By: Jose Luis Penarredonda
Date: April 1, 2020
There are not enough ventilators available in hospitals right now for all of the potential patients who will be struck by the virus. An influential report from Imperial College London estimates that 30% of Covid-19 hospitalised patients are likely to require mechanical ventilation. The only way to avoid overwhelming intensive care units, it says, is with a mandatory lockdown that reduces social contact by 75%.
In terms of their core function, ventilators are not extraordinarily complicated machines. Basically, they are sophisticated pumps – they control the oxygen and air flow from the patient’s lungs, supporting them while they cannot do their work.
So why are they so difficult to design?
Because it isn’t their function that is difficult. It’s that they have to operate in an extremely reliable way in a high-stakes environment.
“If they fail, the patient is very likely to die,” explains Mauricio Toro, a Colombian engineer who joined a group in Medellin that completed the design of three different open-source ventilators. “This is what makes them so challenging to build.”
The race is on
Governments and health authorities are keenly aware of the challenge. The UK government aims to add more than 1,200 ventilators to its system in less than two weeks, and is forecasting it will need 30,000 at the peak of the outbreak. For that, it has called on non-health industries and universities to help in a wartime-like effort.
Even Formula One racing teams are joining the effort. Dyson, the vacuum cleaner company, already received an order for 10,000 ventilators, and Smiths Medical’s efforts to treat less critical patients with CPAP (Continuous Positive Air Pressure) devices, more commonly used for controlling sleep apnoea, are advancing rapidly. Meanwhile, engineers and researchers are coming up with other creative solutions – such as the Ventil, a new machine that, when attached to a ventilator, can allow for the ventilation of two patients simultaneously.
As a result, thousands of experts, entrepreneurs and volunteers around the world are developing a different potential solution: creating open-source ventilators. With access to relatively simple designs, makers in Africa or South America could build ventilators quickly and cheaply using already available hardware and infrastructure. And since all the intellectual property of these projects will be free to use, licencing and copyright issues won’t get in the way of builders.
These designers are working at breakneck speed – at least a dozen ventilator prototypes at different stages have been developed in March 2020 alone by teams in different countries – and organising on Slack channels, Facebook groups, and GitHub repositories. They think they can help solve the bottleneck, particularly in parts of the world with less capability to respond to the crisis, like Africa or South America.
Colin Keogh, an expert in 3D printing at University College Dublin, has been leading a team of volunteers looking at community-sourced and open-sourced projects. His team already has released a first prototype that works by automating “ambu-bags”, the pumps often used in ambulances and urgent care.
Other initiatives are more ambitious. Researchers from Oxford University and King’s College London set up OxVent, a project aimed at developing prototype ventilators“that are not as sophisticated as the ones that are currently used in hospitals, but that nonetheless meet the requirements in terms of safety and features that are required,” says Federico Formenti, a senior lecturer in Human Physiology at King’s College London who is part of OxVent.
Materials are another challenge. They should be able to endure extensive wear and tear, not be likely to spread infection, and hold up under different cleaning methods, like chemicals or UV. These requirements seriously entangle the design process, as they complicate engineering choices. “It cannot be a fire hazard, and oxygen is very corrosive for many materials,” says Medellin engineer Toro.
This can be tricky: for instance, while 3D printing process itself makes the devices sterile, the plastic used in it is very porous, so it is it difficult to keep pieces clean and safe once printed. It means the technique is best suited for creating disposable items and not for replacing conventional parts or entire machines.
Even if designers and engineers can solve all of this, the machines must be easy for health professionals to use, meaning they should be as similar to existing ones as possible or very simple to learn to operate. This is key in order for them to be useful in this crisis: the US National Academy of Medicine, for example, recommends hospitals “minimise the need to train staff” to operate ventilators so they can respond with the rising demand.
This article highlights not only the challenges that are present with current day hospital ventilators, but also brings awareness to the necessity of ventilators and the rate in which hospitals need more in order to care for their patients. As outlined in the text, it is not that hospitals would like to have more ventilators, there is a shortage that can and has resulted in further patient complications in addition to adjustments that include patients sharing a single ventilator. The insights derived from this information has lead to varying directions of DIY ventilators and other collaborative teams seeking to develop new designs that can be efficiently mass produced, once the huddle of testing has been approved. Therefore, the question that has yet to be asked is “How will these new designs effetely be implemented into a hospital?”. Acknowledging that there are people working on the technological advancement of the ventilator machine, there remains underlying inconveniences that have yet to be addressed and accounted for that will enable for the proposed designs to excel in the intend environment with a ‘chaotic atmosphere’ to accompany. This question will guide my future research, to distinguish the Problem vs. Inconvenience and by defining the two my search will be narrowed enough to target the core issues that ultimately create the problem of implementation and user-experience.