It looks very workable to me, but the BLUE BAG is the place where air enters and then is forced into the patient. It MUST be more durable than is in use now as temporary resuscitation devise. THAT SAID, this looks like a very viable design. It is a matter of using the current supply available for resuscitators and improving on the manufacturer's GRADE OF RUBBER/PLASTIC used.
Clinical and design considerations (click here) will be published online; goal is to support rapid scale-up of device production to alleviate hospital shortages.
The current resuscitators CURRENTLY IN THE HOSPITAL are not designed for extended use. That will have to be considered in that design.
...The team, called MIT E-Vent (for emergency ventilator), was formed on March 12 in response to the rapid spread of the Covid-19 pandemic. Its members were brought together by the exhortations of doctors, friends, and a sudden flood of mail referencing a project done a decade ago in the MIT class 2.75 (Medical Device Design). Students working in consultation with local physicians designed a simple ventilator device that could be built with about $100 worth of parts. They published a paper detailing their design and testing, but the work ended at that point. Now, with a significant global need looming, a new team, linked to that course, has resumed the project at a highly accelerated pace....The states are not only competing for equipment, it is actually a global competition.
...We are one of several teams (click here) who recognized the challenges faced by Italian physicians, and are working to find a solution to the anticipated global lack of ventilators. In the US alone, the COVID-19 pandemic may cause ventilator shortages on the order of 300,000-700,000 units (CDC Pandemic Response Plans). These could present on a national scale within weeks, and are already being felt in certain areas. An increase in conventional ventilator production is very likely to fall short and with significant associated cost (paywall warning).
Almost every bed in a hospital has a manual resuscitator (Ambu-Bag) nearby, available in the event of a rapid response or code where healthcare workers maintain oxygenation by squeezing the bag. Automating this appears to be the simplest strategy that satisfies the need for low-cost mechanical ventilation, with the ability to be rapidly manufactured in large quantities. However, doing this safely is not trivial....
They appear to be made of items already in the hospitals in the USA. The cities need to put their city engineers to work on the design and teach hospital maintenance personnel how to assemble them. Basically, there needs to be a teacher to facilitate the distribution of that information to many hospitals.
My only real concern in this design is the DURABILITY of the soft parts and having either items nearby to bring about a quick replacement and/or asking the manufacturer of these SOFT items to make them now more durable for longer term use.
Just a word about the markets. This fluctuation is nothing. They appeared to have stabilized. I have an article I want to discuss about the ethics of the current financial sector, BUT, FIRST, let's discuss the ethics of ventilators.
To being there is such a thing as A HEALTH CARE PROXY AND HEALTH CARE POWER OF ATTORNEY.
Those must be honored at this time and hospital staff that meets the admission to the hospital have ways of assessing the wishes of the patient when being triaged. Many hospitals have a record (copy) in a patient's chart already. These are frequently found in patients hospitalized with end-stage cancer. In the case of these patients, the health care proxy may prohibit ventilation AND may demand Hospice Care at Home or in Hospice units. The demand for PPE by home care staff is necessary as well.
IT IS NOT MY CALL to encourage discharge to the home of seriously ill patients with COVID-19 with Health Care Proxies that demand no invasive methods. Those best to make policy regarding these patients are LOCAL Public Health personnel. When a policy is in effect, the doctors will defer them to Hospice and home. Docs and Nurse Practitioners write the discharge and/or home orders.
To vent or not to vent and termination of a ventilator. It appears there is already some discussion of this. BUT, I would like to see more ventilators. There need to be more ventilators NOT fewer patients when they are very ill.
March 25, 20202
By Dr. Mark Abdelmalek, Kaitlyn Folmer and Josh Margolin
Faced with more critically ill COVID-19 patients (click here) than equipment to treat them, hundreds of hospitals are mapping out how they can ration care and equipment in order to save the greatest number of patients possible.
In the last two days, guidelines were provided to scores of hospitals around the country, including every hospital in Pennsylvania, that include a point system that could – in extreme cases – end up determining what patients live or die.
"Priority is assigned to those most likely to be saved, and most likely to live longer," said Dr. Scott Halpern, professor of medical ethics and health policy at the University of Pennsylvania.
On Monday, Halpern and Dr. Douglas White, chairman of ethics in critical care medicine at the University of Pittsburgh, released guidance to hospitals that is now being adopted throughout the nation.
White said "the existing approach to allocate ventilators was unfair because it excluded large groups of patients."...
Local and State Authorities have the right to review hospital policy under their authority. NO government policy should override the doctor's assessments and ethics. They believe in life and it is their call to order a vent or just oxygen. Even if a COVID-19 patient is end-stage anything, it is still the decision of the physician to make the order with respect to a patient's wishes. That relationship CANNOT change. Physicians and Nurse Practitioners have to be able to look themselves in the mirror and know they acted ethically with each such decision.
AGAIN, euthanasia is illegal in the USA, except where legislation has allowed terminally ill patients their dignity, including I think it is Oregon which allows self-termination.
An example of an end-stage disease that has patients living for a decade or more is kidney failure and dialysis. So, just because a patient has an end-stage diagnosis does not mean they are terminal. Physicians and Nurse Practitioners can determine these decisions.
There are also people in home care with ventilation already. An example of that is ALS. Lou Gehrig's Disease is a terminal illness whereby a patient often dies at home on Hospice with a ventilator. Yes, the ventilator is on until death when the patient no longer is capable of sustaining consciousness.
So, it is the decision of physicians to discern the care of a patient going forward. This is not simply a government policy. The government legislates PERMISSION to the individual American to determine their path forward with advanced methods of sustaining their life. That MUST NOT CHANGE. American physicians have perfected these delineations.
ONE MORE TIME. MORE VENTILATORS AND NOT LESS PATIENTS.
That should do it for now. Public Health authorities can be helpful at this time to help with difficult decisions by government officials.
