6 ms·

That is some bureaucratic nonsense. Setting up and maintaining a ventilator is not rocket science, you can train other staff to do that job pretty quickly. Anc

That is some bureaucratic nonsense. Setting up and maintaining a ventilator is not rocket science, you can train other staff to do that job pretty quickly. Ancillary tasks may suffer from staff shortage, but if you need one, getting a ventilator and minimal care is a lot better than not getting a ventilator.

ironmagma 7y ago
Any guides to how to set up a ventilator by chance? Asking for a friend...
- NohatCoder 7y ago
  Very short guide: Put a mouthpiece on the patient, connect the mouthpiece to the tube from the ventilator, turn the ventilator on. Longer guide: Read the manual for the specific ventilator and have fun adjusting air mixture, pump frequency, pressure, volume and other stuff. Choose one of several different models of mouthpiece, with or without tubes, depending on patient needs. Learn about different failure modes and associated alarms. Learn how to operate the pump manually in case of electronics failure. Learn how to properly clean the machine. It isn't nothing, there are some things you can do wrong if you don't know what you are doing. But a trained medical professional should get up to speed with a crash course.
  - abeld 7y ago
    The type of ventillators required by the most serious cases are much more complicated: as I understand it, it involves push a tube down to the lungs, and the machine breathing instead of the patient, i.e. it has to carefully monitor and regulate the pressure etc. Already the "push tube down to the lungs" part is quite a challenge: avoiding damage to the vocal cords, or to the lungs, etc.
    - beefield 7y ago
      Should we then not be damn sure that there are shitloads of the simpler ventilators so that the complicated ones can be fully reserved for the serious cases?
      - jschwartzi 7y ago
        In the hospital they’re all complicated cases. The simpler vents are for home care use. The hospital doesn’t typically do noninvasive ventilation because it’s meant for patients who are awake and outside of a hospital setting.
    - NohatCoder 7y ago
      Tubes down the lungs is definitely a bit tricky, not all patients will require that model though. As for careful monitoring, that is something the machine does on its own, as long as it has been configured correctly for the individual patient.
      - greedo 7y ago
        This is incorrect on many levels. A ventilator always requires intubation. Sometimes that's through the mouth, sometimes through the nasal passage (both cases are referred to as endotracheal), and rarely through a tracheostomy. Ventilators do have some monitoring capability, but require consistent attention from respiratory therapists. The chances of infection (VAP), pneumothorax etc are serious without careful monitoring by a trained, experienced medical professional. These aren't plug and play devices. Some patients might need supplementary oxygen delivered through a canula, or through a mask, but that's nothing like the procedure used for a vent.
        mhb 7y ago
        A ventilator always requires intubation Can you elaborate? This ventilator documentation[0] says for invasive and noninvasive ventilation [0] https://www.usa.philips.com/healthcare/product/HCNOCTN98/respironics-trilogy-202-ventilator/documentation https://www.usa.philips.com/healthcare/product/HCNOCTN98/res...
        Mvandenbergh 7y ago
        Many vents can also operate in BiPAP or CPAP modes or as pure demand O2 supplies for people who can still breathe. That can be done with a mask.
        greedo 7y ago
        When treating bilateral interstitial pneumonia, you're almost always intubating. Patients presenting BIP require higher oxygenation than a CPAP style mask can provide. Using a limited availability ventilator with just a mask is a waste at this time.
omar_a1 7y ago
I don't know how to operate a ventilator, and have zero medical training, but I'm getting frustrated by the comments claiming medicine is trivially easy. Even using a syringe or blood draw on a patient is something one needs certification to do properly. That isn't bureaucratic nonsense. Having worked with syringes and sterile technique, there are so many ways you can give your patient an infection or otherwise cause them life-altering complications if you don't know what you're doing, even for the actually trivial techniques. Operating a ventilator incorrectly will result in death. Likely a grisly one, as incorrect pressure differentials and human lungs are not a good combination. Now that doesn't mean we need to stick to these bureaucratic rules as they are for this situation, but the people on here advocating for trying complicated medical procedures while knowing fuck all about medicine (or even biology) really need to take a step back and take an inventory of what they don't know, and can realistically expect to accomplish with neither the technical knowledge nor manual dexterity of a trained clinician. A YouTube video and a technical manual aren't going to cut it, folks.
- NohatCoder 7y ago
  I'm not suggesting that you or I operate the ventilators, but I refuse to believe that hospitals can't get someone decently qualified to do the job. If the need arise, those 160000 ventilators will be in operation in a heartbeat. The only reason not to get more is if you believe that there won't be that many patients.
- beefield 7y ago
  I am getting frustrated by the comments that miss the big picture. There are likely going to be lots of people that are going to die without ventilator. Now, who with any common sense and decency[1] cares if 30% of them are dying because the device was not used properly/broke/whatever if the only other available option is that 100% of them die? [1] Sigh... I know, I know. American lawyers and legal system.
  - jschwartzi 7y ago
    The thing you’re missing is these new RTs wold not just be treating COVID-19 patients. There are tons of people who will need ventilator therapy because they were injured or sick and they would have gotten injured or sick anyway. These are people who can be saved with proper treatment or injured by improper treatment. Barotrauma and lack of tidal volume have implications beyond simply alive or dead. We need people but we must make sure they can actually provide adequate treatment.
Quarrelsome 7y ago
I was reading some accounts on /r/nursing that its relatively complex. The issue you have is that its quite easy to kill a patient if you fuck it up and there are multiple factors that impact the operation of the machine (e.g. patient weight for example).
Mvandenbergh 7y ago
Setting up a ventilator for treating ARDS (caused by the viral infection and inflammatory response) is at the much harder end of respiratory therapy unfortunately. This is also one reason why just building the simplest possible ventilator simply isn't possible / useful here. Yes you could basically build a 1960s design en-masse but at the moment 50% of people on modern vents are surviving so this is no panacea. The trick will be to find a minimal feature set design, that doesn't use a lot of specialist long lead time components, can be used by people who are less experienced, and is suitable for treating ARDS. That is a much harder problem than the basic one of getting some kind of ventilator mass produced on an emergency basis.
- thu2111 7y ago
  That minimal feature set is a CPAP machine + maybe an oxygen valve of the 3D printable variety. Modern CPAP machines can generate phenomenal pressures and can be adjusted with simple touch screens. They support automatic pressure reduction on exhalation, and Bluetooth/cloud access to the data in them for remote monitoring via mobile apps. BTW it's not quite as simple as 'hospital ventilators are hard to use'. Firstly, modern ventilators are much easier because the manufacturers realised that high training costs were limiting their market, so they've got a lot easier to use. Secondly, the US did a previous disaster response training exercise where they trained a bunch of non-specialist medical staff like nurses and even vetinarians how to use the machines. After 2 days of training there was an exam: the vets did best.
  - Mvandenbergh 7y ago
    CPAP machines generate continuous positive pressures though, they assist breathing. I know they have slow ramp capabilities for comfort reasons (start off at low positive pressure when you fall asleep and then increase) but I don't think they can swing pressure fast enough to enable inhalation and exhalation. You need: -Gas blending (relatively trivial) -A source of pressure (CPAP has this) -A way of modifying pressure up and down quickly and precisely enough to stimulate breathing (Don't think CPAP has this) -A way of measuring flow and pressure (Does CPAP have this with good time resolution? I doubt it as not required for CPAP) -A controller which uses the flow and pressure data to vary the system pressure (CPAP doesn't have the right software but presumably this is less time constrained than the others) So I'm really not sure that you can do this with a modified CPAP machine. BTW I'm not sure that you can print oxygen valves, maybe air valves or patient valves. High pressure inlet oxygen parts need to be oxygen compatible and many 3d printed materials may combust under those conditions.

ironmagma 7y ago

Any guides to how to set up a ventilator by chance? Asking for a friend...

NohatCoder 7y ago
Very short guide: Put a mouthpiece on the patient, connect the mouthpiece to the tube from the ventilator, turn the ventilator on. Longer guide: Read the manual for the specific ventilator and have fun adjusting air mixture, pump frequency, pressure, volume and other stuff. Choose one of several different models of mouthpiece, with or without tubes, depending on patient needs. Learn about different failure modes and associated alarms. Learn how to operate the pump manually in case of electronics failure. Learn how to properly clean the machine. It isn't nothing, there are some things you can do wrong if you don't know what you are doing. But a trained medical professional should get up to speed with a crash course.
- abeld 7y ago
  The type of ventillators required by the most serious cases are much more complicated: as I understand it, it involves push a tube down to the lungs, and the machine breathing instead of the patient, i.e. it has to carefully monitor and regulate the pressure etc. Already the "push tube down to the lungs" part is quite a challenge: avoiding damage to the vocal cords, or to the lungs, etc.
  - beefield 7y ago
    Should we then not be damn sure that there are shitloads of the simpler ventilators so that the complicated ones can be fully reserved for the serious cases?
    - jschwartzi 7y ago
      In the hospital they’re all complicated cases. The simpler vents are for home care use. The hospital doesn’t typically do noninvasive ventilation because it’s meant for patients who are awake and outside of a hospital setting.
  - NohatCoder 7y ago
    Tubes down the lungs is definitely a bit tricky, not all patients will require that model though. As for careful monitoring, that is something the machine does on its own, as long as it has been configured correctly for the individual patient.
    - greedo 7y ago
      This is incorrect on many levels. A ventilator always requires intubation. Sometimes that's through the mouth, sometimes through the nasal passage (both cases are referred to as endotracheal), and rarely through a tracheostomy. Ventilators do have some monitoring capability, but require consistent attention from respiratory therapists. The chances of infection (VAP), pneumothorax etc are serious without careful monitoring by a trained, experienced medical professional. These aren't plug and play devices. Some patients might need supplementary oxygen delivered through a canula, or through a mask, but that's nothing like the procedure used for a vent.
      - mhb 7y ago
        A ventilator always requires intubation Can you elaborate? This ventilator documentation[0] says for invasive and noninvasive ventilation [0] https://www.usa.philips.com/healthcare/product/HCNOCTN98/respironics-trilogy-202-ventilator/documentation https://www.usa.philips.com/healthcare/product/HCNOCTN98/res...
        Mvandenbergh 7y ago
        Many vents can also operate in BiPAP or CPAP modes or as pure demand O2 supplies for people who can still breathe. That can be done with a mask.
        greedo 7y ago
        When treating bilateral interstitial pneumonia, you're almost always intubating. Patients presenting BIP require higher oxygenation than a CPAP style mask can provide. Using a limited availability ventilator with just a mask is a waste at this time.

omar_a1 7y ago

I don't know how to operate a ventilator, and have zero medical training, but I'm getting frustrated by the comments claiming medicine is trivially easy. Even using a syringe or blood draw on a patient is something one needs certification to do properly. That isn't bureaucratic nonsense. Having worked with syringes and sterile technique, there are so many ways you can give your patient an infection or otherwise cause them life-altering complications if you don't know what you're doing, even for the actually trivial techniques. Operating a ventilator incorrectly will result in death. Likely a grisly one, as incorrect pressure differentials and human lungs are not a good combination. Now that doesn't mean we need to stick to these bureaucratic rules as they are for this situation, but the people on here advocating for trying complicated medical procedures while knowing fuck all about medicine (or even biology) really need to take a step back and take an inventory of what they don't know, and can realistically expect to accomplish with neither the technical knowledge nor manual dexterity of a trained clinician. A YouTube video and a technical manual aren't going to cut it, folks.

NohatCoder 7y ago
I'm not suggesting that you or I operate the ventilators, but I refuse to believe that hospitals can't get someone decently qualified to do the job. If the need arise, those 160000 ventilators will be in operation in a heartbeat. The only reason not to get more is if you believe that there won't be that many patients.
beefield 7y ago
I am getting frustrated by the comments that miss the big picture. There are likely going to be lots of people that are going to die without ventilator. Now, who with any common sense and decency[1] cares if 30% of them are dying because the device was not used properly/broke/whatever if the only other available option is that 100% of them die? [1] Sigh... I know, I know. American lawyers and legal system.
- jschwartzi 7y ago
  The thing you’re missing is these new RTs wold not just be treating COVID-19 patients. There are tons of people who will need ventilator therapy because they were injured or sick and they would have gotten injured or sick anyway. These are people who can be saved with proper treatment or injured by improper treatment. Barotrauma and lack of tidal volume have implications beyond simply alive or dead. We need people but we must make sure they can actually provide adequate treatment.

Quarrelsome 7y ago

I was reading some accounts on /r/nursing that its relatively complex. The issue you have is that its quite easy to kill a patient if you fuck it up and there are multiple factors that impact the operation of the machine (e.g. patient weight for example).

Mvandenbergh 7y ago

Setting up a ventilator for treating ARDS (caused by the viral infection and inflammatory response) is at the much harder end of respiratory therapy unfortunately. This is also one reason why just building the simplest possible ventilator simply isn't possible / useful here. Yes you could basically build a 1960s design en-masse but at the moment 50% of people on modern vents are surviving so this is no panacea. The trick will be to find a minimal feature set design, that doesn't use a lot of specialist long lead time components, can be used by people who are less experienced, and is suitable for treating ARDS. That is a much harder problem than the basic one of getting some kind of ventilator mass produced on an emergency basis.

thu2111 7y ago
That minimal feature set is a CPAP machine + maybe an oxygen valve of the 3D printable variety. Modern CPAP machines can generate phenomenal pressures and can be adjusted with simple touch screens. They support automatic pressure reduction on exhalation, and Bluetooth/cloud access to the data in them for remote monitoring via mobile apps. BTW it's not quite as simple as 'hospital ventilators are hard to use'. Firstly, modern ventilators are much easier because the manufacturers realised that high training costs were limiting their market, so they've got a lot easier to use. Secondly, the US did a previous disaster response training exercise where they trained a bunch of non-specialist medical staff like nurses and even vetinarians how to use the machines. After 2 days of training there was an exam: the vets did best.
- Mvandenbergh 7y ago
  CPAP machines generate continuous positive pressures though, they assist breathing. I know they have slow ramp capabilities for comfort reasons (start off at low positive pressure when you fall asleep and then increase) but I don't think they can swing pressure fast enough to enable inhalation and exhalation. You need: -Gas blending (relatively trivial) -A source of pressure (CPAP has this) -A way of modifying pressure up and down quickly and precisely enough to stimulate breathing (Don't think CPAP has this) -A way of measuring flow and pressure (Does CPAP have this with good time resolution? I doubt it as not required for CPAP) -A controller which uses the flow and pressure data to vary the system pressure (CPAP doesn't have the right software but presumably this is less time constrained than the others) So I'm really not sure that you can do this with a modified CPAP machine. BTW I'm not sure that you can print oxygen valves, maybe air valves or patient valves. High pressure inlet oxygen parts need to be oxygen compatible and many 3d printed materials may combust under those conditions.