Low-Cost Arduino-Based Ventilator
github.com
github.com
Edit: Another design we're considering based on an Army prototype: https://docs.google.com/document/d/1Hcuu-55q2a3_-LmBwg0uBdgM...
If you would like to help please join us at the #project-pneumatic-ventilator room of the Helpful Engineering Slack: https://helpfulengineering.slack.com/join/shared_invite/zt-c...
...and at home, the FDA isn't there to tell you not to use your home-made respirator.
“Uncertified ventilated vs dead” is not decision.
I'm pretty sure the regulator is willing to work with you. Also you should contact them now. It is actually possible you can tap into a lot of incidental industry experience if they point you toward someone who has spent a lot of time doing medical equipment certs or ventilator certs before.
Where is the core team of 12 people plus 108 collaborators that should have been assembled a month and a half ago to figure out how to retune US manufacturing to start producing stripped down ICU beds and the supplies needed to keep them operational?
This game is easy. The parameters are well understood. You could assign the basic problem to a middle schooler. Getting realistic numbers? Well it doesn't matter, no matter what those number are, every single fully functional ICU bed that can be brought online in the next 2 weeks is probably going to save 2 lives. According to some of the other economic analysis that has been posted here today suggesting that we let people die, that is 18 million dollars in human lives.
How many fully stocked ICU beds can you make for 18 million dollars? There's your startup idea for the next 2 weeks.
Not ignoring the fact that you need a team to staff it and work it, but guess what, you ALSO have two weeks to train as many people as you can to run these things.
WHERE IS THIS TEAM?
You don’t understand where things were at a month ago. I had a fight with my wife at Costco because she thought I was wasting money and overreacting when I purchased the 50 lb bag of rice (among other items).
She understands now. We all do. But a month ago people were in absolute denial about the inevitable and it was impossible then to convince them otherwise.
Now they're all sheltering in place in their homes.
It's amazing how big a difference you can make in the world if you can just get started... a month ago.
This one is trending towards 0.6%-0.1% so you can see why the response may not be the same given the 3 orders of magnitude lower estimated fatality rate. Yeah it’s serious but don’t kid yourself, it’s not the plague.
For instance I don’t think the UK would be contemplating just giving it to everyone young enough if it were to kill half to all of them. I don’t recall Thanos getting elected prime minister.
https://www.theverge.com/2020/3/13/21179291/elon-musk-corona...
I thought you were going to say "a history of making thoroughly unrealistic goals come to fruition" because that seems more accurate.
Good place to hide out from COVID-19, I'd reckon.
Yes, but everyone else in the space sector has missed by a bigger margin.
How’s the Bush Mars mission coming along? Bush senior that is, initiative announced 1989.
> and has only managed to pull through because hordes of taxpayers and investors continue to line up to dump money into his black hole projects on the back of his self-aggrandising.
You mean the rockets which are half the cost of any other provider including both government and private launch agencies?
Or do you mean the car company which turned electric cars from a hippy fantasy into a rich person fantasy and just made its millionth vehicle?
That seems like a disingenuous comparison given how much control a President has vs a CEO in this context. Bush Sr. had less than four years.
This isn’t meant to bash Musk, just to point out the somewhat unfair comparison. I actually think entities like SpaceX are necessary to combat the political risk inherent in administration turnover
I can only think of one that topped 20,000 units, and they've hit 1 million. Being the only company since WWII to startup and do that is not a small feat.
Sure, I could listen to all of his hype and crazy rosy projections. I could also listen to the things his worst detractors say sometimes. Both sets are just as wrong, though, so I prefer to pay attention to what his businesses are actually doing.
Any hospital bed + a ventilator is probably good enough. Sounds like the government and hospitals are putting in orders wherever they can.
But I imagine hospitals aren't going to buy slapped together untested products unless its really really bad.
I’d really like to help! But there’s no central organization for this. I think we have to quickly organize ourselves!
If anyone has any ideas please add them here in these hacker news comments, AND/OR I’ve just created a thread on my website which we can use for focused discussion: https://reboot.love/t/coronavirus-thread/281
I’m working from home and have some freedom to delay my normal work and assist with this. What should I do? Is it ventilators that are most obviously needed?
We could 3D print the air pumps, but where do we get a vast supply of cheap motors? Or in another case hospitals just needed replacement parts for existing ventilators. How do we get in touch with hospitals and determine their needs? People have also suggested multiple people can be connected to one ventilator with some success. Could we make an adapter to help with that? How would we determine requirements?
So the use-case here is people putting their loved ones on these ventilators at home because the hospitals are full (which is entirely possible).
Ideally, we should be working with existing ventilator manufacturers in the US to have them increase their current output.
2. Ventilators aren’t dumb iron lung machines. Current ventilators are large, complex and very much specialized machines which require special training to operate.
Once you get to the point you need a ventilator the ventilator is the least of your problems.
But really, I think this "home care in case the hospitals are full" thing is a pipe dream. A uniquely American pipe dream. For one thing, how are you going to hydrate and feed your loved one while they're on your homemade ventilator? Do you know how to insert an IV? Do you have saline solution on-hand? Ventilated patients in the hospital are being sedated, to my understanding. Do you have an anesthetist on hand to manage that? Etc. The American impulse to independence and prepping is so silly sometimes.
The only practical use for these ventilators is in a hospital context, employed by real doctors and nurses. And then only if the number of available ventilators ends up being the bottleneck (as opposed to the amount of healthcare worker labor available or some other factor). Any other imagined use is just a safety blanket, IMO.
As a former respiratory therapist I understand you concern about a project like this. I doubt anything beyond a CPAP machine is helpful for home care without risking a ventilator lung injury which is often characterized as the same lung pathology that COVID-19 creates in the acute respiratory cases.
That said, at home you could help at home patients relieve some symptoms until proper medical attention is available by doing positive breath holding exercises and chest percussion therapy to recruit more alveolar activity.
Paging Dr. Scott Weingart
https://emcrit.org/emcrit/some-additional-covid-airway-manag...
Also I’ve worked out a potentially simple functional solution. I’m going to try to make a YouTube video to appeal for input.
Not that we are in a shortage yet, there are only 50 people hospitalised but it's expected to rise.
It will come very quickly.
Yet nurses and doctors probably won't be able to keep up even with all the beds and respirators.
all medical startups are legal heavy, there's not much space for gung-ho attitudes.
imagine the shitstorm that would ensue if someone dies on a makeshift ventilator. and they will, because being ventilated gives no guarantee of survival.
My employers are industrial equipment dealers who remember WW2, and the pivoting of industrial production that it took to win the war.
We can still make a major difference if we are able to manufacture open source ventilators en masse.
What am I doing about it? First I'm reaching out to the engineering departments of two major academic institutions to find local engineering leads that can help in conceiving or identifying sound open source plans for a ventilator. The goal being to find consensus and validate a ventilator design that we can mass produce as fast as possible in North America. In parallel we would reach out to our provincial government to pitch this initiative. For this to be a success we need local as well as national government support. Not delegating the work to government but rather getting their legal support.
My employers know some local manufacturers, some in the USA, and in Mexico; all of them capable of manufacturing various parts as well as assembling on site. The knowledge, equipment, and production facilities are scattered. We just have to identify who can do what part in their shop as per plans that have been reviewed and approved. Ultimately we could use this production model for all essential equipment to fight Covid-19.
About patents. No patents were required during WW2 if governments had to produce equipment that would win the war. The Covid-19 pandemic might be worst than war so to win it patents should not be an impediment.
There are multiple online forums where a low-cost or open source ventilators are being discussed. I'm not seeking to add noise to this very important endeavour but I do feel the need to at least contribute towards a coordinated, structured effort.
I'm actively searching for open source ventilator initiatives all over the world to identify the most promising ones: I need your help in getting this done, the world needs your help, so please reach out via opensourceventilator@gmail.com along with your suggestions and advice.
Last but not least, I just registered opensourceventilator.org and will gladly donate it if needed to centralize efforts in this fight.
Thank you for taking the time to read this, good night, and have a pleasant tomorrow.
PS: Elon, how ya doing?
I agree. I wish the system did as well. :(
https://www.theverge.com/2020/3/17/21184308/coronavirus-ital...
> Medical company threatens to sue volunteers that 3D-printed valves for life-saving coronavirus treatments
> The valve typically costs about $11,000 — the volunteers made them for about $1
We're much better off right now with the government seizing the means of production and figuring out how to make as many as possible.
Also, government is much less effective at producing things than private companies.
You don't know how happy I am to see you say that.
https://threadreaderapp.com/thread/1239675564199481347.html
>The President said today that governors should try to get things like respirators and masks on their own. The problem with that approach is that suppliers will have to emergently engage w 50 different state purchasers who would in effect be competing for supply. 8/x
>Instead, the US fed gov should be central buyer and partner to this industry. It brings substantial immediate resources, and clarity. And when manufacturers make new ventilators in a mass effort, the fed gov would help organize their distribution around the country. 9/x
>What we need is a massive fed gov program to buy ventilators on unprecedented scale and with unprecedented speed. They don’t need to be the fanciest ventilators on the market. They need to be able to keep ARDS pts alive through course of COVID infection. 10/x
>This @forbes article gives snapshot of vent industry and a sense of what might be possible. It quotes one US manufacturer from 2 days ago saying he could ramp up production 5 fold but he hasn’t been asked to do it yet.
Why would we give them a choice?
The last thing we want is for "the government" to go around seizing production capacity from companies that have successfully produced these units for decades. When you imagine "the government", don't imagine your ideal policitian in a cape - you should imagine the bloke down at the local tax office who keeps opening obvious malware emails.
Corporations are not your faceless enemy, they're the ones who've helped your hospitals become amazing in the last few decades.
There's no way the current problem is only the price, for sure they are already trying to sell the most they can, they simply can't produce enough of them. Allowing some kind of shadow production, handled by the manufacturer can only means much more product made thus sold. It's a win-win for both the manufacturer and the government.
> We're much better off right now with the government seizing the means of production and figuring out how to make as many as possible.
Sure that would work, but that's always been true for anything. If the government could seize production, it would be "cheaper" to produce because the cost of R&D and production has been already done. That's not healthy though, that will now be an added risk in the industry that will have a cost to be mitigated.
Lets works together, not against eachother.
The arrangement does actually work fairly well in a crisis; you just need the sense of urgency to get everyone in the private sector all cranking on the same problem.
Or at least it has worked well before. Things like the F-22, F35, and Littoral Combat Ship aside... There is a point where stuff turns into a nightmare. The medical equipment needed though isn't really a problem where you should run into the sort of slog those projects ran into though.
Because capitalism only works with a functioning economy. If everything goes all pear shaped, and we have tens of thousands of people dying because we don't have enough ventilators (and the numbers suggest that this is quite possible), these companies that have been filling their bathtubs with cash are going to have angry gun toting mobs of newly homeless and bereaved Americans using their office windows for target practice. This will happen regardless of what's right or wrong, legal or illegal. We haven't seen this here before because we haven't had a strong enough economic collapse yet (excluding the Great Depression of course, where some of this did happen). It's happened in many other countries, and may happen here too if CEOs don't take a more long term perspective on pricing.
NIV does not allow the lungs to clear fluid and mucus. It also allows the virus to spread via aerosol and infect anyone without full PPE in the vicinity.
Those are also nowhere near as effective as the real deal i.e. intubation where you stick a tube down the lungs that sucks out fluid and pushes in air.
Why don't we have people upside down when stuff like lung fluid drainage is a concern?
I do it at home when I've got bronchial issues going on and while not pretty, gravity does a great job at assisting fluid expulsion as long as you can keep the swelling to a reasonable level.
Yes, you look silly, and your head can get a bit stuffy; but in the long run I've found it an invaluable practice when I've already tapped out everything else I have to throw at the problem for myself At home.
Inversion tables aren't exactly difficult to manufucture either; even if you do need to make sure you have someone else around for safety sake.
This would actually be a good public service if they would do for free and provide to hospitals, etc. for emergency use.
I "hack" (not really, just doing stuff / adjustments that clinics supposed to do) my machine for no other reason than they clinicians are useless once they sell you a sleep study and machine. You are typically on your own once you get it unfortunately, which is why the success rate of people using CPAP machines is usually pretty low. It can be a frustrating process without help and even if you do have good clinician, it is still frustrating to get used to it (some moreso than others).
There are forums out there that teach you how to adjust the settings on your CPAP/APAP/BiPAP machines, including how to get into the "clinician mode" to make REAL adjustments (e.g., like pressing and holding two buttons down on machine for couple seconds puts you into clinician menu settings). There is also software out there that will let you download the data from the SD card in most machines to your computer and analyze it. This isn't terribly critical, but if you have motivation / need it is handy to know how to do this. Makes titration much faster/easier and with less trial and error.
sleepyhead is the name of software (open source, no long maaintained unfortunatly but entirely functional still). Just google for sleep apnea forums.
Good luck with your son and rest of family!
Now, though, there is a complete 180 ? What gives ?
There is also the question of supply-side issues - uCs and IC boards are overwhelmingly manufactured in East-SE Asia. These projects can't get around these issues, right ? If only there were someway to hack the abundant numbers of smartphones in order to do something useful.
HN is being HN, for better or worse. First skepticism, then shallow takes, then acknowledgement and analysis, now frenzied problem solving.
> a ventilator was just one component in the ICU ecosystem.
Yes, the ventilator is a CPAP machine on steriods. The Respiratory Therapist, Intensivist and Critical Care Nursing staff are what actually keeps someone alive. It's not uncommon for one or more of these to have multiple touches per hour for evaluation and adjustment of the parameters, management of other life support, etc.
We need to buy a shit-ton of ventilators and PPE from existing manufacturers and provide relief for the front-line staff who will be using them.
Maybe a stupid question, but why can't this be automated?
It's called the "practice of medicine" for a reason. You can do everything "right" by the book and still have things go wrong. There is no substitute for eyes on the patient. Ever.
They have a tendency of expressing and voting with their emotions.
In fact, there is a much greater danger in abolishing emotion in its entirety from your decision making process period. It is very easy to end up in a situation where you create more problems than you created a solution for because you didn't take into account the fact you're dealing with other human beings. A practice famous for requiring good interpersonal communication; something dependent on being able to see things from another point of view.
Also, let them. The truly novel solutions tend to be hiding in places no one bothers looking because we're trying to take the rational structures have, and work backward to a solution whereby we can use as much of what we already have in place to make what we want. Working from a dearth of preconceived notions can lead to genuine innovation in some cases.
If it can get you a helicopter, it can get you a ventilator.
Without the threat of an overwhelmed healthcare system, why worry about a DIY ventilator? It would comfortably register as SEP (Someone Else's Problem) on most people's radar given the complexity of the rat's nest of regulation around the industry. With the crisis being what it is, however, you suddenly have a very interesting optimization problem, with very high stakes.
I can't fault folks for at least trying; and at the end of the day, who knows, someone may make something better/more efficient/cheaper/reliable/good enough to help. You'll never know if you don't try.
Just remember: do your research, learn why the current state of the art is what it is first, then make sure you can justify any design alteration you make in your particular implementation, then consult a regulator. They are there to either help or to specifically be part of whether or not your design is good enough given the logistical shape of the field.
That doesn't mean everyone go spam the FDA at once, mind. You don't want to DDoS the regulatory pipeline. If you're serious about it though, and willing to jump through the hoops in hope of being able to provide an alternative just in case; do so. Note it doesn't hurt to put a little more strain on the regulatory infrastructure as well. It helps the regulator to justify innovating how they can do their job more efficiently to!
Then, once you have regulator buy-in, go to your investors, and make the case for getting some mass production spun up, or figure out whether your job is done in the sense you're more of a design person, and less of an implementer, and get your design to those who can run with it.
This is the magic of the market at work! Not some arbitrage scheme, but an honest to God shift toward creating a greater supply capability to fill increased demand.
Some things are good to DIY, but not this, we need HN to stop allowing these dangerous posts.
Here is my experience: CPAP (actual APAP) for a several years now. Godsend for me. Don't even nap without it. In addition to the sleep apnea and impact it had on my life and long term health, there has been one other remarkable benefit. I have had no lung issues (bronchitis, asthma, pneumonia or even just wheezing), since not long after started using. For decades prior (I'm 50 now), I had yearly bouts with bronchitis due to my mild asthma combined with allergy seasons, etc. I also had couple which progressed to pneumonia. I have had NONE of that since starting and we are on the 4th year now. The APAP helps expand lungs and breath deeply, in addition to the intended benefit of keeping my airway from collapsing / sleep apnea.
CPAPS aren't dangerous. I've already thought about scenario where I'd use it on loved one over past couple weeks (prior to reading this article). Damn believe I will if have to. Alternative is potentially death.
Yes, ventilator (to me implying being intubated) is of course totally different.
I started using an APAP (Resmed10 autoset) about 2 years ago. My sleep study (overnight onsight at clinic) said I needed CPAP for sure and they slapped one on me in the middle of the night to "titrate" it just right for me. After got my machine, they were useless to adjust it. I did bare amount of research and found everything I needed to really adjust settings to work for me over couple months. I don't even take 30 minute nap without it now. Godsend.
I've also snagged the same model machine off ebay with only 30 hours on it (VERY hard to come by because the machine manufacturers are diligent and aggressive in getting them off resale market because of their status as prescribed medical equipment). Anyway, put my brother on said ebay machine, spent week or so of monitoring results and titrating his settings and he has been happy camper since. He had worse apnea than me, but alas no medical coverage at that time.
Of course, ventilators are in different class. That said, keeping CPAPs as prescription only medical devices is a scam and many lives could be extended and saved if could buy without script.
This appears to be simpler solution that can be AM'd quickly
Also, medical staff prefer not to use face masks because if the mask does not fit well on to the patients face there is a potential to aspirate body fluids and aerolise the virus.
I wonder what kind of expert rapid requirements review and qualification process could be created?
The comparable risk if the system is overwhelmed is life losses in triage or outright using using medical personnel as human ventilators - causing fatigue and mistakes too.
It could be an awful lot worse than nothing, especially since it's coming from GitHub and not somewhere like the Red Cross or MSF, with experience of medical care in tough environments , that knows the difference between "actually better than nothing" and "just something".
by giving those under-qualified to accurately diagnose a condition medical equipment that requires expertise to use, you increase the chances of incorrect use and non-indicated use.
This person isn't necessarily saying "Go build this if you have trouble breathing", it's a proof of concept.
If a ventilator can be powered by a brushed motor blower, this is quite doable and scaleable. There are unique opportunities to get maker grade devices enhanced and tested for production when lives are being lost. Certainly worth the effort while we sit on the sidelines.