
E-VENT: Emergency ventilator design toolbox - zdw
https://e-vent.mit.edu
======
tlrobinson
I can't find it at the moment, but I recall seeing a report from China that
80% of COVID-19 patients placed on ventilators still ended up dying. I assume
that's not the case in the US? (does anyone have stats on this yet?)

I also recall seeing (again, can't find it right now) a scientist concerned
about the potential for widespread usage of ventilators to rapidly increase
the prevalence antibiotic resistant bacteria.

My point is, having as many ventilators as we need is good, but it's even
better to not need the ventilators in the first place. I hope we don't fixate
on ventilators too much at the expense of mitigation and other treatments.

~~~
nabla9
The number of people dying on ventilators is not meaningful question because
patient dying from COVID-19 almost always becomes critical before dying. If
there is ventilator, they get hooked into them for a some time.

The real question to ask is how many people who would survive with ventilator
die without it.

~~~
alkonaut
> because patient dying from COVID-19 almost always becomes critical before
> dying

Actually I read the opposite. That the patients in ICU's are younger 40-70
with the bulk in their 60's, while those dying are mainly 75-100, mostly over
80 years old.

That is: many if not most of those who die never pass the ICU. Obviously
people in ICU wards die too, a significant fraction. But the age of the group
that die mostly (80+) means it's mostly non-ICU patients. Doctors know a 80
year old with some comorbidity isn't going to survive being tubed. By
"survive" they mean survive for X months afterwards too (This number can be
e.g. 6 or 12 months to use as a guideline for survivability, to consider ICU
treatment).

~~~
outworlder
This is what makes discussions on this subject infuriating. Most people only
have access to the absolute death numbers, and yet try to draw conclusions
from them.

If it is the case, as you say, that a significant fraction of young people
need to go into intensive care to have a chance to recover, that makes this
pandemic much worse than most people think.

I do know that the number of hospitalizations is high (and possibly should be
higher still, if hospitals were not turning away patients)

~~~
IgorPartola
Then here are the numbers:
[https://www.statista.com/chart/amp/21173/hospitalization-
icu...](https://www.statista.com/chart/amp/21173/hospitalization-icu-
admission-and-fatality-rates-for-reported-coronavirus-cases/)

COVID-19 still requires very high hospitalization rates, even among young
people.

------
coliveira
Kudos to the MIT group, but I think the problem of ventilator shortages has
nothing todo with technology (this is old, well understood tech), but the lack
of leadership in mobilizing industrial production to supply this lifesaving
equipment. Since the early days of this crisis this country should had
mandated companies to produce record levels of ventilators, masks, vests, and
other equipment that are now needed to save lives. On the contrary, the
federal government is up to this point dilly-dallying about how to procure and
produce ventilators, without a clear solution in sight.

~~~
mdorazio
How exactly do you mandate companies produce something which they don't even
have the parts to make? The problem is not manufacturing capacity or will,
it's that supply chains for medical devices are global and those supply chains
have been broken. Increasing production of something like ventilators purely
domestically requires increasing (or building from scratch) production of the
components, which requires new or re-tooling, sourcing of raw materials, etc.

Yes, the current federal mismanagement of the whole crisis is awful, but even
if everyone had acted quickly, there would still be shortages. Covid spreads
faster than device production.

~~~
coliveira
I can guarantee you that this country has the industrial capacity to produce
any kind of parts, especially for a well known technology like ventilators.
The fact is that they are not doing it because nobody alerted and told them to
do so three months ago.

~~~
freeopinion
I'm not convinced that it would have been reasonable to do so three months
ago. Three months ago there were rumors that there was something brewing in
some part of China most people had never heard of.

I point this out to suggest that your expectation might be a little unfair. If
such an order had gone out one month ago it would have been controversial. But
if you want to say that the administration is a month behind in their
reactions it would be more fair.

You seem to have observed that a giant beauracracy is reacting weeks behind a
crisis and this seems to upset you.

~~~
thomk
3 months ago 5K people were infected in a single day in China. The current
administration was completely trained on how to handle a pandemic right after
the inauguration. Unfortunately most of those folks have been fired and 3
months ago we were distracted by yet another scandal this time ending in
Impeachment.

However 2 months ago this was the message from the White House: 'When you have
15 people, and the 15 within a couple of days is going to be down to close to
zero.'

That un-fucking-believable 'head in the sand' moment happened at peak
infection in China; 80K people infected. This administration isn't a month
behind; they simply don't deal with things unless they are forced to.

The US stockpiles ventilators for emergencies like this for a reason. Someone
was asleep at the switch in our Federal Government and the reaction is to lie
about how well they are doing and blame everyone else.

I'm fed up, aren't you?

~~~
freeopinion
3 months ago the first four cases walked into a hospital in China.

I don't want to defend the current US political powers. I'm highly discouraged
about a lot of things. But it doesn't help to make unfair accusations based on
bad facts. If your criticisms are based on fiction they get tossed out.

Just rebase on truth and you might have some much more supportable criticism.
There's plenty to legitimately criticize. When you drown out legitimate
criticism with baseless criticism, the noise to signal suppresses real
criticism. It is unclear whether this is intentional.

------
app4soft
_PLEASE, Let 's collect all Open-Source Ventilator projects in single article
on Wikipeda!_[0]

[0] [https://en.wikipedia.org/wiki/Open-
source_ventilator](https://en.wikipedia.org/wiki/Open-source_ventilator)

~~~
mcguire
And include data on which ones have been tested for safety.

~~~
MuffinFlavored
What could do wrong if you use one that is not tested for safety?

~~~
hcknwscommenter
Lung perforation. Inadequate ventilation. Aerosolization/Contamination.
Suffocation. Death. You know, bad stuff.

------
Jim-
I wonder if it will actually get built and used due to the critical nature of
the Medical Field, even amidst this emergency.

The good thing; at least you'll have a working Ventilator.

On the other, your life depends on this frankenstein'd together machine made
with hospital spare parts.

~~~
bayesian_horse
It's not as bad as you think. The ventilator is only one part of the solution.
There are also sensors for heart rate and oxygen consumption, maybe even CO2
(though that's expensive) and Human beings involved in monitoring everything.

First, most of these patients are probably not completely breathing-depressed
to the point they don't breathe on their own at all. That extends the time
necessary to fix anything.

If indeed one of these ventilators malfunctions, it is probably visible at
once. In case of loss-of-function an operator can immediately grab the bag and
resume ventilation. In other failures he can disconnect the device and
reconnect a non-mechanized manual bag in seconds.

This can even be done by volunteers with minimal training, in such emergency
situations.

------
Palomides
none of the hospitals in my area are accepting amateur-manufactured equipment
or PPE, so I wonder a lot about these efforts.

I have a 3D printer, so I think I'm waiting until they get desperate.

~~~
wegs
In my area, they're burning through PPE like there's no tomorrow, and
complaining about shortages. When the crisis really hits, that's when they'll
need to go for amateur-made, reusing, and working naked.

The lack of foresight in this whole situation has been astounding.

------
saadalem
There is a ventilator concept(with pressure booster double acting) that's
fully mechanical and very simple that can be plugged into an air supply or
water supply to power the ventilator. It sould easily be made and used
anywhere in the world at home, ICUs and ambulances. The ventilator could
operate without any power source at all. It can be powered by water (even by
any tape) You can easily add adjusting stroke length & volume of breath,
cadence, ratio of inhale/exhale, connecting many ventilators to one system
etc.. Let me know and feel free to develop the idea further !

------
pugworthy
Right now I'm doing a lot of research into GxP for a life sciences project I'm
working on. Quoting something I found online...

 _" GxP is an acronym that refers to the regulations and guidelines applicable
to life sciences organizations that make food and medical products such as
drugs, medical devices, and medical software applications. The overall intent
of GxP requirements is to ensure that food and medical products are safe for
consumers and to ensure the integrity of data used to make product-related
safety decisions."_

I would guess that the GxP mindset is lacking in a lot of these projects, and
in truth it would be a burden to progress to be full in on it.

But that said, I do hope people who are doing these things are at least aware
of the importance of data integrity and a very good log of their work. Don't
just record what works, but also record what doesn't work. If a motor, or an
Arduino, or any other part fails on you or you find that using a cheap one
leads to issues, this is REALLY important to record and note for the record.
This is especially true for anyone attempting to duplicate your work.

That said, it's worth noting that the site specifically states that...

 _" We are working to submit a specific variant of the MIT E-Vent design to
the United States FDA for review under the Emergency Use Authorization (EUA)
authority."_

and

 _" The Department of Health and Human Services (DHHS) has declared liability
immunity for medical countermeasures against COVID-19."_

------
DoreenMichele
Please look up medically recommended air clearance methods. These have a long
history of being used by people with serious lung issues to help keep them
alive. One news video indicated that Italian doctors are using them before
people are so bad as to need a ventilator, but they don't seem to be getting
anywhere near as much press as the "ooh, shiny" solution of mechanical
ventilators.

Edited for clarity.

~~~
brigandish
Can you provide a link? I did a search for "medically recommended air
clearance methods" and nothing stood out.

~~~
DoreenMichele
[https://www.cff.org/Life-With-CF/Treatments-and-
Therapies/Ai...](https://www.cff.org/Life-With-CF/Treatments-and-
Therapies/Airway-Clearance/)

~~~
brigandish
Thanks. I'm not a doctor so I could be wrong (and happy to be corrected) but
from my understanding the problem with those techniques in this situation is
that they are for clearing mucus from the lungs (in the bronchi and
broncioles) not from alveoli, because mucus isn't the type of fluid in the
alveoli. Hence, they'd have little effect.

This video[1] goes into what happens when you have ARDS caused COVID and how
it will be treated. It shows why machines like CPAP aren't appropriate too.

[1]
[https://www.youtube.com/watch?v=okg7uq_HrhQ](https://www.youtube.com/watch?v=okg7uq_HrhQ)
How Coronavirus Kills: Acute Respiratory Distress Syndrome (ARDS) & COVID-19
Treatment

~~~
DoreenMichele
A. One news video indicated Italian doctors are using airway clearance in less
severe cases. Not all cases end up needing ventilators.

B. I know ways to also treat inflammation. I've left remarks about that
various places, but a few people were following me around and harassing me on
the excuse that I'm not a doctor, I'm just someone who lives with serious lung
issues.

C. I originally brought this up because people were asking "What can be done
at home?" They are de facto rationing health care because there aren't enough
medical supplies to go around. So I talked about what I know about managing
serious lung issues to say "If medical care is unavailable and you find
yourself in serious respiratory distress, there are things you can do on your
own." Because no one else was really offering up solutions.

D. I also spoke up to express my concerns that we are posting all these
articles about homemade ventilators because ventilators are invasive and
promote serious secondary infections that are more likely to be antibiotic
resistant. I wish we were emphasizing other measures.

I have a form of cystic fibrosis. I deal daily with serious lung issues. This
includes inflammation which is supposed to be chronic and progressive.

[https://onlinelibrary.wiley.com/doi/pdf/10.1002/ppul.24129](https://onlinelibrary.wiley.com/doi/pdf/10.1002/ppul.24129)

I have, anecdotally, found that it is possible to reverse the inflammation. If
you really want to see my previous remarks, there is a link in my profile. I'm
disinclined to link it here because of people following me around and
harassing me.

I am not interested in having this turn into endless drama. Rest assured, lung
clearance is known to help improve lung function, even when there is chronic
and irreversible lung inflammation. If you have no other options because the
medical system is overwhelmed, it's worth knowing about.

Please note that I am absolutely not suggesting this as an alternative to
seeking medical treatment if it is available. I'm only suggesting it as an
option in cases where you simply cannot get medical care due to overwhelming
demand and find yourself in respiratory distress.

------
dang
There are a number of projects among recent ventilator threads, if anyone
wants to compare:

[https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...](https://hn.algolia.com/?dateRange=all&page=0&prefix=true&query=Ventilator%20comments%3E3&sort=byDate&type=story)

------
raphman
A condensed recent Twitter rant of mine regarding this influx of DIY
ventilators based on bag-valve masks (BVMs):

There are quite a few BVM-based ventilators being designed right now. However,
there are a lot of caveats I have become aware of. In short: ventilators for
use in intensive care need to be safe and adjustable. Oh, and it is not clear
whether ventilators actually change the outcome.

Lungs of COVID-19 patients are often damaged, and ventilation causes
additional damage. As the patients' alveoli no longer capture enough O2, you
need to increase air pressure to force more O2 into them. More pressure = more
damage to alveoli, so you need to be very careful. So you need to be able to
adjust the pressure curve very finely. None of the BVM solutions I have seen
so far has such a feature. COVID-19 already causes severe lung damage in some
people - you don't want to damage them even more due to wrong ventilation.

Unlike emergency care (where BVMs are usually used), intensive care of COVID19
patients needs to play the long game. AFAIK, patients need constant care,
supervision and medication over a period of 10+ days. Any damage you cause to
the lungs early on will make it harder later on.

But won't it be better to keep people alive with a simple ventilator even if
they will suffer lung damage? Maybe not. I am aware of the gut-wrenching
situation doctors face in Italy and elsewhere - deciding whom to connect to
the few available ventilators. It seems (I'm not really sure about it yet)
that ventilators just delay inevitable death by a few days in most cases. A
study from Wuhan notes: _“32 patients required invasive mechanical
ventilation, of whom 31 (97%) died.”_ [1]

 _" Not everyone is a good fit for ICU. Even outside of COVID, if you are of a
certain frailty and you have certain underlying conditions, your chances of
making it off a ventilator when you are deathly sick is close to 0%."_ [2]

So the question is indeed whether one should really extend a patient's
suffering for a few days or whether one should instead focus on making their
last few days as comfortable as possible, and give them the chance to stay
conscious and say goodbye to family.

Even if there is a subset of patients who might benefit from a BVM-based
ventilator (and I am not sure about this), I would be very hesitant to rely on
them. If a motor burns out, a tube gets loose, or a microcontroller goes
crazy, the patient might choke, panic, even die. None of the DIY ventilators
has gone through rigorous testing yet. None of the ones I have seen has backup
mechanisms (spare motor, continuous surveillance of all parameters, fail-safe
power supplies, etc.) I would not want to inflict them on dying patients - or
caregivers.

This leads me to the most important point: the most severe bottleneck are
qualified professionals. Should we really hand these people some DIY Arduino-
based ventilators that might fail any moment, that lack important features,
and that need additional training? A ventilator that malfunctions at the wrong
time (or does not reliably function at all) will take away time and attention
from exactly those people whom we really don't want to get distracted or burnt
out.

There is a UK government guidance which gives a good overview of essential
requirements for ventilators [3]. It states:

 _" A ventilator with lower specifications than this is likely to provide no
clinical benefit and might lead to increased harm, which would be unacceptable
for clinicians and would, therefore, not gain regulatory approval."_

Disclaimer: I'm no expert on medical tech or intensive care. I have just
followed a few of those projects over the past weeks and read reports of
experts. It could be that I am wrong and those projects will save many lives.
There could also be use cases where DIY ventilators may help (e.g. in home
care). But overall, I am rather skeptical and would rather suggest focusing on
stuff that might be more useful.

[1]
[https://www.sciencedirect.com/science/article/pii/S014067362...](https://www.sciencedirect.com/science/article/pii/S0140673620305663?via%3Dihub)

[2]
[https://www.reddit.com/r/Coronavirus/comments/fnl0n6/im_a_cr...](https://www.reddit.com/r/Coronavirus/comments/fnl0n6/im_a_critical_care_doctor_working_in_a_uk_high/fla5579/)

[3] [https://www.gov.uk/government/publications/coronavirus-
covid...](https://www.gov.uk/government/publications/coronavirus-
covid-19-ventilator-supply-specification/rapidly-manufactured-ventilator-
system-specification)

~~~
alanbernstein
Would you feel more accepting of these projects (the more-vetted ones at
least) if hospitals start explicitly asking for any and all ventilator
hardware?

~~~
raphman
Hmm, good question. Probably yes. After all, if medical professionals would
see a benefit of simple devices, who am I to question them.

However, every single professional whom I've talked to, or whose comments I
read, argued that well-trained professionals are the real bottleneck. None of
them said they would try out a minimalist ventilator.

I can really understand the desire to do _something_ in order to help those
who work on the frontline. However, all this effort and ingenuity would be
better spent on other projects:

\- personal protective equipment (masks, face shields)

\- simple replacement parts

\- maybe some simple devices (e.g., CPAP, air filters)

~~~
alanbernstein
I'm not surprised if you're right about that, but I would love to see some
authoritative sources about specifically which DIY projects would be most
effective.

I read some of your links from above, and I agree it's good to be skeptical.
I'm basically waiting for hospitals to start announcing that DIY ventilators
are the right move, but by the time that happens, it may be too late to start
sourcing materials and get things built in time to make a difference.

------
zenit-mf-1
One idea that is keep coming to my mind. Why ventilator are built to be used
by individual at once?

Sorry, I am not subject matter expert, but was wondering is there is way to
design ventilator that can serve X patients?

------
chromaton
The real fallback for lack of ventilator machines is the use of the bag valve
mask. This is a manually operated device, no motors or electronics.

[https://en.wikipedia.org/wiki/Bag_valve_mask](https://en.wikipedia.org/wiki/Bag_valve_mask)

I have to assume this is more reliable than whatever somebody hacked together
in their garage. Your average builder may be able to make something that works
OK in testing, but having it work 24/7 by people unfamiliar with its quirks is
a different matter entirely.

The official word out of New York is that they are going to use bag valve
masks when they run out of ventilators and train people how to squeeze the
bag.

~~~
bayesian_horse
The proposed system uses exactly such a thing. But a mask doesn't work because
you want to put pressure into the lungs, not inflate the cheeks. Masks only
work temporarily to assist a patient that is still breathing relatively well
on his own.

And there is nothing technically preventing the use of those bags right now.
But you'd have to have one person standing beside each bed, 24 hours a day.
Which means a hell of a lot of foot traffic, and those will get infected with
a high probability. They also need to be trained to a minimal standard.

It's not practical.

~~~
AstralStorm
Masks do and can increase pressure in lungs, the reason intubation is used is
to provide fluid drainage, prevent choking. So that the critical patient does
not drown. Other than that, they're equivalent. Cheeks can puff out only so
far.

~~~
bayesian_horse
I have never used masks that way and I would worry about the fit. But it may
be possible, temporarily, especially when you hold it down.

Procedurally most physicians seem to reach for the intubator as soon as there
is any trouble breathing, even though that takes longer than putting on a
mask.

------
fasteddie31003
Ventilators are at the bottom of the COVID-19 infection funnel. The cost-
benefit is not as good as mechanisms higher up the funnel. I'd advocate
narrowing the infection funnel at the top by adopting a universal mask
protocol. [https://www.maskssavelives.org/](https://www.maskssavelives.org/)

~~~
onetimemanytime
USA can chew gum and walk at the same time.

------
nimbius
not seeing any value from MIT here other than an opportunity for them to ink a
quick patent.

Heres something more feasible if you're looking to endorse or support an
effort:

[https://opensourceventilator.ie/](https://opensourceventilator.ie/)

~~~
ecopoesis
Students built this in 2010.

