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Professional Insight? #16

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aris-t opened this issue Mar 17, 2020 · 28 comments
Open

Professional Insight? #16

aris-t opened this issue Mar 17, 2020 · 28 comments

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@aris-t
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aris-t commented Mar 17, 2020

So I hit up a friend with connections to people who actually make ventilators and these are some areas of concern they brought up.

  • "This seems like a very very dangerous endeavor"
  • Inflating patient’s lungs correctly (including being in sync with their respiratory drive)
  • Weaning the patient off support later is a super complex thing with no room for error.
    Though I believe this really only becomes an issue after ~24 - 72 hrs of use, (Needs confirmation)
  • They also pointed out that this wouldn't be a true ventilator as you usually sedate and intubate patients in that case.
  • They were also concerned with the potential for the positive pressure gas exiting the patient to contain aerosolized virus.
@mrquincle
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mrquincle commented Mar 17, 2020

What's their suggestion? Can they open source their hardware? Can they ramp up their production enough? Can they under NDA have other companies helping them to ramp up?

@peteflorence
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peteflorence commented Mar 18, 2020

Re: project comparison with other projects

  1. The ideal scenario would be to ramp production of FDA approved ventilators.
  2. There are parallel efforts to this project to do exactly that.
  3. Given the possibility that these efforts might not meet global demand, then we should explore low cost, easy-to-manufacture ventilator options. Keep in mind this will be a global need, not just for privileged countries like the U.S., etc.
  4. Parallel to this project, there are other low cost open source projects as well.

Given the importance of each day, we should have some parallel efforts (although probably not too many).

Re: technical questions

  1. Regarding intubation with an endotracheal tube -- could somebody point to if we know that COVID patients actually need an endotracheal tube? This overview on ventilators (https://www.youtube.com/watch?v=gk_Qf-JAL84) points out that there are two different use cases for ventilators. One (1) is that the patient can't protect liquids and solids from going down the trachea. Two (2) is that they can't breathe on their own. If the requirement is only for (2), it seems possible that an endotracheal tube is not required. Need doctor to advise.
  2. If an endotracheal tube is needed, it could be added to the design.
  3. "They were also concerned with the potential for the positive pressure gas exiting the patient to contain aerosolized virus." -- yes, need to make sure this is solved for and tested.
  4. "Inflating patient’s lungs correctly (including being in sync with their respiratory drive)" -- it depends on the mode of operation of the ventilator. If the patient initiates the breath, then yes the event of the patient starting to inhale needs to be sensed. Note though that not all modes of operation require this. See https://www.youtube.com/watch?v=gk_Qf-JAL84 for more. Need a doctor to advise on which mode(s) are needed for COVID.

@jcl5m1
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jcl5m1 commented Mar 18, 2020

The material I find online is very bipolar. This person falls in the "if you don't do it right, it's a terrible idea". The other camp, is bolting pieces of wood together to make something that might help. There's not much middle ground of helpful information which is "in an emergency, these are really the things that matter...".

Bag-Valve Mask Ventilators don't seem to require intubation to be effective.

If the environment already has a lot of infected patients coughing, won't there already be a lot of aerosolized virus?

When I tested it, it was very easy for me to match the rate driven by the machine. How important is it for the machine to match the person vs the other way around?

@peteflorence
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FWIW -- I am hearing from doctor friends that in severe cases, intubation is required, but not always. Don't have data on the ratio.

@fireb0lt
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Pressure support ventilators can be used with or without intubation. They can help prevent pneumonia from Covid19

@Arif-I
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Arif-I commented Mar 18, 2020

hi, I am from Bangladesh and following your project. The situation is getting worse here and we'll def need more breathers. Even if this works with 40 or 50 % efficacy, that will be great help. I appreciate the effort of the community.

@allen-munsch
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"They were also concerned with the potential for the positive pressure gas exiting the patient to contain aerosolized virus." -- yes, need to make sure this is solved for and tested.

https://en.wikipedia.org/wiki/Venturi_scrubber

@ghost
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ghost commented Mar 18, 2020

Re: pandemic ventilator- i am not a programmer - It is my first time on github and i am a bit lost- would someone, anyone, please call me ANYTIME asap. Anthony Cabrera md, frcsc---Tel: 1-905-923-1766 OR whatsapp: 34-653-08-58-41 (34 is for Spain but i live in Hamilton, ontario, canada) OR give me your number and location and i will call you back- FYI: email: acab45@yahoo.ca
thank you
Anthony Cabrera md, frcsc

@aris-t
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aris-t commented Mar 18, 2020

So i started this thread as an attempt to stir up some technical considerations which we may be overlooking but a more experienced practitioner would point out right away. I was fully expecting the response ive been getting from my more conventional contacts of "if you don't do it right, it's a terrible idea". I don't subscribe to that im much more for if you can help at all you should. Therefore im reaching out to some less conventional but more open minded contacts now.

Overall seeing @peteflorence and @jcl5m1 comments this thread seems to be serving its purpose. Keep up the good work.

@rzeimer
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rzeimer commented Mar 18, 2020

i suggest that providing devices that can match ventilators is not fruitful. rather we should get feedback on what are the specifications that need to be added to CPAP like machines to be useful for the cases that are not severe, which will make a large population and put pressure on the resources.
we could then use existing CPAPs which abound

@allen-munsch
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Also checkout : https://gitlab.com/TrevorSmale/OSV-OpenLung

@ghost
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ghost commented Mar 19, 2020 via email

@TimVanDyke
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TimVanDyke commented Mar 19, 2020

I've been talking to acab45 and he also shared this video with me and I thought it might be a bit helpful.

I think what we need to know here is basically what the use case we need to fulfill of a ventilator is.
As in, we need something along these lines (Please correct me if I'm wrong):
ex:
Patient has corona virus and needs a ventilator in AC (or whatever) Mode.
they need:

  • a minimum of x breaths a minute
  • They don't (or do if they do) need a ET Tube to go into their trachea
  • to monitor from u pressure to v pressure at y level precision
  • alarms for a, b, and c, scenarios
  • etc

with more clarity on what's needed it would really help get people moving towards that. So as we look for resources and people to talk to it'd be nice to be able to talk to an expert in building them if possible, but the next best thing would be an expert in precisely what's needed.

@ghost
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ghost commented Mar 19, 2020 via email

@ghost
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ghost commented Mar 19, 2020 via email

@ghost
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ghost commented Mar 19, 2020 via email

@jcl5m1
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jcl5m1 commented Mar 19, 2020

I had a long call with a pulmonologist yesterday. Here are my notes:

https://github.com/jcl5m1/ventilator/wiki/Notes-from-chatting-with-a-pulmonologist

@ghost
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ghost commented Mar 19, 2020 via email

@ghost
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ghost commented Mar 19, 2020 via email

@allen-munsch
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Some techinical specifications can be found here :

Specification For RMVS Challenge.pdf

@ghost
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ghost commented Mar 19, 2020 via email

@ghost
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ghost commented Mar 19, 2020 via email

@ghost
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ghost commented Mar 20, 2020 via email

@maday
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maday commented Mar 23, 2020

Johnny, I appreciate what you are trying to do and want to help. Posting this so that I can be part of the thread.

@MordiSacks
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This might be helpful
https://www.youtube.com/watch?v=mnIpD1VwyMo

I have been following this channel for a while, very very good information

@RWL-69
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RWL-69 commented Mar 29, 2020

Hello, all.

I have not had a chance to look at everything linked in this thread but I wanted to make some comments.

My thought on this looks at why this project is so important at this time. A growing number of cases and a lack of hardware in many countries. As the cases increase that require a ventilator, the choice between one that provides all the bells and whistles and one that keeps someone alive disappears. There is even discussion in the USA about automatic DNR's for victims due to lack of equipment.

I agree with the idea of making one that can be built from automotive parts as a basic system as these parts can be grabbed from the street if need be. Adding in the various monitors and sensors is possible given a long enough lead time.

A summary sheet of what the limits are for a basic unit to a wish list of what would be nice for a complete unit would be a handy tool. A chart with check boxes might be the way to go.

If some of this could be attached to Wiki for the project, that would be a great reference.

@MordiSacks
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Medtronic is sharing its portable ventilator design specifications and code for free to all

https://techcrunch.com/2020/03/30/medtronic-is-sharing-its-portable-ventilator-design-specifications-and-code-for-free-to-all/

@ErichBSchulz
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Hiya - I'm a medical doctor (anaesthetist/anesthesiologist depending on where you live)- I've been collating note here:

happy to collaborate.

https://docs.google.com/document/d/1sdrKYQ0mDOu4bJum6Fx6piRutIJovo7UqFKYHHxUD5A/edit?usp=sharing

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