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Pandemic Ventilator Project

panvent.blogspot.com

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Re: Pandemic Ventilator Project

#71

Post by rectang »

DataDrivenMD wrote: post #70
rectang wrote: post #67

Earlier quoted context omitted.

Anecdotally: My mother is a retired RN with an "inactive" license in Washington state. She does elder care as a side gig for individual clients. She recently had to turn someone down because the patient was intubated; it's not legal for her to care for such a patient. If anything went wrong she could be both at risk of a lawsuit and in trouble with the state for practicing medicine without a license. (She's also in h…

You raise a related issue, which is critical to address as well. That is, we need people to help manage patients before, during, and after their hospital stay. I’m less concerned about the licensing issues because public health emergency declarations make it possible for state officials to clear the way for someone like your mom. Where you, and fellow hackers can help, is by offering tech solutions that solve the iss…

Count me in!

> revisit the concept of an Uber-like platform for healthcare delivery

Where has this been discussed before? There are lots of referral services, some of them charities, some of them private businesses. For example, in Washington state there's the Korean Women's Association: https://www.kwacares.org/

Re: Pandemic Ventilator Project

#72

Post by wool_gather »

rectang wrote: post #67
DataDrivenMD wrote: post #62

As an anesthesiologist and hacker, I love the enthusiasm here. I’m less concerned about the hospital use-case. It would be helpful to crowdsource solutions to address the need for ventilators after patients leave the ICU. Based on current practice patterns, some patients will undergo tracheostomy tube placement, and then need to be discharged to respiratory rehab facilities. We will need to increase capacity in this…

Anecdotally: My mother is a retired RN with an "inactive" license in Washington state. She does elder care as a side gig for individual clients. She recently had to turn someone down because the patient was intubated; it's not legal for her to care for such a patient. If anything went wrong she could be both at risk of a lawsuit and in trouble with the state for practicing medicine without a license. (She's also in h…

Is it not a "simple" matter of the state waiving license requirements like this? I thought I had heard of this being done already.

I.e., either the governor or the legislature says "it's no longer impermissible for RNs with inactive licenses to care for intubated patients". Or even "all inactive licenses shall be considered active on request of the licensee, until DD/MM/YYYY". Fiat, done.

Re: Pandemic Ventilator Project

#73

Post by DataDrivenMD »

rectang wrote: post #71
DataDrivenMD wrote: post #70

Earlier quoted context omitted.

You raise a related issue, which is critical to address as well. That is, we need people to help manage patients before, during, and after their hospital stay. I’m less concerned about the licensing issues because public health emergency declarations make it possible for state officials to clear the way for someone like your mom. Where you, and fellow hackers can help, is by offering tech solutions that solve the iss…

Count me in! > revisit the concept of an Uber-like platform for healthcare delivery Where has this been discussed before? There are lots of referral services, some of them charities, some of them private businesses. For example, in Washington state there's the Korean Women's Association: https://www.kwacares.org/

Sweet. Looked into the KWA's site, seems like a clear use-case. If we were to break down the build into achievable chunks we may have more success, and have a bigger impact along the way.

There's an immediate need for a single source of truth for all the locations where COVID-19 testing is available. Trump said Google was building it, but turns out they are weeks away from an MVP that would only cover the SF Bay Area. I propose we start by solving that problem.

Building on this, we can answer the question: what is the scope of the problem? Today, the CDC doesn't have an accurate count of the # of COVID-19 tests that have been performed because they don't have a way to collect that info from the growing number of labs that are performing the tests. Moreover, there's no way for anybody to know how many people have actually been tested, because the same person can be tested multiple times. We could solve this problem by crowdsourcing that information directly from individuals.

Building on this, we need to know where the sickest people are right now, and predict where they could be in the near future. This is crucial information for healthcare providers (like me) and public health officials alike. Without this information in hand, it's virtually impossible to know where to direct resources (like doctors, nurses, ventilators, medical supplies, testing equipment, etc.). We need to be able to track demand AND supply in real-time --> this is the point at which the project starts shaping itself into an Uber-like platform.

Building on this, we could enable individuals to post offers to help and for others to request assistance. This would allow people like your mom to lend a hand where it is a) safe for her and b) most needed.

The ultimate goal would be to build an open-source platform that could be used by communities around the world with little-to-no deployment overhead. Ideally, it would be possible to clone the repo, customize a few parameters, and deploy instances in less than an hour.

I'll flesh this out a bit more, and submit the idea as an Ask HN topic.

Re: Pandemic Ventilator Project

#74

Post by duckymcduckface »

DataDrivenMD wrote: post #60
pcj-github wrote: post #46

I'm surprised we haven't seen anything detailing the supply chain involving O2. This is as important than the actual machine.

Anesthesiologist here: yes and no. It depends on whether the patient is having difficulty clearing CO2, in which case ventilation is more important. If the patient’s lungs are unable to extract sufficient oxygen from the air such that the blood oxygen levels drop below a certain threshold, then supplemental oxygen becomes important. In fact, excessively high oxygen concentrations in inhaled gas has the potential to d…

Where do hospitals get their O2 supply from out of curiosity? Do they buy it from one of the major gas suppliers like praxair or airliquide and store it in the back as GOX/LOX or can it also be produced on site?

Re: Pandemic Ventilator Project

#75

Post by davidzweig »

semi-extrinsic wrote: post #10

I've been looking over the designs being put forward in the various places now, and I cannot understand why people aren't just planning to copy the Manley ventilator. This was the standard ventilator in Europe for decades. It is simple to design, does not even require electricity (mechanical solution driven by air from central compressed air system) so all parts can be sourced locally, and the design has a clinically…

I proposed a design on the slack group based on a centrifugal blower and airflow and pressure sensors.. I think this is the principle modern hospital ventilators use. You do the logic and control system in C code rather than mechanical linkages and valves.. very few moving parts, and pcbs/pcb assembly are quick and cheap. just don't make any bugs..

Re: Pandemic Ventilator Project

#76

Post by yourapostasy »

projektfu wrote: post #29

I would imagine an epidemic of ventilator associated lung injury if people started rolling out homemade ventilators in quantity.

Please don't take this as a personal address to your specific comment. Yours was simply the last drop of water that tipped the scales in me to comment on an overall trend I'm seeing. What I'm beginning to see in a lot of these types of discussions is those calling for caution/compliance are missing the term "in extremis".

I've seen no one is suggesting that these DIY/hacking efforts of all stripes replace the existing healthcare infrastructure. What I see is concern the existing infrastructure is not scaled to handle what we anticipate will happen even in a moderate scenario. We have in this very thread a real MD who confirms that post-ICU ventilation is not being addressed but still needs to be, yet that confirmation seems to fly by those who say that DIY isn't advisable.

My position on the mitigation however, starts from these two premises:

In Extremis, any action is better than no action at all.

In Extremis, don't let perfect be the enemy of good.

When asked, I believe many will opt for a 1% chance of living on a DIY ventilator intubated by recently-out-of-license nurses emergency-authorized during the pandemic when no other intubation staff are available in the time required to attempt saving a life, than a 100% chance of dying with no ventilation option whatsoever.

What I'm not seeing are any alternative solutions offered by those who want to stick to the "official" script. Let's in about 6-8 weeks from now our healthcare infrastructure is overwhelmed by severe respiratory distress cases, starting in the June timeframe. What do you suggest we do to prepare for that starting now instead of any of the DIY efforts you deem too risky/non-compliant?

I'm honestly asking in response your specific post, now. Even an answer like "triage non-comorbid over comorbid patients, let the comorbid patients die" is acceptable. Even if your response is, "I'm no domain expert, I'm leaving it all up to the experts", that works for me, too. I'm just trying to figure out what your mitigation angle is.

What doesn't help improve our probabilities nor mesh with my personal philosophy is giving criticisms with either no alternatives or no position statement of what you believe is an acceptable protocol going forward. It's in my nature to seek answers and address my curiosity, even if it only leads to a partial answer. If that's not you, then you live your best life, and thanks for the note of caution, it is definitely a concern to manage as best as we can.

Re: Pandemic Ventilator Project

#77

Post by khwerou098 »

duckymcduckface wrote: post #74
DataDrivenMD wrote: post #60

Earlier quoted context omitted.

Anesthesiologist here: yes and no. It depends on whether the patient is having difficulty clearing CO2, in which case ventilation is more important. If the patient’s lungs are unable to extract sufficient oxygen from the air such that the blood oxygen levels drop below a certain threshold, then supplemental oxygen becomes important. In fact, excessively high oxygen concentrations in inhaled gas has the potential to d…

Where do hospitals get their O2 supply from out of curiosity? Do they buy it from one of the major gas suppliers like praxair or airliquide and store it in the back as GOX/LOX or can it also be produced on site?

In the past they had large tanks of liquid O2.

More recently, many have a large oxygen concentrator machine on site which just takes it from the air.

Re: Pandemic Ventilator Project

#78

Post by rectang »

DataDrivenMD wrote: post #73
rectang wrote: post #71

Earlier quoted context omitted.

Count me in! > revisit the concept of an Uber-like platform for healthcare delivery Where has this been discussed before? There are lots of referral services, some of them charities, some of them private businesses. For example, in Washington state there's the Korean Women's Association: https://www.kwacares.org/

Sweet. Looked into the KWA's site, seems like a clear use-case. If we were to break down the build into achievable chunks we may have more success, and have a bigger impact along the way. There's an immediate need for a single source of truth for all the locations where COVID-19 testing is available. Trump said Google was building it, but turns out they are weeks away from an MVP that would only cover the SF Bay Area…

> There's an immediate need for a single source of truth for all the locations where COVID-19 testing is available.

Seems like that could be achieved with a static HTML website, possibly augmented with a REST API.

I doubt that information is changing very quickly. It could theoretically even be committed to a Git repo in a CSV file. However, although that would work for generating a website, it wouldn't be clone-able. So perhaps consider some canonical datastore in the cloud somewhere.

Also: I propose Apache/MIT licensing to minimize the friction of collaboration with both commercial entities and charities.

Technology wise, I don't care: it should just be something mainstream, popular and easy.

> Moreover, there's no way for anybody to know how many people have actually been tested, because the same person can be tested multiple times.

That seems like a harder problem because of patient privacy issues.

Re: Pandemic Ventilator Project

#79

Post by ozi »

pujjad wrote: post #20
trevyn wrote: post #3

Any thoughts about using a regular sleep apnea CPAP device for this type of situation, where one has access to the pressure settings?

Someone dear to me needs a ventilator per tracheostomy (Trilogy 100). Her Consultant Aenesthesist who was in Italy four weeks ago and works on an Intensive Care Unit told me that 6 out 10 Covid-19 affected ITU patients require an ECMO ( https://en.m.wikipedia.org/wiki/Extracorporeal_membrane_oxyg... ). This is very bad. I could sense his unease, these are machines you don't come by easily. His ITU is preparing for wa…

Most hospitals have just a handful of ECMO machines, if any. And most of them are talking about not providing ECMO to COViD-19 patients because of this.

Re: Pandemic Ventilator Project

#80

Post by nerfhammer »

klipt wrote: post #64
wbl wrote: post #39

Earlier quoted context omitted.

There is a manufacturer of emergency ventilators. Why they aren't working triple shifts to make millions is beyond me.

Well we'd need to get the government to pay them to ramp up production, otherwise they might go bankrupt producing more ventilators than end up being needed. Paying for "insurance" in the form of extra ventilators should probably be done by the government, not by a corporation.

I don't think there's a big risk they'll have trouble selling ventilators
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