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Ventilators for covid-19
#75004 17/03/20 6:35 PM
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If you have spare ventilators that are either in storage, or emergency back up, please can you make me aware of what you have available (not in operational use) via the private message facility if this forum.

I have had an offer of support to pull together a country wide list of redundant/spare ventilators.

If we can pool ventilators, and understand where they are located, we can potentually save lives.

Lets work together to understand where we have some flex in the system, and ensure that these devices can be utilised.


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Re: Ventilators for covid-19
John Sandham #75008 17/03/20 9:22 PM
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It's a noble gesture, John ... and yes, a database of available ventilators would be useful.

It will be interesting to see what response you get ... as I doubt that too many have been squirreled away; and any that are could well be obsolete (or unserviceable), anyway. frown

But, say that your can round up a dozen or so ... who is going to re-commission and (or) service them? And will consumables, servicing kits and what-have-you still be available?

Another consideration that comes to mind is that of staff training (on "unfamiliar" ventilators) - especially as they will be very busy, anyway.

Are you thinking about modern ICU-type vents ... or would Manleys et al* also be of interest?

Maybe we need to re-call some of the Greybeard Biomeds out of retirement (or out from their Care Homes)! laugh

* I used to know where a Cape-Waine was still being used, but I imagine (hope) that one has gone by now.


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Re: Ventilators for covid-19
John Sandham #75017 18/03/20 10:31 PM
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Good Evening,
I work for one of the companies that is currently looking at the UK ventilator challenge, I'm a mechanical engineer to trade, but have not had previous experience with ventilators, so the past couple of days has been a crash course in terminology and history of ventilator design!
My own thinking at the moment is that a ventilator design that is relatively proven, but from the era before PLC/microcontrollers might be the best bet for restarting volume manufacture - something that's simpler, proven in service, but not over-engineered and while having fewer features, is less likely to go wrong.
I've been looking for information on the following models which seems like the right sort of era - but happy to take some guidance on this:

British Oxygen Company (BOC) models:
- Harlow
- Beaver II
- Cylclator

Manley-Blease
- MP2
- MP3
- Pulmovent
- Servovent

W Watson & Sons
- Barnet Mark III Ventilator

There is currently a programme of work underway at the moment (as I understand) to discuss the availability of designs from current manufactures, but I think that something dipping back into the archives might be more realistically manufacturable with the supply chain that we have in the UK/components that might be held in stock here.
Any feedback and pointers towards available resources (service manuals, BOMs/parts lists, drawings, photos) would be much appreciated
Thanks
Murdoch

Re: Ventilators for covid-19
Murdoch #75018 19/03/20 11:47 AM
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Welcome to the forum, Peter. smile

Wow ... some nice "blasts from the past" there, Mate.

But those that you mention are not what I would call ICU-type ventilators. In fact a couple of them are more likely to be considered "anaesthesia" ventilators. So I'm wondering if simple machines like this are actually what is required. frown

I would suggest that before charging ahead your team should make sure that any design(s) are likely to meet the clinical requirements of the situation; in other words, ensure that the design and (or) ultimate hardware is actually going to be "fit for purpose"!

Otherwise I agree with what you're saying about simplicity of design, but if you're thinking in terms of manufacturing from scratch, I would have thought that a new design - based on the Manley et al - aimed at ease (and speed) of production would be in order.

I presume you have already contacted the remaining UK manufacturers (if indeed any still exist) about design details, manufacturing jigs and what-have-you.

By the way, I notice you have not mentioned Penlon, or "East of Oxford".

Meanwhile, check out this resource. Also, Diamedica are pretty good at innovation.

Good Luck! smile

Here is an interesting link showing a history of (mainly American) ventilators.


If you don't inspect ... don't expect.
Re: Ventilators for covid-19
John Sandham #75019 19/03/20 12:23 PM
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Hi Geoff, I accept your points, but I don't think manufacturers will be able to fill the gap in such a short space of time. I have discussed the need for approx 8000 additional ventilators over the coming peak of covid-19. Every little helps.

Breas UK is ramping up ventilator production as the UK government calls on engineering firms to help.
https://www.eenewseurope.com/news/uk-looks-ramp-ventilator-production-covid-19
Other suggestions of companies with medical equipment skills have included Meditec England
http://www.meditecengland.co.uk/index.html, Smiths Medical, SLE, Diamedica, OES Medical and Penlon.


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Re: Ventilators for covid-19
John Sandham #75020 19/03/20 12:30 PM
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Interesting, John. But 8,000? Wow!

I suppose it all depends upon the actual demand as things pan out. I wonder if we (you know, Joe Public) are actually being given the full picture. When is the peak likely to occur; how long will the "curve" last; will it reappear next year (and every year) etc.? frown

I think it may have been someone from Wuhan who first said:- "May you live in interesting times"! whistle

Meanwhile, do you have any information about the "spec" of the required ventilators? Do you (they) have a particular "prototype" (model) in mind? think

I read yesterday that "more than 75 percent of the country’s [UK's] ventilator machines are already being used for patients unaffected by the coronavirus".


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Re: Ventilators for covid-19
John Sandham #75022 19/03/20 12:45 PM
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Hi Geoff,
The NHS/Government require various types of ventilators, but ITU spec vents would be needed for patients requiring intubation. MTS Health Ltd are offering resources foc to coordinate bringing together the database: MTS_Health_launches_appeal_for_disused_ventilation_equipment MTS Health wants to create a countrywide equipment library to help hospitals cope with rising number of patients needing respiratory support. It is joining the fight against coronavirus, with bosses calling on health trusts to send them spare or redundant ventilation and gas therapy equipment. The company is offering its resources to support the creation of a countrywide equipment library of redundant and spare ventilators. And it will be working with equipment manufacturers and other experts to bring this equipment back into operational use. A spokesman said: “The Government has announced additional measures to seek to reduce the spread of Covid-19 across the country. It is essential these measures succeed, but the NHS must prepare for, and respond to, the anticipated large numbers of patients who will need respiratory support, particularly mechanical ventilation and, to a lesser extent, non-invasive ventilation. All trusts have been told to enhance their critical care capabilities, and will be fully reimbursed. The goal is to have as many beds, critical care bays, theatre and recovery areas able to administer life-supporting respiratory care as possible. “With this in mind, we are asking anyone who has spare or redundant ventilators or associated gas therapy equipment that is in storage and for whatever reason cannot be used, to make us aware using; info@mtshealth.co.uk. “If we can pool ventilators, and understand where they are located, we can all help to save lives. “Let’s work together to understand where we have some flex in the system, and to ensure these previously-retired devices can be utilised.”


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Re: Ventilators for covid-19
John Sandham #75023 19/03/20 12:49 PM
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My suggestion to industry is to obtain the designs required under protection from already established manufacturers. Why not release now unsupported models designs? Add in a built in time out system that renders the device until such an incident once more happens.
This happens in domestic appliance, aerospace and mobile technology to mention a few. A British company Westland building an Italian model of Helicopter, Agusta.
The problem is that we have spoken about this for many years now. MIRS, SARS, HN51, Swine Flu, Avian Flu etc. But it never made the big jump. It has now done this and nobody was ready.
There is a lot to be said for having a spare pack of 9V batteries in "that" drawer in your kitchen - a smoke alarm will invariably help reduce death. The hospitals have been down £3 billion over the years and now we have a blank cheque whereby we are all scrambling for the same items and it wont work unless rules are broken for a temporary period and with protection ( EU protection would work very well). So now we all need a giant drawer and fill it with kit that will be required at a moments notice in the future.
Hospital trusts will soon be realizing that EBME departments have a huge roll to play in this and we may now be getting some very much overdue airtime. It is our responsibility to email everyone who needs to listen. Put your suggestions forward and dont stop until they listen. Do the same to your local MP too.

My very best to everyone of us out there doing our best. Keep a diary of what you would do differently-it may come in handy when the powers start to listen.


30 years since the Chernobyl disaster and yet we still have no super heroes or zombies.
Re: Ventilators for covid-19
John Sandham #75024 19/03/20 12:57 PM
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Well John, you know I have always been a fan of databases, John (and before that, "lists"). smile

You would have thought (or perhaps, hoped) that a National Health Service would already have a massive database of (at least) critical and (or) capital items of equipment.

Meanwhile, when do we re-open all those closed wards; or have they all been bulldozed by now? Otherwise, when do we start building some new ones?

Does anyone else remember the "Chest and Fever" - really "isolation" - hospitals found in other parts of the world? Basically large groups of buildings with lots (often thousands) of beds, out of town, and generally surrounded by nice gardens.


If you don't inspect ... don't expect.
Re: Ventilators for covid-19
John Sandham #75025 19/03/20 1:07 PM
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Hi Murdoch, Geoff,
Any vents are better than no vents but the survival rates (from early reports) are not good. From what I have read, non-invasive ventilators can risk the spread of infection to staff caring for the patients.

From the Lancet:
From 52 of 710 patients with confirmed COVID-19 that were admitted to an intensive care unit (ICU) in Wuhan, China.
29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.
Jonathan Chun-Hei Cheung and colleagues do not recommend use of a high-flow nasal cannula or non-invasive ventilation until the patient has viral clearance. First, although exhaled air dispersion during high-flow nasal oxygen therapy and non-invasive ventilation via different interfaces is restricted, provided that there is a good mask interface fitting, not all hospitals around the world have access to such interfaces or enough personal-protective equipment of sufficiently high quality (ie, considered fit-tested particulate respirators, N95 or equivalent, or higher level of protection) for aerosol-generating procedures, and several hospitals do not have a negative pressure isolation room.
Non-invasive ventilation is not recommended for patients with viral infections complicated by pneumonia because, although non-invasive ventilation temporarily improves oxygenation and reduces the work of breathing in these patients, this method does not necessarily change the natural disease course.
See: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext


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