I’ve seen concern that hospitals will run out of ventilators. Potential intervention: design a cheap machine to pump bag valve masks (which are ubiquitous and apparently do much of the same job as a ventilator, but currently require a human operator). I’d guess you could build something to perform this job for <$50; possibly very quickly if you had a team of competent engineers.
I don’t know how you’d get them distributed though, and I’m skeptical that the FDA would make it easy to sell them to US hospitals. I’m interested in anyone with experience in the medical device space, or experience in the constraints on what devices hospitals are allowed to use, weighing in on that question.
Found this paper: “Optimizing respiratory management in resource-limited settings” ″Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs. Recent case series report crude mortality rates for ventilated patients of between 36 and 72%. Measures to avert the need for invasive mechanical ventilation in LMICs are showing promise: bubble continuous positive airway pressure has been demonstrated to decrease mortality in children with acute respiratory failure and trials suggest that noninvasive ventilation can be conducted safely in settings where resources are low.” … “One of the most significant developments in acute care research in LMICs in recent years has been the publication of three trials demonstrating that continuous positive airway pressure (CPAP) can reduce mortality in children under 5 years of age, compared with oxygen delivered via standard low-flow nasal cannula [35▪,36,37▪]. CPAP can also decrease the need for invasive mechanical ventilation [38▪▪]. There are three main ways to generate CPAP: first, by using a pressure driver or a ventilator; second, using high flow nasal-cannula oxygen therapy (HFNC); or third, by submerging the expiratory limb of a breathing circuit in water to create so-called bubble CPAP. Traditionally bubble CPAP circuits also contain a driver, although some newer iterations only use the oxygen/air flow from an oxygen concentrator to generate CPAP [39].
All three trials used bubble CPAP as the intervention and together showed a risk ratio of survival of 0.58 [95% confidence interval (CI) 0.41–0.82] [38▪▪]. One study had an additional intervention arm using HFNC, but no conclusions were drawn regarding its efficacy as the study was terminated early due to increased mortality in the control group.
Nasal cannulae, used as the patient interface in all three trials, are an attractive option for understaffed environments because they generally require lower levels of nursing supervision to use safely [39]. The basic circuits and simplified care protocols meant that the equipment required few adjustments, especially when compared with invasive mechanical ventilation.
There are elements of each of these studies that epitomize context-appropriate innovation and research. The bubble CPAP circuit deployed in the Bangladesh study was fashioned out of readily available, cheap equipment (standard nasal cannula, a shampoo bottle and intravenous fluid tubing) so the cost of the circuit was approximately $3 per patient [35▪]. They used an oxygen concentrator and no driver in the circuit with additional cost savings.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319564/
A “portable, easy-to-use ventilator” was highlighted in the Johns Hopkins Center for Health Security report on Technologies to Address Global Catastrophic Biological Risks (press release, full PDF). Their write-up of this technology is on page 61-63 of the report.
I’ve seen concern that hospitals will run out of ventilators. Potential intervention: design a cheap machine to pump bag valve masks (which are ubiquitous and apparently do much of the same job as a ventilator, but currently require a human operator). I’d guess you could build something to perform this job for <$50; possibly very quickly if you had a team of competent engineers.
I don’t know how you’d get them distributed though, and I’m skeptical that the FDA would make it easy to sell them to US hospitals. I’m interested in anyone with experience in the medical device space, or experience in the constraints on what devices hospitals are allowed to use, weighing in on that question.
Found this paper: “Optimizing respiratory management in resource-limited settings”
″Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs. Recent case series report crude mortality rates for ventilated patients of between 36 and 72%. Measures to avert the need for invasive mechanical ventilation in LMICs are showing promise: bubble continuous positive airway pressure has been demonstrated to decrease mortality in children with acute respiratory failure and trials suggest that noninvasive ventilation can be conducted safely in settings where resources are low.” … “One of the most significant developments in acute care research in LMICs in recent years has been the publication of three trials demonstrating that continuous positive airway pressure (CPAP) can reduce mortality in children under 5 years of age, compared with oxygen delivered via standard low-flow nasal cannula [35▪,36,37▪]. CPAP can also decrease the need for invasive mechanical ventilation [38▪▪]. There are three main ways to generate CPAP: first, by using a pressure driver or a ventilator; second, using high flow nasal-cannula oxygen therapy (HFNC); or third, by submerging the expiratory limb of a breathing circuit in water to create so-called bubble CPAP. Traditionally bubble CPAP circuits also contain a driver, although some newer iterations only use the oxygen/air flow from an oxygen concentrator to generate CPAP [39].
All three trials used bubble CPAP as the intervention and together showed a risk ratio of survival of 0.58 [95% confidence interval (CI) 0.41–0.82] [38▪▪]. One study had an additional intervention arm using HFNC, but no conclusions were drawn regarding its efficacy as the study was terminated early due to increased mortality in the control group.
Nasal cannulae, used as the patient interface in all three trials, are an attractive option for understaffed environments because they generally require lower levels of nursing supervision to use safely [39]. The basic circuits and simplified care protocols meant that the equipment required few adjustments, especially when compared with invasive mechanical ventilation.
There are elements of each of these studies that epitomize context-appropriate innovation and research. The bubble CPAP circuit deployed in the Bangladesh study was fashioned out of readily available, cheap equipment (standard nasal cannula, a shampoo bottle and intravenous fluid tubing) so the cost of the circuit was approximately $3 per patient [35▪]. They used an oxygen concentrator and no driver in the circuit with additional cost savings.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319564/
here’s a build diagram for a bubble cpap
https://www.edjones.org/articles/bubble-cpap-in-resource-poor-settings/?fbclid=IwAR05oxQ2tPg1LDD6o73cBWOGKukaYBq8APcFpNmB1y900nPovTwV0yFBWBQ
are studies indicating it’s helpful for adults (despite its primary use in infants)
https://intjem.biomedcentral.com/articles/10.1186/s12245-019-0224-0
This is super interesting—Some of the most interesting-sounding links seem broken, though [edit: fixed]
A “portable, easy-to-use ventilator” was highlighted in the Johns Hopkins Center for Health Security report on Technologies to Address Global Catastrophic Biological Risks (press release, full PDF). Their write-up of this technology is on page 61-63 of the report.
One of the sources they link describes the OneBreath ventilator. Might be a good place to start looking!