take 2 years or so to become confident and competent to look after one ventilated patient at a time.
If you use new or old ventilators you need to know what you are doing with them, and you need to be able to rely on them.
It's likely that ITU nurses will end up looking after a number of patients on ventilators; hence the need for good, reliable, usable kit.
It really isn’t that complicated. No need to re-engineer any new machines or products, just a case of giving existing manufacturers additional manufacturing capacity and it is already happening and has been for a couple of weeks. All the same controls and regulations will be adhered to as the original manufacturers are still managing the supply chain. Will take some time to get up and running to
full production, but once at full production they will be churning them out.
Or just take control of the existing manufacturers drawings and farm out the production as happens with just about every product today. I imagine assembly and test would take a little while to get up to speed but nothing more than a week.
That’s if you actually want to produce it and aren’t going to let bureaucracy get in the way.
Interesting stuff. I have an image in my head of the ExCel conference centre staffed by Military medics and recent retirees, using thousands of these machines.
All the same controls and regulations will be adhered to as the original manufacturers are still managing the supply chain. Will take some time to get up and running to
full production, but once at full production they will be churning them out.
I wish I shared your optimism. For sure production will be ramped up but if we continue to follow Italy's experience with COVID-19 then it won't be enough and it won't be soon enough. Also what about the circuit boards, I'm guessing they aren't made in the UK and what about the testing of each unit that needs to be done?
Yep, you’re guessing. There’s plenty of UK PCB manufacturers around.
Raspberry Pi is made in Newport IIRC.
I wish I shared your optimism.
Ultimately we'll see. But this is day job for manufacturing engineers and supply chain managers and happens all the time across a massive variety of products. I work in Aerospace and it doesn't come much more highly regulated than that..moreso than medical I'd guess and there are very well established mechanisms to do just this whilst maintaining product integrity quality standards.
Obviously it takes time and effort to set up initially and go through all the first article inspections (as called in the aerospace industry at least) so that components and products can be demonstrated as being equivalent in terms of fit, form and function. But once that has been established it's then like shelling peas.
Normally the blockers to this activity are around commercial agreements...I would like to think that under the current circumstances and while everything is being underwritten by governments the usual commercial friction will be taken away.
Several of the motorsports/car manufacturers are deep into making things happen with the support of their Existing supply chain of cnc machine shops.
I think I’m going to be living in a caravan outside my machine shop for months if things go the way I think they are.
Neil SuperstarComponents
This twitter link explains far better than I could how just using a basic ventilator may not be the answer. ITU vents are really complex and weaning patients off these temporary ones may be nearly impossible.
https://twitter.com/aroradrn/status/1243091107149418496?s=19
