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"Open source ventilators" are a really really bad idea. Patients on ventilators need to be intubated first, which involves using a specialized tool to insert a

by mike_d 7y ago

"Open source ventilators" are a really really bad idea. Patients on ventilators need to be intubated first, which involves using a specialized tool to insert a tube down past the vocal cords and inflating a balloon that seals the airway. You can kill a person before you've even turned on your nifty machine. Once you have a patient tubed, you have full control of their respiration. If your calculations are wrong you either over inflate the lung and they literally burst, or you under oxygenate and the patient dies of oxygen deprivation. I know engineers look at something like a ventilator and go "you don't have enough machines? I can make machines!" This is very admirable and I appreciate the desire to help, but I can't stress enough how dangerous this is. Edit to add: This study showed that trained paramedics were only successful in tracheal intubation 52% of the time. You have a 0% chance of doing this at home. https://www.jwatch.org/na47414/2018/09/07/maybe-paramedics-should-not-perform-endotracheal https://www.jwatch.org/na47414/2018/09/07/maybe-paramedics-s...

smdz 7y ago
Agreed. Need for ventilator is quite bad enough state for the human body. And it gets complicated further after intubation. Most patients have to be sedated to reduce the distress and anxiety caused by the endotracheal tube. Extubation is also a risky process and patient may have to be re-intubated when though they have recovered but stayed in for a recommended max period around 2 weeks and lungs got weak. When patient is on ventilator, it requires many control parameters to help a patient live longer - the sedatives have to be just right depending on the patient, antibiotics, secondary infection risks, intravenous needles risks, pre-existing illnesses, allergies, etc, etc, etc. All this assuming that the ventilator machines and peripherals are perfectly safe. On a large scale during a pandemic, there aren't just enough doctors, experienced nurses and heath care workers who that can deal with it. Engineers can build the ventilators, but the logistical part is still a nightmare.
jariel 7y ago
This is not a fair assessment and I think it sidesteps the point. "This is very admirable and I appreciate the desire to help, but I can't stress enough how dangerous this is." Indicating that 'medical equipment requires specialization' is not a special insight that most people are going to miss. Assuming that the product will be designed by those who lack credibility or that such equipment might not be of sufficient quality of design, construction, or that it may be misused is unwarranted. 'Open source' encryption and other systems are behind the entire world's financial systems, it has integrity partly because it's 'open source'. It's not designed by fools, and just because jokers and everyone else can 'fork and do something' doesn't mean it will be implemented anywhere that matters. Obviously regulations, security, risk etc. play a role 'where it matters'. Any kind of medical equipment development is going to require some kind of oversight, regulatory approvals, and special manufacture, but this is all feasible within the concept of 'open source'. There are plenty of highly credible and knowledgeable people, possibly even those who have worked on 'closed source' ventilators can possibly contribute. Sheppard through some kind of regulatory process, manufacturing setup, and possibly deployment and training, it's not infeasible at all that something like this could help. Even the availability of high-quality, unlicensed equipment designs, with parts pre-designed for manufacture and ready to be made by qualified entities ... could feasibly make all the difference in the world. For example, once a design is complete and approved, the medical wing of a poor country, or possibly an NGO could facilitate the actual manufacture and distribution to medical staff in various places. There are massive margins (bordering on criminal) in medical equipment and supplies these days, hospital beds now cost more than automobiles (!), it's high time there was an open approach to such issues. I can absolutely see medical researchers and PhD's at universities, teaming with Engineers, MDs, and manufacture/supply chain specialists to produce this kind of stuff. Obviously there's a limit to complexity here, but I hope they figure out not only ventilators, by any number of other kinds of gear. Though odds are it will fail, it's not a bad idea, it's a great idea.
- UncleMeat 7y ago
  > Assuming that the product will be designed by those who lack credibility or that such equipment might not be of sufficient quality of design, construction, or that it may be misused is unwarranted. Given the number of software engineers who have written detailed and strongly opinionated analyses of the situation rather than relying on expert opinions... I'm not so sure we can assume that this project is operated by experts.
- mike_d 7y ago
  Ventilators are not lacking a design. There are many functional designs across a variety of medical device manufactures (most of which are sub-$1000). China is already ramping up production to assist other countries. The only thing open sourcing a design does is encourage DIY home builds, which is wildly irresponsible in a time of panic.

by mike_d 7y ago

smdz 7y ago

Agreed. Need for ventilator is quite bad enough state for the human body. And it gets complicated further after intubation. Most patients have to be sedated to reduce the distress and anxiety caused by the endotracheal tube. Extubation is also a risky process and patient may have to be re-intubated when though they have recovered but stayed in for a recommended max period around 2 weeks and lungs got weak. When patient is on ventilator, it requires many control parameters to help a patient live longer - the sedatives have to be just right depending on the patient, antibiotics, secondary infection risks, intravenous needles risks, pre-existing illnesses, allergies, etc, etc, etc. All this assuming that the ventilator machines and peripherals are perfectly safe. On a large scale during a pandemic, there aren't just enough doctors, experienced nurses and heath care workers who that can deal with it. Engineers can build the ventilators, but the logistical part is still a nightmare.

jariel 7y ago

This is not a fair assessment and I think it sidesteps the point. "This is very admirable and I appreciate the desire to help, but I can't stress enough how dangerous this is." Indicating that 'medical equipment requires specialization' is not a special insight that most people are going to miss. Assuming that the product will be designed by those who lack credibility or that such equipment might not be of sufficient quality of design, construction, or that it may be misused is unwarranted. 'Open source' encryption and other systems are behind the entire world's financial systems, it has integrity partly because it's 'open source'. It's not designed by fools, and just because jokers and everyone else can 'fork and do something' doesn't mean it will be implemented anywhere that matters. Obviously regulations, security, risk etc. play a role 'where it matters'. Any kind of medical equipment development is going to require some kind of oversight, regulatory approvals, and special manufacture, but this is all feasible within the concept of 'open source'. There are plenty of highly credible and knowledgeable people, possibly even those who have worked on 'closed source' ventilators can possibly contribute. Sheppard through some kind of regulatory process, manufacturing setup, and possibly deployment and training, it's not infeasible at all that something like this could help. Even the availability of high-quality, unlicensed equipment designs, with parts pre-designed for manufacture and ready to be made by qualified entities ... could feasibly make all the difference in the world. For example, once a design is complete and approved, the medical wing of a poor country, or possibly an NGO could facilitate the actual manufacture and distribution to medical staff in various places. There are massive margins (bordering on criminal) in medical equipment and supplies these days, hospital beds now cost more than automobiles (!), it's high time there was an open approach to such issues. I can absolutely see medical researchers and PhD's at universities, teaming with Engineers, MDs, and manufacture/supply chain specialists to produce this kind of stuff. Obviously there's a limit to complexity here, but I hope they figure out not only ventilators, by any number of other kinds of gear. Though odds are it will fail, it's not a bad idea, it's a great idea.

UncleMeat 7y ago
> Assuming that the product will be designed by those who lack credibility or that such equipment might not be of sufficient quality of design, construction, or that it may be misused is unwarranted. Given the number of software engineers who have written detailed and strongly opinionated analyses of the situation rather than relying on expert opinions... I'm not so sure we can assume that this project is operated by experts.
mike_d 7y ago
Ventilators are not lacking a design. There are many functional designs across a variety of medical device manufactures (most of which are sub-$1000). China is already ramping up production to assist other countries. The only thing open sourcing a design does is encourage DIY home builds, which is wildly irresponsible in a time of panic.