Overcoming supply disruptions during pandemics by utilizing found hardware for open source gentle ventilation

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This article details the design of an open source emergency gentle ventilator (gentle-vent) framework that can be used in periods of scarcity. Although it is not a medical device, the system utilizes a wide range of commonly-available components that are combined using basic electronics skills to achieve the desired performance. The main function of the gentle-vent is to generate a calibrated pressure wave at the pump to provide support to the patient’s breathing. Each gentle-vent permutation was tested using a DIY manometer as it would be utilized in the field in low-resource settings and validated with an open source VentMon. The most rudimentary implementation costs less than $40.

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Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic

Megan Ranney, Valerie Griffeth, Ashish Jha (2020)

New England Journal of Medicine

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COVID-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome

Luciano Gattinoni, Silvia Coppola, Massimo Cressoni … (2020)

To the Editor: In northern Italy, an overwhelming number of patients with coronavirus disease (COVID-19) pneumonia and acute respiratory failure have been admitted to our ICUs. Attention is primarily focused on increasing the number of beds, ventilators, and intensivists brought to bear on the problem, while the clinical approach to these patients is the one typically applied to severe acute respiratory distress syndrome (ARDS), namely, high positive end-expiratory pressure (PEEP) and prone positioning. However, the patients with COVID-19 pneumonia, despite meeting the Berlin definition of ARDS, present an atypical form of the syndrome. Indeed, the primary characteristic we are observing (and has been confirmed by colleagues in other hospitals) is a dissociation between their relatively well-preserved lung mechanics and the severity of hypoxemia. As shown in our first 16 patients (Figure 1), a respiratory system compliance of 50.2 ± 14.3 ml/cm H2O is associated with a shunt fraction of 0.50 ± 0.11. Such a wide discrepancy is virtually never seen in most forms of ARDS. Relatively high compliance indicates a well-preserved lung gas volume in this patient cohort, in sharp contrast to expectations for severe ARDS. Figure 1. (A) Distributions of the observations of the compliance values observed in our cohort of patients. (B) Distributions of the observations of the right-to-left shunt values observed in our cohort of patients. A possible explanation for such severe hypoxemia occurring in compliant lungs is a loss of lung perfusion regulation and hypoxic vasoconstriction. Actually, in ARDS, the ratio of the shunt fraction to the fraction of gasless tissue is highly variable, with a mean of 1.25 ± 0.80 (1). In eight of our patients with a computed tomography scan, however, we measured a ratio of 3.0 ± 2.1, suggesting a remarkable hyperperfusion of gasless tissue. If this is the case, the increases in oxygenation with high PEEP and/or prone positioning are not primarily due to recruitment, the usual mechanism in ARDS (2), but instead, in these patients with poorly recruitable lungs (3), result from the redistribution of perfusion in response to pressure and/or gravitational forces. We should consider that 1) in patients who are treated with continuous positive airway pressure or noninvasive ventilation and who present with clinical signs of excessive inspiratory efforts, intubation should be prioritized to avoid excessive intrathoracic negative pressures and self-inflicted lung injury (4); 2) high PEEP in a poorly recruitable lung tends to result in severe hemodynamic impairment and fluid retention; and 3) prone positioning of patients with relatively high compliance provides a modest benefit at the cost of a high demand for stressed human resources. Given the above considerations, the best we can do while ventilating these patients is to “buy time” while causing minimal additional damage, by maintaining the lowest possible PEEP and gentle ventilation. We need to be patient.

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Sourcing Personal Protective Equipment During the COVID-19 Pandemic

Edward Livingston, Angel Desai, Michael Berkwits (2020)

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Author and article information

Contributors

N. Gallup

Journal

Journal ID (nlm-ta): HardwareX

Journal ID (iso-abbrev): HardwareX

Title: HardwareX

Publisher: Elsevier

ISSN (Electronic): 2468-0672

Publication date PMC-release: 23 December 2021

Publication date Collection: April 2022

Publication date (Electronic): 23 December 2021

Volume: 11

Electronic Location Identifier: e00255

Affiliations

[a ]Department of Electrical & Computer Engineering, Michigan Technological University, Houghton, MI 49931, USA

[b ]Department of Biomedical Engineering and Mechanical Engineering, Michigan Technological University, Houghton, MI 49931, USA

[c ]Department of Electrical & Computer Engineering, Western University, London, ON N6A 3K7, Canada

Author notes

[* ]Corresponding author. ngallup@ 123456mtu.edu

[1]

Given his role as Co-Editor in Chief, Joshua Pearce had no involvement in the peer-review of this article and has no access to information regarding its peer-review. Full responsibility for the editorial process for this article was delegated to Prof. Todd Duncombe.

Article

Publisher Item ID: S2468-0672(21)00085-7 Publisher ID: e00255

DOI: 10.1016/j.ohx.2021.e00255

PMC ID: 9058574

PubMed ID: 35509937

SO-VID: 2432d2e4-7dbd-4dc7-9d03-c492f6f98bc7

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 11 August 2021

Date revision received : 9 December 2021

Date accepted : 18 December 2021

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Overcoming supply disruptions during pandemics by utilizing found hardware for open source gentle ventilation

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Novel Coronavirus Disease COVID-19

Most cited references 35

Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic

COVID-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome

Sourcing Personal Protective Equipment During the COVID-19 Pandemic

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