Open source ventilator? Time for us to make it happen. - Page 3
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  1. #41
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    I feel that I need to chime in here to clarify some things that have been said, dispel myths and expose some untruths. This post is not against anyone in particular and is meant to be informational only!

    >>Ventilators have to provide positive and negative pressure to inflate and deflate the lungs. --> That is not true. The old iron lungs used negative pressure to inflate the lungs. Modern ventilators do not use negative pressure to deflate the lungs. It is positive pressure only.

    >>The early ventilator technology used a pressure on breathing in and release all pressure on exhale. This caused distress of the aveoli (air sacs)in the lungs. --> this is somewhat true. Current ventilator technology, not just early modern ventilators, uses positive pressure. The distress is called barotrauma.

    >>The treatment with this technology did not give a much better outcome than no treatment due to lung damage inhibiting the healing process. --> this is not true. I think the OP is trying to discuss the idea of ARDS and the ARDSnet trial, but the statement made is untrue.

    >>This lead to the third generation in which the patient is sedated and and the breathing muscles purposely paralyzed. This allows an optimal matching of the lung air pressures at the cost of 100% of breathing function is controlled by the ventilator. --> this is not true. Both sentences are untruths.

    >>...working on a scaleable Automated Bag Valve Mask (BVM) project as we speak. --> while I cannot comment on whether or not that person is working on the project, this is true. There are Automated BVMs on the market right now (called by a different name). They have been used for years in the medical field.

    >>...sucking wound admits...So an Army doc in Vietnam came up with a rubber tube with the end squashed. --> this is true. I don't know about it being an Army doc in Vietnam, but the treatment is still used today. The non-permeable bandage taped on three sides is used as well, but, as the person mentioned, it does not work as well as the finger-of-glove with the tip cut off.

    >>Look, the CDC is already putting out guidance on how to hook up 1 mechanical ventilator to a split for 4 patients. --> to my knowledge this is not true. However, this is a quickly evolving and fluidic pandemic. This may very well be true tomorrow. If you have the link, please give it.

    >>This has been tested on artificial lungs successfully, and UMC Trauma did it with 4 total patients across 2 ventilators during the Las Vegas shooting, but received new vents within 3 hours. --> please link the case report of this because that is news. As of right now, it is in the testing phases and has some problems. It's not the end-all, be-all. I have not heard of this being done in a non-research setting.

    >>...when one of those vents fails, you now have 90 seconds to get 2-3 people in that room (per patient)... --> while the management is a true statement, the time course and people needed would depend on the type of ventilator failure.



    This is not an attack on anyone. Nor am I trying to 'call people out'. There is a lot of misinformation out there and I want to bring clarity.

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  3. #42
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    Quote Originally Posted by barbter View Post
    They UK gov disagree with you
    They want to get aircraft car and military manufacturers to stop what they're doing and "TURN THEIR PRODUCTION LINES OVER TO MAKING THESE".
    After all these year, i never realised it was THAT simple...
    They seem to think the world is already running on 'replicator' technology.

    Too bad they missed the first step of the War Production Boards, which was to find out WHAT capabilities were actually available and where, and then dole out the production contracts to those that could meet them!

    For that to be of any use at all, they would also have to understand production, or trust the knowledge of someone that did, which sure isn't happening out there these days!

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  5. #43
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    Quote Originally Posted by GregSY View Post
    By the time all the open source geniuses get it done, there will be a massive glut of real ventilators on the market. Why? Because the people already making them will have made a billion of them, the government will have bought them, and they'll be sitting idle and unused and no one will want any more.
    "Real" vent makers (Medtronic, GE, Drager, etc) are claiming they might be able to 3x-5x output, within the next 3 months.

    Problem is, the worldwide market for these things is about 40k units/year. The US fleet of 160k ventilators is the total inventory for about 10 years of production (new models go to ICU/ER, older models get shunted to general or put in the basement for cold storage). So even if they went full current output, you're looking at getting just under 30k more ventilators by June, and about 12k a month thereafter. Mind you, that is global capacity you would need to share with Europe and their affiliates (Germany just placed a 10k order from Drager, the largest single order in the company's history).

    That is pretty fantastic, but if the US demand for ventilators peaks at 400,000 patients sometime in mid May? You're still looking at 200,000 folks who won't be breathing.

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    Quote Originally Posted by metal-ica View Post
    Hospitals are going to choose who lives and who dies.
    I don't think this is fair to doctors. I am pretty sure they will be doing the best they can for everyone, but in the face of limited resources, what do you expect them to do ? Pull equipment and beds out of their sleeves ?

    You can thank your for-profit health care system for this. Live by the sword, die by the sword.

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  8. #45
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    Quote Originally Posted by medsar View Post
    >>...working on a scaleable Automated Bag Valve Mask (BVM) project as we speak. --> while I cannot comment on whether or not that person is working on the project, this is true. There are Automated BVMs on the market right now (called by a different name). They have been used for years in the medical field.
    Gas driven paramedic vents are a thing and have been for years. The problem is that they are powered off of the input pressure from O2. Hospital O2 systems do not have anywhere near the capacity for having 3x their normal patient volume on current gas lines.

    You also run into supply issues trying to boot up 50k+ of such units. Their high precision internal valves and components are not conducive to unprecedented mass-scale manufacturing ramp.

    >>Look, the CDC is already putting out guidance on how to hook up 1 mechanical ventilator to a split for 4 patients. --> to my knowledge this is not true. However, this is a quickly evolving and fluidic pandemic. This may very well be true tomorrow. If you have the link, please give it.
    Dr Babcock posted the video to YouTube yesterday, and it was linked around as having been put out by the CDC... Now that I look it up again, that is because the CDC and YouTube have a thing where the CDC has a panel at the bottom of every video that looks a lot like the title and channel block. I feel like this was an honest error!

    >>This has been tested on artificial lungs successfully, and UMC Trauma did it with 4 total patients across 2 ventilators during the Las Vegas shooting, but received new vents within 3 hours. --> please link the case report of this because that is news. As of right now, it is in the testing phases and has some problems. It's not the end-all, be-all. I have not heard of this being done in a non-research setting.
    YouTube

    The above referenced video.

    >>...when one of those vents fails, you now have 90 seconds to get 2-3 people in that room (per patient)... --> while the management is a true statement, the time course and people needed would depend on the type of ventilator failure.
    This is fair, but let's face it... dealing with airway management during unexpected vent failure is always a goat rodeo. Now multiply that x4. Now have that happen in an ICU setting where things are so fucking grim and packed to the gills that this whole vent split hack is even necessary.

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    Quote Originally Posted by metal-ica View Post
    If I hear someone else mention regulations again I think I my head will explode. Fuck regulations. This is a great idea, great thread and we need to get this done. Hospitals are going to choose who lives and who dies. A diy ventilator at home will at least give the person a fighting chance. We're a community with great resources. Lets come together as Americans and make this happen and regulations be damn. If we have a proven, working unit shops around the country can focus on parts in their wheelhouse and we can ship to an assembly facility. I'll shut down all operations to focus on this. Lets make it happen.
    Ever looked up the numbers annually, for medical error deaths?

    You probably should. Here. Some light reading. Medical errors third-leading cause of death in America And a dissenting, but by no means reassuring opinion Are medical errors really the third most common cause of death in the U.S.? (2019 edition) – Science-Based Medicine Maybe the Doctors can up their game and clear a little extra bedspace.

    The numbers for Canada are supposedly around 28,000. We are fewer and more spread out.Thousands die from medical errors yearly, notes advocacy group

    I know that I looked up the CDC's numbers for deaths annually from heart disease, and compared to the 12 deaths so far that has California about to institute their panic measures, those 62,000 deaths may just be more wort worrying about.Stats of the State of California

    I hear what with folks crapping on sidewalks out that way, TP isn't so hard to find though....LOL!

    The only thing panicking will do is to start a stampede of the sheeple. It's probably best for all concerned that that not actually happen, or everyone is liable to wish they actually got the virus.

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  11. #47
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    Is this going to cause a reappraisal of the idea that medicine should be run as a for-profit business ?

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    Quote Originally Posted by EmanuelGoldstein View Post
    Is this going to cause a reappraisal of the idea that medicine should be run as a for-profit business ?
    I would rather live in a world where 99.999% of the time, we use $100k ventilators that are masterpieces of technology, but we need to scrape something together in a pandemic that hits every 50 years.

    ... instead of living in a world where we use scraped together ventilators all the time, and the $100k units don't even exist.

  13. #49
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    Quote Originally Posted by gkoenig View Post
    ... instead of living in a world where we use scraped together ventilators all the time, and the $100k units don't even exist.
    So you think doctors nurses and medical suppliers are just in it for the cash, hunh ? Without the big bucks there'd be no science ?

    Nice.

    This is tangential to ventilators but might be helpful, information-wise - a little dated but many parts applicable. And too optimistic



    p.s. fifty years my ass, last one was 8 years ago and the previous one 15. As the population grows, everything becomes more crowded, travel gets even more common and faster, people encroach upon bats; tend pigs, birds, camels, horses and other virus intermediaries, this is going to become more and more frequent.

    p.p.s A lack of profit does not equate to a lack of money.

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    Hi
    The reason compliance with regulations and standards is so important is the USA is because of a fundamental flaw in the legal system.
    In the USA, if someone sues you, you have to pay costs to defend, even if you win. Litigation can be used as a weapon by the wealthy.

    In most countries, if someone sues you, and they lose, they pay your costs. In practice, this hurdle reduces litigation to those cases that are legitimate and winnable. In my country, I have never seen a TV advertisement by a law firm.

    The USA legal system makes a fortune on frivolous litigation that legal defense is usually paid for by liability insurance companies. As a result liability insurance in the USA is really expensive. My liability insurance forbids me from selling into the USA.

    So lets say someone in the USA ignores the regulations and standards and successfully builds a fully functional open source ventilator.
    No insurance company will provide liability insurance to a non-compliant medical device.
    No hospital or medical facility will touch it because it would void their insurance and expose them to litigation.
    The existing medical suppliers would lobby government to block open source competition to protect their market share and profits.
    The first person that dies under the open source ventilator will attract a swarm of lawyers.
    So the combination of commercial, legal, medical and insurance systems operating in the USA would crush any attempt to produce an open source a ventilator. Those systems operating in the USA prevent the use of solutions successfully applied in other countries.

    The USA medical system is the most expensive and least effective of any 1st world country. The medical system leaves over 28 million citizens unprotected by medical insurance. This number can be expected to grow as people lose jobs and can't afford to maintain medical insurance. Many of these millions will not be able to access Covid19 testing, the most important task of detecting and controlling the virus.

    If you really want to make a difference, figure out how to make Covid19 testing accessible to uninsured citizens. Without an accessible testing system, Covid19 outbreaks will only be detected when patients are connected to ventilators in hospital beds. The poor management of the virus in the USA is likely to result in higher infection and death rates than other 1st world countries. Poor crisis management also makes it likely that the USA will suffer greater economic pain than other countries. Trump's speech Wed 11 March was described by the Financial Times as the most expensive in history, causing the largest one-day fall in the stock market since 1987. The strategy of targeted early detection and containment applied by other countries will significantly reduce the demand for ventilators.



    Dazz

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  16. #51
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    Quote Originally Posted by GregSY View Post
    It's not a great idea, it's a dumb idea.

    By the time all the open source geniuses get it done, there will be a massive glut of real ventilators on the market. Why? Because the people already making them will have made a billion of them, the government will have bought them, and they'll be sitting idle and unused and no one will want any more.

    There might (or might not) be an actual need for ventilators for a short time. Then it will be over.
    So true. You need to have a promising purchaser before you manufacture anything. I haven't seen a single promised purchase / customer in this thread yet. "Cart before the horse" story.

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  18. #53
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    I believe my group of folk are now part of the same project...
    PM inbound

    Quote Originally Posted by gkoenig View Post
    I'm leading a small team working on a scaleable Automated Bag Valve Mask (BVM) project as we speak. We're rolling our first prototype out in a couple of days.

    Our approach is that you are sort of 100% correct - there is absolutely no way a team could ever mass-manufacturer from scratch a contemporary mechanical ventilator found in hospitals. These things are crazy wicked advanced, for fuck sakes - most are turbine driven. Multiple data points are collected, monitored, and self-adjusted. Numerous specialty modes of operation are offered. They are self-powered in a power loss. They have 6 Sigma levels of reliability. They also cost from about $20k for the low end model to well over $100k for the latest Medtronic PB 980. The current manufacturers think they might be able to 5x output of these devices if given unlimited POs and maximum government assistance - which gets you ~3000 of these things over the next 6 months.

    Imperial College of London's latest model for the US puts us at about 200,000 vents short on the moderate outcome.

    70 years ago before we were building mini AI jet engines to do this job, the Bag Valve Mask was invented by a German and a Dane. Over those years, the design has been meticulously optimized and turned into a highly advanced, medical grade, commodity item of such reliability that you don't even think about them going wrong. These are what paramedics are gonna be squeezing to keep you breathing. They are how you get oxygenated before the airway gets shoved down your throat. They are always within arms reach of the Porsche priced ventilator if/when something goes wrong with it. They are as reliable as a wood burning stove, inexpensive, hundreds of thousands are trained how to use them, and every hospital has one in almost every room already.

    So it is simple - you make a device that automates this. Simple bag squeeze mechanism, very basic microcontroller, servo motor. Existing sensors for airway pressure plug right in to guide it. Teams from Rice and MIT have already validated the concept in multiple student engineering products to create a low-cost ventilator for 3rd world countries.

    With this design - the entire air circuit is a known-quantity, carrying complete FDA certification, made from biocompatible materials, intrinsically patient safe. If the automation portion stops working? You yank the bag out from between the squeeze mechanism and go old fashioned - the patient might not even notice.

    The design we are working on is focused on ease of manufacturing and component flexibility. The latter is the real problem - nobody on the globe is keeping anything in stock, we live in a Just In Time world. If you need 50,000 NEMA17 stepper motors, you can get them in 6 weeks from... China. Who won't be delivering anything in those quantities within the next 6 weeks because they are even more fucking hosed than we are. So we are optimizing the design to have a min/max component mix that can take any size motor, any electronics, any power supply we can get our hands on.

    I have no idea if any of this is going anywhere, but at the very least, this is an interesting challenge and I finagled some super smart folks to work on it. The absolute worst case scenario is that some poor bastard would ever be getting kept alive with our work-product, because if that happens? We are all really totally fucked.

  19. #54
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    Some collaborative efforts going on here Open Source COVID19 Medical Supplies Public Group | Facebook

    Here is a site to link needs and resources Get us PPE – Getting Frontline Workers PPE

    I'm still waiting to hear back from my local hospital and government to see if there are any needs where I am.


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