
Tesla Ventilator - ericzawo
https://www.youtube.com/watch?v=zZbDg24dfN0
======
pdq
Yes, this is an impressive amount of work done in a few weeks by a small team
at Tesla. However, medical devices, especially for _life support_ systems, are
not a Hackathon project.

These devices breathe air into patients lungs. They need to be manufactured in
clean room conditions, with medical grade parts, not plumbing parts from a big
box store. They must be designed and tested to ISO specifications. If this
fails, the patient can die.

I can't imagine any hospital or doctor careless enough to connect one of these
to a patient, even in this current emergency.

The smarter idea is to ramp up existing proven designs, not reinvent the wheel
and basically do a publicity stunt about your engineering talent.

~~~
baybal2
> If this fails, the patient can die.

In the current situation, I doubt anybody will give any regard to your
sentiment. Though, I myself will.

> The smarter idea is to ramp up existing proven designs, not reinvent the
> wheel and basically do a publicity stunt about your engineering talent.

This is what China did. Ctrl-C, Ctrl-V, and knockoff ventilators began to fly
off assembly lines in less than a month.

P.S. In other news, A VERY BIG THING that no news seem to be reporting. China
has effectively _banned nearly every medical export_ as of April 1 through
enforcement of impossible to comply paperwork:

[https://www.scmp.com/news/china/society/article/3077953/coro...](https://www.scmp.com/news/china/society/article/3077953/coronavirus-
china-bans-export-test-kits-medical-supplies-firms)

A man I know, who works at a medical clothing, and bedding factory, says that
even such basic things that should not require any certification are now
banned for export.

~~~
tazjin
> In the current situation, I doubt anybody will give any regard to your
> sentiment. Though, I myself will.

I think the thought process for a lot of people will go more along the lines
of "If you were given the choice of not having a ventilator (because they ran
out) and dying, or using an unproven Tesla ventilator and maybe surviving,
what would you do?".

That's assuming that Tesla (or other companies working on this) actually ends
up manufacturing and supplying these things, and this is not just a publicity
stunt.

~~~
mcguire
I'm given to understand that Chinese traditional medicine is effective as
well, and with their reported success in controlling the epidemic, we should
look into those techniques as well.

How much can we count you in for?

------
sschueller
For more background info on what is needed for a ventilator and why it isn't
that simple:
[https://news.ycombinator.com/item?id=22779665](https://news.ycombinator.com/item?id=22779665)

~~~
Retric
The Tesla prototype seems much closer to a medical ventilator than most of the
overly simplified models shown in that video. Working Medtronic is likely a
large advantage here.

Adjusting air temperature and humidity seems like the biggest missing piece.

~~~
mceachen
The schematic on the whiteboard had a humidifier component, fwiw.

------
LittleNemoInS
This is not Tesla, but Seat has already done it :
[https://www.seat.com/company/news/company/from-making-
cars-t...](https://www.seat.com/company/news/company/from-making-cars-to-
ventilators.html)

Less techie, more down to earth, they used wipe motors.

~~~
bonestamp2
That's great. I hope wiper motors can take that kind of continuous actuation
-- it's not really what they're designed for. I'm sure they'll stress test the
hell out of it.

~~~
gpm
Driving for hours in heavy rain results in pretty continuous actuation of
wiper motors. I'm far from a mechanic but I can't say I've ever heard of a
wiper motor failing either. I'm sure they have real data on it instead of this
handwaving, but as an outsider I would be surprised if it was an issue.

~~~
Frondo
Not a comment on the ventilator made from a wiper motor, but I have had one
fail, and had to have it replaced for something like $255.

All mechanical parts will fail (the antikythera device isn't still
operational, but that's a pretty long-lived device!), it's just a matter of
when and why.

------
nabla9
Tesla didn't do this from scratch as people here seem to assume.

Tesla partnered with Medtronic [https://www.medtronic.com/us-
en/index.html](https://www.medtronic.com/us-en/index.html) It seems that they
also work as parts supplier for Medtronic.

------
nsxwolf
Are ventilators even helping? I see numbers like a 30% survival rate in some
places, but they don't mention if that means "aren't dead yet" or recovered
and removed from the ventilator. I definitely read about people who have
successfully been removed and are recovering, but that's all anecdotal.

~~~
Spare_account
The information we need is:

1\. Percentage of patients who needed ventilation, got ventilation in good
time, and recovered vs died.

2\. Percentage of patients who needed ventilation, didn't get ventilation due
to lack of resources, recovered vs died.

Then we'll know how much ventilators are helping.

I understand that prior to this pandemic, typical survival rates for patients
who required invasive ventilation was in the region of 30%. 70% die even with
ventilation.

I've also heard that of Covid-19 patients that require ventilation, 80% die
even with ventilation. So it has a slightly lower survival rate than other
illnesses.

------
zebrafish
I'll be interested to see how well they can scale this up. Production
functions are always dependent on the most scare component. Hopefully Tesla
can leverage their already existing supplier base to easily source everything
needed for this design.

~~~
gullyfur
I'm interested in this too. In the video, they said they're attempting to make
this using as many car parts as possible, to prevent themselves from taking
supply away from other ventilator manufacturers. That's a noble goal, as well
as it helps them leverage their existing supply chain.

~~~
heleninboodler
I'm curious what the mixing chamber is used for in an electric vehicle. Is it
part of the climate control system?

~~~
zodo123
It said “Continental” as the manufacturer on it. If I had to guess, I would
say it was the reservoir for their adjustable height air suspension.

~~~
heleninboodler
Ah yes, that makes a lot of sense. It looks quite beefy for climate control.

------
salvagedcircuit
This is pretty excellent. It is one of the first ventilator solutions that
actually implements appropriate air sensors, a PEEP function and air flow
monitoring. Hats off to the tesla engineers for throwing this together so
quickly. It's pretty neat that so many car parts could be reused. I can
imagine they are finalizing the software interface and optimizing the
machining process to reduce the cut time on the custom manifold production.
Again, awesome job guys!

------
gruez
Are there certification requirements for newly designed ventilators? If so,
how long would that take?

~~~
penagwin
This might be one of those scenerios similar to what's currently happening
with PPE - where we just have to use uncertified equipment because we have
nothing that is certified left.

Like many others have pointed out, if the option is this uncertified machine
or certain death - which would you choose?

Actual proper testing and certification would likely take years - and we need
them within the next few weeks.

~~~
viklove
Who pays the liability when the ventilator backs up and blows the patient's
lung apart?

~~~
penagwin
If you're the patient, and the doctor says "I'm sorry but we have no more
ventilators. You can elect to choose this experimental device and sign away
liability as a last resort. Otherwise you are going to almost certainly die."

How would you respond? If anything I'd be appalled if I was the patient, and
was basically just left to die because of all the certification red tape.

~~~
gruez
>If anything I'd be appalled if I was the patient, and was basically just left
to die because of all the certification red tape.

AFAIK that's what already happens now with highly experimental drugs. You
can't just give terminal patients whatever you want with the excuse "they were
going to die anyways".

------
DubiousPusher
The main criticism I see here is that without prolonged testing it's very
possible for a piece of equipment like this to do harm to a person.

On the other side I see people saying that for those that can't get a
ventilator and are going to die anyway, why not use it.

I'm curious if that category of patients exists though. With Covid are doctors
able to make that call at any point? I've heard lot of Hail Mary treatments
criticized because unlike in the movies there are many ailments where there's
not really a clear point where someone's not coming back.

Anyone know if it's a common scenario with this where a doctor knows someone
is def going to die but there is still time left to do meaningful treatment?

------
gok
The FDA would take years to approve a new ventilator that was an old one with
a new paint color. A new design like this would probably be approved for use
in US hospitals around 2025 if they're lucky.

Might be useful sooner in a country with a more functional administrative
state.

~~~
xkjkls
There are many reasons for long testing on medical supplies. While there might
be some laxing of them for a "hail mary pass" in the situation we are
currently in, we shouldn't claim that equipment shouldn't have validation.

------
panpanna
Not sure what to think of this.

Any people working with real medical ventilators care to comment on this?

~~~
op03
Free PR nothing else (and nothing wrong with that). Those engineers didn't
call up the marketing/pr dept and ask for a professional video crew to show up
- "cause we just want to share an update with the world".

~~~
Robotbeat
It’s more than that. Tesla engineers themselves probably are itching to help.
Check out GE’s workers getting mad that the company wasn’t helping to make
ventilators. People join companies like Tesla and SpaceX because they want to
be challenged, have a bias for action (of course, everything still needs to be
qualified), and make the world a better place. In a global pandemic that can
be helped by addressing a shortage of manufactured stuff, engineers aren’t
going to want to just sit on their hands if there’s a chance their efforts
could be helpful.

It’s not just corporate PR. It’s not just Elon Musk. It’s also these workers
wanting to help the world.

~~~
op03
That's pretty much what Trump and his team say too. It's all PR to me, until
they are standing next to their product, in use, saving lives.

~~~
xiphias2
That would be an unwise decision. Doctors can be replaced with other doctors,
but if an engineer working on the ventilator gets sick, and possibly infects
the whole team, they are hard to replace, as other engineers don't have the
experience and expertise that they got in the last couple of weeks (and maybe
years).

------
detaro
previously:
[https://news.ycombinator.com/item?id=22789605](https://news.ycombinator.com/item?id=22789605)

------
DanBC
This is good, and I'm glad they're doing it.

They've clearly got involvement with existing ventilator manufacturers.

Are they talking to doctors in ITUs? Here's a recent Facebook thread from
people involved in London's new hospital:
[https://www.facebook.com/permalink.php?id=103930280957826&st...](https://www.facebook.com/permalink.php?id=103930280957826&story_fbid=217689892915197)

It shows that ventilation of covid-19 patients is not like ventilation of
other patients.

I'll paste part of it here because I know some can't visit Facebook.

It's by Daniel Martin OBE, Macintosh Professor of Anaesthesia, Intensive Care
Lead for High Consequence Infectious Diseases.

\---everything below this point is a direct quote from Daniel Martin---

Ventilation

\- Early high PEEP is probably not the right strategy and may be harmful. This
is not ARDS in the early phase of the illness.

\- Avoid spontaneous ventilation early in ICU admission as also may be
harmful.

\- There is clear microvascular thrombosis happening in the pulmonary
circulation, which leads to an increased dead space.

\- Also some evidence of early pulmonary fibrosis reported from Italy,
possibly oxygen related, possibly inflammation related.

\- Not many patients have reached extubation yet in London, re-intubation
seems to be common. I highlighted our experiences of airway swelling / stridor
/ reintubation.

\- Brompton are seeing wedge infarcts in the lungs on imaging, along with
pulmonary thrombosis without DVT.

\- Proning is essential and should be done early. Don’t just do it once.
Threshold for many centres is a PF ratio of 13, but all agreed, do it even
earlier.

\- Early on in the disease, the benefit of proning lasts < 4 hours when turned
back to supine, as the disease progresses into a more ARDS type picture, the
effect is more long lasting.

\- Many centres using inhaled nitric oxide and prostacyclin with good effect.
Tachyphylaxis with NO after 4-5 days.

\- Generally people are using humidified circuits with HMEs.

\- A very interesting thing they are doing at Georges is cohorting by phase of
disease i.e. early, late, extubation / trachy. It involves more moving of
patients but helps each team to focus on things more easily.

\- Leak test before extubation is crucial, others are also seeing airway
swelling.

\- Wait longer than usual before extubating, high reintubation rates reported.
Do not extubatne if inflam markers still high.

My conclusions from this are:

\- Less aggressive PEEP strategy at the beginning of the disease and go
straight for proning.

\- Thromboembolic disease is prevalent, look for it. No one is sure about
whether we should anti-coagulate everyone, this is probably too risky.

\- An extubation protocol is needed immediately.

\- We should consider using inhaled prostacyclin again (like we previously
did) as it seems to be working early in the disease.

------
yoda_sl
Extremely curious the outcome... I hope they can get some folks in the medical
field to provide quickly some feedback.

~~~
toomuchtodo
Tesla is working with Medtronic (per Medtronic's CEO on CNBC Mar 25th) to
rapidly iterate on their designs.

------
vernie
Is this like the kid-size submarine or does it have a chance of being mass-
produced?

~~~
dkdbejwi383
Definitely a PR stunt like the "submarine". See this comment:
[https://news.ycombinator.com/item?id=22794211](https://news.ycombinator.com/item?id=22794211)

------
Beltiras
I just took possession of a Model 3 about 2 weeks ago. Feel like I underpaid
for it when seeing how some of the residuals are being used now.

------
m4tthumphrey
I just love the environment in the video! It looks like they're all in college
experimenting! Loving the rowdy shirts and leather jackets!

------
vorpalhex
This looks promising. They're being smart to use their own supply chain as
much as possible, but obviously things will get interesting when it comes to
getting clearance to deploy the device. Even if the design can't be used in
it's entirety, they may be able to fill part of the supply chain for other
manufacturers.

One complaint - everyone keeps touching their damned masks. Keep your booger
picker away from your face.

~~~
ha4fsd3fas
It's because their masks keep dropping when speaking. It's surprisingly hard
to fit the mask in a way that you do not feel the urge to adjust it every now
and then.

------
ProAm
Hopefully they get these right instead of ordering C-PAP machines [1]

[1]
[https://www.forbes.com/sites/billroberson/2020/04/04/health-...](https://www.forbes.com/sites/billroberson/2020/04/04/health-
officials-say-ventilators-donated-by-tesla-are-wrong-type-and-not-powerful-
enough/#1554fae56264)

~~~
post_break
I see this everywhere. I also saw where they literally listed what machines
they needed, and Tesla brought the exact machines they wanted, including B-PAP
and C-PAP machines.

~~~
ProAm
[1] [https://www.inputmag.com/tech/where-are-elon-musks-
promised-...](https://www.inputmag.com/tech/where-are-elon-musks-promised-
ventilators)

