COVID 19 Ventilator

Forwarded from University College Cork .... In these difficult times medical devices such as ventilators/respirators are in very high demand. Please help us in mobilizing and facilitating production of these devices that are (or could become) desperately needed in hospitals throughout the world to save lives. Based on global high demand of ventilators and respirators, Medtronic made available plans to facilitate production of ventilators. In this interview, Omar Ishrak (Medtronic CEO), tells a great deal about different grades of ventilators, how production is being increased, and where they are going: https://www.cnbc.com/video/ 2020/03/25/medtronic-ceo-omar- ishrak-on-ramping-up- ventilator-production.html In case you know factories and/or students that want a COVID-related project, they can download the plans for this Ventilator and produce them: https://www.medtronic.com/us- en/e/open-files.html?cmpid= vanity_url_medtronic_com_ openventilator_Corp_US_ Co...

https://www.spservices.ie/item/O-TwoMedical_SMARTBAGVentilationTrainerBoxwithSMARTStandardBVM_51_63_3688_1.html Lung simulator for bag-valve-mask use includes stomach filling simulation

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/876167/RMVS001_v3.1.pdf everything a ventilator needs to be to treat COVID19   Ventilation   1. Must have a t least 1, optionally 2 modes of ventilation   a. Must have CMV – Continuous Mandatory Ventilation  b. The CMV mode must be either        i. (ideally) Pressure Regulated Volu me Control,  or        ii. pressure controlled ventilation (PCV)  or       iii. minimally a volume controlled ventilation (VCV).    c. PRVC/Pressure Controlled - a set pressure is delivered for the period of inspiration and the volume achieved is measured and displayed. Ideally PRVC , an adaptive mode where the tidal volume is set and the lowest possible pressure is delivered to achieve this volume. PCV where the user has to provide the adaptive control ...

Blood pressure cuff around the bag partially inflated this provides pressure on bag,squeeze the blood pressure cuff rather than the bag directly. Attach a manometer to facemask to get confirmatory mouth air pressure https://www.researchgate.net/figure/Flow-sensor-integration-to-adult-sized-tracheal-intubation-tube_fig5_319597503 

from https://old.reddit.com/r/pics/comments/foo7qm/italian_guy_designed_a_3d_printable_valve_to_turn/ [–] Vandimal88 184 points 14 hours ago   It looks like it would essentially work as non-invasive positive airway pressure similar to CPAP or BIPAP. That still uses positive pressure to force air into the lungs but without a tube that goes down the trachea past the vocal cords. There are many limitations on this kind of ventilation compared to intubation. With intubated patients you can control parameters such as positive end expiratory pressure (PEEP) which helps stent open the alveoli when they fill with fluid (acute respiratory distress syndrome) which is a common complication from COVID-19. You can’t reliably control all of these parameters with non-invasive positive airway pressure because it relies on the patient to be able to take their own breaths. They can tire out or if their mental status deteriorates and they are not able to maintain their airway ...

Lung monitoring with electrical impedance tomography: technical considerations and clinical applications https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688044/  

From https://en.wikipedia.org/wiki/Mechanical_ventilation Risk Mechanical ventilation is often a life-saving intervention, but carries potential complications including pneumothorax , airway injury, alveolar damage, ventilator-associated pneumonia , and ventilator-associated tracheobronchitis . [4] [5] Other complications include diaphragm atrophy, decreased cardiac output, and oxygen toxicity. One of the primary complications that presents in patients mechanically ventilated is acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). ALI/ARDS are recognized as significant contributors to patient morbidity and mortality. [6] In many healthcare systems, prolonged ventilation as part of intensive care is a limited resource (in that there are only so many patients that can receive care at any given moment). It is used to support a single failing organ system (the lungs) and cannot reverse any underlying disease process (such as terminal cancer). For this reason...

https://www.spservices.ie/item/O-TwoMedical_SMARTBAGVentilationTrainerBoxwithSMARTStandardBVM_51_63_3688_1.html has a bag-valve-mask test kit, which can show  if the lungs are over-inflated or the delivered flow rate is too high, the high airway pressure generated will cause air to enter the stomach. In real life this can only be seen when the patient's abdomen distends and/or they begin to vomit. Also: 1 cmH 2 O (conventional) = 98.0665  pascals  or approximately  1 cmH 2 O (conventional) ≈ 100  pascals  or 1 cmH 2 O (conventional) ≈ 1 hectopascal https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/maximal-inspiratory-pressure  appears to have an incorrect obscure or deceptive diagram for inspiratory lung pressures on the x-axis it seems to contradict the text. https://www.ncbi.nlm.nih.gov/pubmed/16677384   details maximum inspiratory pressure for healthy people . In  women, maximum ex...

https://onlinelibrary.wiley.com/doi/pdf/10.1197/j.aem.2006.05.009

https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Continuous_positive_airway_pressure_(CPAP)_and_non-invasive_ventilation_(NIV)/ Physical Assessment / Observations – during therapy Patients should receive a complete nursing respiratory assessment at least once at the commencement of each shift, where the patient’s respiratory status changes, or where CPAP/NIV settings are adjusted. Monitor patient for and document hourly on EMR, in the Ventilator Pressures row, under Observations: Level of consciousness Breath rate, pattern, and effort Heart rate Use of accessory muscles Oxygen requirement Pulse oximetry Compliance/comfort with therapy Patient respiratory synchronization with bi-level ventilation Mechanical Driver/Device Assessment / Observations At the commencement of each nursing shift the ventilator settings should be checked against the medical orders and documented on EMR, in the Ventilator Pressures row, under Observations. Mo...