Ventilators 101: What they do and how they work
hackaday.com
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This is a difficult point for many people to understand. Sometimes the problem really is too complicated for a simple solution.
Programmers, just get out your checkbooks and stop trying to help.
Often the PE is more of a lawyer than an engineer. They typically do have an engineering degree, but are years out from any hands-on engineering work. They do final legal sign-off, and are knowledgeable about statutes and insurance policies, but rely on people with more recent technical experience to do any technical work.
Which is significantly stronger than the state of software engineering.
So, a medical device engineer.
I agree programmers are not on this level.
That said - the vast majority of developers are nowhere near that.
It's a really long tail.
Anyway reinventing the wheel is underrated. Taking actual wheels as an example, there’s a long and impressive history there and we’re not close to being done yet. And so with most other things.
At its core, these are all variations of Pascal’s wager. I believe what would be most useful is pointing out that using the scientific method does not automatically lead to multi-year 3-phase trial requirements. It’s perfectly possible to use the statistical methods we usually do, but adjust parameters such as cutoffs for significance or weighting of side-effects to better match our preferences and increased risk tolerance.
An important factor here is also the unfettered, obnoxious arrogance that seems to be ubiquitous in tech culture. It's not so much "I don't believe in science" so much as "I'm above science, and therefore already understand all of it."
It's the idea that if you have a sufficient mastery of software engineering then, by extension, you have a mastery of the technical aspects of literally every other field, whether it's medicine, science, psychology, law, or even art. (Or, at least can easily master it after reading a few Wikipedia articles on the topic.) And if only the experts in that unrelated field would listen to the ingenious ideas that you thought of just now, then the crisis would be averted.
But, I'm being uncharitable here. It also comes from a place of genuinely wanting to help during an unprecedented global crisis when we're all frightened, isolated, and feeling helpless.
On the other hand, sometimes they do upend industries by remaking things, usually by finding and banishing some devastatingly huge false assumption the legacy players have built everything around, and exploiting the opportunity that this opens up.
So yes, uncharitable.
I've been yelling this at the top of my lungs across a range of platforms. I understand the hubris created by the Dunning-Kruger effect. We all fall prey to that at some point or another in life.
That said, just because people don't know what they don't know it doesn't magically endow them with supernatural powers to be able to create solutions to problems that have decades of development, a complex history of evolution and are the result of intense development, testing and manufacturing by dedicated multidisciplinary teams over years of dedication.
You cant Superman ventilators.
Please stop.
Find other ways to contribute. If you must work on ventilators, call established companies making them and ask how you might be able to help. Ask to work for them for free if you are able to.
Anyone doing this should consider the possibility that the answer may be that there's nothing they can do on a useful timeline except write a check.
If you want to help, you gotta swallow your ego.
-H. L. Mencken
I guess that makes your comment Dunning-Kruger about Dunning-Kruger.
"In the field of psychology, the Dunning–Kruger effect is a cognitive bias in which people assess their cognitive ability as greater than it is. It is related to the cognitive bias of illusory superiority and comes from the inability of people to recognize their lack of ability."
Engineers who don't know they don't know what it takes to design, manufacture and test a life-critical medical piece of equipment at scale. Yup, very much Dunning-Kruger. They think they know far more than they actually do. There's was a link HN just a few days ago from a bunch of physicists who set out to design a ventilators using, among other things, Home Depot parts. Let me put it this way. We have someone in my family with a PhD in Physics. Super smart guy. He has never built anything and can't build anything, much less life saving devices by the thousands.
DK doesn't just apply to "dumb" people. I have worked with dozens of engineers who don't understand just how much they don't know.
Maybe not the strict intent of DK, but very much the same kind of effect.
Let's not split hairs. I think you know what I meant.
hardware also fails in the field in unpredictable ways. Especially to anyone without long practical experience.
I calm down when I realize none of the people asking the questions understand manufacturing one bit. And then I get rattled again because they are communicating falsehoods to the general population. We don't have enough masks, test kits or ventilators because you can't Superman hardware production.
It isn't Trump's fault or anyone else's. It takes time --lots of time-- to setup a manufacturing process and start to produce product at scale with consistent quality and performance. Weeks for the most trivial of products, years for more complex hardware. Yet people don't have an understanding of this.
Ventilators? Holy cow. Talk about not being able to Superman something into existence.
If people understood they would realize that we made a massive mistake over the last 50 years by allowing our industrial base to evaporate and migrate to China to the extent it has. Consumers are as much at fault as the decades of incompetent politicians who allowed this to happen. While we bothered with nonsense (wars, etc.) China quietly went from an agrarian society to the second economy in the world. And, even worse, the world's factory. We, quite literally, cannot make anything in the US or Europe without Chinese components and, in some cases, all we are able to do is design in the US or Europe and have no choice but to manufacture in China.
I suspect things might change over the coming years. The money we wasted in wars would have been far better spent keeping industry alive locally. Yes, subsidies, no taxes for manufacturers, relaxed regulatory burden, etc. Either we do those things or the next pandemic will, once again, find us not being able to even manufacture face masks at scale. How laughable is it that people have to sew face masks at home in the US? Sad.
BTW: In Spain they just woke up to the reality that they received 340,000 bad test kits from China.
Sure, ideally we'd want the certified equipment, built by the professional knighted safety engineers, stamped by the right bureaucrat, with 1000 pages of documentation proving how thoroughly expert-approved they are, but when you run out of these, what do you do?
[1]: https://www.thelancet.com/journals/lanres/article/PIIS2213-2...
by the way, the critically interesting thing in that piece from the lancet is that the rational for discouraging non invasive respiration is a lack of good masks and negative pressure rooms. These are problems where I think there has been an historical lack of imagination and are ripe for some novel solutions.
A few days after the surgery, he couldn't even breath on his own: MRI showed that parts of his brain were damaged. At that time, I think it's more sympathetic to let him go instead of making his life depending on a ventilating machine for the rest of his life.
The circumstances of this situation is that ventilated COVID patients often drown in their own plasma, get bacterial pneumonia or their lungs are irreparably destroyed. Like ECMO, this sort of ventilation is a hail mary procedure to try to salvage patients.
Even COVID survivors with mild symptoms, they may have reduced lung capacity due to lung damage.. and that may well be permanent. I suspect lung transplant lists will be backlogged the world over due to this pandemic.
We should be upfront about the odds of a full recovery and allow room for thoughtful discussion around patients’ wishes. The frenzied environment of ICUs during a pandemic isn’t conducive to this, so we need to be deliberate and talk about it as a country. The “job one is saving lives” rhetoric may not be best for patients and their families.
I’m not sure if that experience is caused by the ventilation, or by the disease and misattributed. In any case, I’ve decided not to get infected by this bug. And if I fail at that, I might even consider a living will excluding ventilation.
The first time they put some kind of special tube in under general. When I came to 3 days later there was no ventilator, and the end of the tube was in my throat. It felt like a rectangular block. They extubated me while I was awake and immediately put me on high flow oxygen. They would've intubated me on the spot if I couldn't breathe. Never felt a gagging sensation in this instance.
One way to help would be to aid physical containment. The first thing that comes to mind are online tools for communication, learning and doing basic daily life things. I think that there is still room for improvement.
The next thing comes to my mind is that people need to go out to buy food, medicine, etc. They also need to drink something and in some places water needs to be sanitized. Maybe DIY sanitizers are an option?
Food and other supplies might be bought online, but companies doing online sale and food delivery seem to have issues handling the load. I think that the biggest issue is finding drivers and delivery man to bring groceries do people's doors. Surely, self driving cars and trucks and robots taking packages and climbing staircase or using the elevator aren't an option, but I have other ideas.
People could order stuff through internet from their local shops and supermarkets and then pick them packaged in boxes from parking spaces or a drive through with store employees putting boxes in people's trunks or even a system where people go to a door with a belt, scan a QR code from an app, see the door open and their package arriving on that belt.
I remember that when the epidemic was starting, journalists reported that people rushed to shops and all the pictures of people with their carts filled with toiled paper standing very close to each other in a very long queue. To me it seemed like the best way of getting infecded.
I have many other ideas for 'improvements' and notice other 'mayor problems', but this comment is already way too long...
I hope that this isn't off topic in the ventilator thread.
Isn't there a way to oxygenate blood outside of the body like dialysis? Why isn't that used more?
Yes, we don't have enough ventilators. But we have more ventilators than what our currently trained staff can operate.
But that isn't a problem that excites engineers.
> VOCSN integrates five separate medical devices, including a ventilator, oxygen concentrator, cough assist, suction, and nebulizer, into one multi-function ventilator.
First, mucus is protective of the lungs. Personally, I don't believe there really is such a thing as "too much mucus."
As someone with chronic lung problems, I cough up less crap when I can keep mucus production up. So I think that if you have junk in your lungs, it's phlegm, not mucus.
They can be hard to tell apart. The difference is phlegm is basically infected drainage, sort of like the lung equivalent of pus.
Salt and fluids are the two main components of mucus. To support mucus production, you should stay hydrated and get enough salt.
Second, there are other ways to improve lung function in the face of pneumonia and inflammation. Many of these methods are medically prescribed and used daily by people with serious, chronic, incurable lung conditions, such as cystic fibrosis.
I have talked about this before. I don't really want to harp on it or argue with people.
I'm not a doctor. I'm just someone who has a form of cystic fibrosis, so management of serious lung issues is a daily part of my life.
Please see some of my previous comments for additional info:
I am aware of the official explanation for CF and have noted what it is in another comment of mine in this same discussion.
I am not actually looking to get into some long tangent concerning my opinion about how CF really works. It's irrelevant to this discussion.
If you don't care for my personal opinions about how this works, please just focus on the takeaway that "non mechanical air clearance methods exist and are medically prescribed" and please seek out official medical sources of information on airway clearance, which Italian doctors are apparently using in cases not serious enough for a ventilator.
Airway clearance is medically prescribed and it's not because we tend to have big holes in our lungs from repeated infections. It's because we tend to have too much gunk in our lungs.
Reduced lung function per se for people with CF is typically due to the lungs being eaten away by infection. The end game for medical treatment of that issue is typically lung transplant. People with CF account for about a third of all adult and half of all pediatric lung transplants in the US, or did the last time I looked up such stats.
Some also get away with just taking in oxygen, I guess at the hospital they have to evaluate and monitor.
> The ultimate goal with these three things is to give the patient time to develop antibodies and fight the virus and clear out the lungs
Where does the fluid come from in the first place? Do the viruses (I can hardly believe) or bacteria produce it? Doesn't the patients own body do? If it does then why and how? Can that be inhibited?
With covid-19 and flu, you generally don’t die from the effects of the virus, you die from the side-effects of your own body’s immune response.