14 ms·

Risky hack could double access to ventilators

257 points by spookybones 7y ago

sjg007 7y ago
This will become standard in about a month I bet
- bitexploder 7y ago
  I hope not, but if this can save a few extra lives that would probably be better than any hack I ever pulled off.
bitexploder 7y ago
This is really neat. It seems a lot of the risk is how specific lung capacities and conditions interact with the ventilator and how much oxygen someone needs. My question to any MDs reading this: how often do you have to tweak ventilator volume for patients using one? What is the feedback loop? Blood oxygen levels?
- theturingnerd 7y ago
  (physician here) Vents can be quite tricky to get right; primarily because as disease progression continues on many things change. We are always trying to balance the deleterious effects of the intervention (in this case, the vent) with the goals of care. What most people don't know is that vents cause a lot of injuries on their own. (See ARDS). Hypoxemic respiratory failure is serious stuff, and it's almost always not the only insult we're dealing with. So, it's about balance. In the feedback loop is a lot of things. Certainly, oxygen saturation is a core measure, but we are also thinking about things like hypercapnia (and acidosis); overall perfusion status (blood circulation); infection management; etc. Gas exchange is important, but there are a lot of things that have to go right for the lungs to take oxygen in, get it into the right transport, and get carbon dioxide back out. You can over-optimize for any of those at the expense of the other (see: hypercapnia). In short, it's complex and there isn't a solid formula that will work for every patient. It's actually the subject of a lot of debate on details (some of it quite passionate in our Critical care / pulmonology community). This is why we call it PRACTICING medicine ;)
  - djsumdog 7y ago
    What do you think are the risks of cross contamination in this setup (let's say, just for 2 people sharing one unit)? She mentions how, in a situation where you'd have to use this, they'd have the same infection. What if they have different secondary infections or different types of pneumonia? The example of the Vegas disaster is different because they were all gunshot victims; they were healthy, but wounded. I hope we would never need to see if these would be effective.
    - markmichalski 7y ago
      MD here. There is an inhalation and exhalation tube for each patient; the exhalation tubes would be in continuity using the described configuration. However, at least for part of the transmission route, viral particles would have to move against flow. So there is likely some cross-contamination. All that being said in the situation where this is deployed I think it would be a risk most providers would take.
  - bitexploder 7y ago
    Thanks for this explanation.
  - gdubs 7y ago
    I can't even figure out what my HVAC vents do, or how not to mess up my entire heating and cooling situation – so I leave them alone. Utter respect for you and all the other medical professionals who are having to adapt and deal with this unfolding situation. Many thanks for what you do.
  - forkexec 7y ago
    IANAMDOMP. After respiratory therapists, it seems like perfusionists will be stretched thin too because there are so few of them globally. I would predict lots of ECMOs and long waiting lists for lung transplants in the next few months, but also lots of poor outcomes for COVID patients with preexisting cardiopulmonary issues. I just hope young and middle-aged people take it seriously and don't avoidably waste healthcare resources through irresponsible behavior.
  - 7y ago
ummonk 7y ago
The virus doubles in less than a week, so this hack (which is being used extensively in Italy from my understanding) can only by you so much time to stop its spread with mitigation measures.
- grej 7y ago
  Depends on whether you flatten out the growth rate. It won't/can't keep growing like that when everyone is sheltering in place.
  - Polylactic_acid 7y ago
    Seems likely. Italy is currently seeing a 13% increase per day while the US is now very close to a 50% increase per day. There are news reports showing beaches and bars in the US are still fully packed. It probably relates the US culture of disregarding expert advice and doing the opposite to "own the scientists"
    - nathanlied 7y ago
      It's not just the US. This happened across countries in Europe as well; Italy had it happen, Germany had "Coronavirus Parties", even. It happens because some people are idiots, and others aren't quite aware of how serious the situation is. Once reality sets in, only the absolute idiots that don't care for being socially ostracized (or in some cases even legal consequences) will continue that behaviour. And luckily those are normally a minority.
    - loeg 7y ago
      The US federal government isn't actually doing much at the top level. Individual states are shutting down at variable times and rates. The beaches and bars are mostly in these slow-moving states.
      - gwright 7y ago
        That is because that is how our system of executive administration is designed. It is a federal system with the vast, vast majority of police powers (https://en.wikipedia.org/wiki/Police_power_(United_States_constitutional_law) https://en.wikipedia.org/wiki/Police_power_(United_States_co... residing in the state, not federal authorities.
609venezia 7y ago
I thought I remembered reading somewhere recently that 2:1 is already in use in some cases (maybe in Italy?), but I can't find a source. Is there increased risk of ventilator failure with this approach? That seems like it could be an additional terrible factor to weigh, because parts have become so scarce.
- froindt 7y ago
  The article makes it sound like the ventilators have a wide enough range of operation to accommodate. It may not work for the tail end (set of 4 people each with large lung capacity), but could work for many.
- pzlarsson 7y ago
  The 2:1 setup was used to save lives after a mass shootings in Las Vegas a few years ago. They paired patiets of similar size, put them on the same ventilator and double the flow rate. It was mentioned in a blog post by an ER physician linked from hn back then.
  - enchiridion 7y ago
    The article for the interested. It's a tough but good read. https://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/ https://epmonthly.com/article/not-heroes-wear-capes-one-las-...
- gizmo686 7y ago
  I spoke with a father (a pulmonary and critical care doctor) about this. Based on the specs, he estimates that a single ventilator could support up to 4 patients [0]. The bigger issue is the control system. Ideally, a ventilator will allow the patient to decide when to breath, and provide assistance; only forcing a breath when the patient fails to breath at all. WIth multiple patients, this is impossible, and you are forced to use continuous mandatory ventilation mode, where the ventilator cycles air pressure at a constant pattern regardless of what the patient is doing. Modern ventilators do not even support such a mode; although it can be emulated by programming the ventilator such that it would never detect a breath. Another issue is doctor error. When programming a ventilator you can either program it in terms of air-flow or pressure. With multiple patients, programming in terms of air-flow is almost certainly wrong, and would cause a change in condition of one patient to negatively effect the treatment of all attached patients. This problem goes away with pressure based controls. However, if you have doctors who are used to using flow based controls, and are overworked, while using a novel treatment method, I would expect to see accidents where they either continue to use flow-based controls, or do switch to pressure based but are less effective at it due to it being yet another change from their normal practice. Another downside is that all patients attached to the same ventilator need the same settings. You could potentially mitigate this cheaply by using analog pressure step-downs on the valves, but this just compounds the above problems, and introduces even more room untested elements to the equation. [0] The exact number depends on how much airflow you want to provide. Apparently, in cases such as this, you actually want to provide relatively little airflow to avoid further damaging the lungs by over-inflating them.
riffraff 7y ago
It was my understanding ventilators also do CO2/O2 analysis to understand how to work on the fly, how would that work in this case?
- djsumdog 7y ago
  I would assume those numbers would be meaningless. This is a hack, so the main goal would be to simply keep as many people alive as possible.
liquidify 7y ago
They kept giving reasons why this might not work... * not tested in humans * cross infection potential * different sized people mess it up ... but I see no reason why any of these things would stop me from using this in the real world. If things are bad enough that we need to do this, then we should be able to find relatively similar sized people. Cross contamination is not a concern when someone is dying here and now and likely has the same disease as the guy next to him who is also dying. Priority 1 is save them. Make their next of kin sign a waver or something, but save them. Lastly, who cares if it hasn't been "tested"? It was used in the real world, in a real life and death scenario, and it worked. I'd absolutely take my chances with it given that the failed option is to pull people off and set it back to single person mode. At least try. Lastly, I would imagine that some common pressure regulation values could be used to compensate for different sized people.
- tathougies 7y ago
  > Cross contamination is not a concern when someone is dying here and now and likely has the same disease as the guy next to him who is also dying If COVID evolves into multiple strains, then there is a real risk of cross-infection that would make the immune system forced to work harder? Moreover, a lot of the pneumonia deaths are not due to covid itself but rather due to opportunistic infections (often bacterial) that end up causing the pneumonia that causes death. Letting two COVID patients share a ventilator could mean that now one is exposed to a novel bacteria in the other that causes them to develop pneumonia.
  - lordnacho 7y ago
    But it doesn't have to be covid patients. There will still be people who need a ventilator but aren't part of the epidemic, freeing up ventilators for covid patients.
    - tathougies 7y ago
      As an example, my aunt just recently had a heart attack about two weeks before this covid stuff and had to be put on a ventilator. While in the ICU she developed an infection from a rare fungal disease that had been in her lungs for a while but suddenly had the opportunity to grow and cause respiratory distress. A lot of people have strange microbes in them that are being held at bay by the immune system. When all of a sudden you expose an already immuno-distressed person to someone else's novel microbes, you risk opportunistic infections, even in non-covid patients. I'm sure they can figure out how to re-use ventilators, but there probably needs to be some kind of assurance so that things can't cross.
nayuki 7y ago
This sounds like a real-life kind of trolley problem ( https://en.wikipedia.org/wiki/Trolley_problem https://en.wikipedia.org/wiki/Trolley_problem ).
blackrock 7y ago
Cross infection? F! This solution might be worse than the disease.
- lostlogin 7y ago
  More than one person needs the only ventilator. Could you explain how they are worse of sharing a ventilator than being dead?
  - blackrock 7y ago
    What types of infections are transmitted? Is it blood borne? What if you get cross infected with HIV? You get saved from the coronavirus, only to get HIV and die of AIDS. This is not a good trade off either.
    - wtallis 7y ago
      > You get saved from the coronavirus, only to get HIV and die of AIDS. This is not a good trade off either. Dying from COVID19 in the next few days vs risking HIV and maybe AIDS years or decades later is a pretty obvious choice.
      - blackrock 7y ago
        I don’t know. Having HIV and AIDS is the ultimate scarlet letter. It’s the mark of death. Even in this day and age, over 30 years later, the stigma of having it is socially unacceptable, regardless of what is publicly promoted.
        tempestn 7y ago
        What are you talking about? You're saying given the choice between dying of COVID-19 right now due to lack of a ventilator, and a hypothetical chance of getting AIDS (a treatable disease that you could very well live with for decades), you don't find the choice obvious? That doesn't make any sense.
yread 7y ago
I've seen it discussed by intensivists on Twitter in January, that they've used it during 2009 pandemic
- qiqitori 7y ago
  Here's a tweet saying they're already doing it now: https://twitter.com/PeterAttiaMD/status/1240293938684018688 https://twitter.com/PeterAttiaMD/status/1240293938684018688
  - Havoc 7y ago
    That's terrifyingly soon
yread 7y ago
There is quite some discussion of it here https://emcrit.org/pulmcrit/split-ventilators/ https://emcrit.org/pulmcrit/split-ventilators/ It has certain disadvantages (like not being able to trigger a breath on yiur own)
- Robadob 7y ago
  The video's here, in Italy, show the ventilators used with a bag over the patient's head to create a bubble of positive pressure (and quarantine off their head). So presumably in a scenario like this it's less of a problem about 'triggering own breath'. https://news.sky.com/story/coronavirus-they-call-it-the-apocalypse-inside-italys-hardest-hit-hospital-11960597 https://news.sky.com/story/coronavirus-they-call-it-the-apoc...
fifteenforty 7y ago
There are lots of problems with this, but I think it is possibly a better move than some of the home-built ventilators you see floating around. I’m biased though: I’ve designed a 3D printed improvement on this idea that potentially allows you to ventilate multiple patients with different pressures: https://www.prusaprinters.org/prints/25808-3d-printed-circuit-splitter-and-flow-restriction-d https://www.prusaprinters.org/prints/25808-3d-printed-circui...
- RegBarclay 7y ago
  I was thinking as I read the article that there was a next step innovation in the wings to vary the treatment by patient.
- markmichalski 7y ago
  Fellow MD trying to help with engineered solutions. Perhaps check this out as well; someone used a common valve from a hardware store to titrate pressures up and down: https://www.youtube.com/watch?v=eSVbwWANqRI&feature=youtu.be https://www.youtube.com/watch?v=eSVbwWANqRI&feature=youtu.be. I've been thinking about how we might increase ventilation to one part of the circuit if the pCO2 drops too badly--any thoughts there?
  - fifteenforty 7y ago
    Thank you for pointing this out! I’m trying work out how to get in touch with this guy, unfortunately he has turned off all comments. I’m not sure I understand your question: do you mean if the one patient is getting hyperventilated? My suggestion is to set the pressure settings to ventilate the poorly compliant compliant lung, then use the flow restrictor to compensate on the more compliant lung.
_ZeD_ 7y ago
"Risky hack" is not something I want to apply during a sanitary emergency
- newsbinator 7y ago
  This may sound hyperbolic, but world wars are full of risky hacks, when things are dire. It's good to have them on napkins in back pockets, just in case.
- appleflaxen 7y ago
  it's all about tradeoffs of course you don't want to but in italy, fatalities increased because there aren't enough ventilators. US is days away from that point so if it's a matter of no ventilator or a dirty ventilator, most people will take the dirty vent. after all: the sanitary crisis is for Coronavirus, and you already have it.
  - _ZeD_ 7y ago
    I was wondering about he infamous Liston's most famous case https://en.wikipedia.org/wiki/Robert_Liston#Liston's_most_famous_cases https://en.wikipedia.org/wiki/Robert_Liston#Liston's_most_fa...
- solarkraft 7y ago
  What's the alternaitive, just not even trying to help half of the people you could theoretically save?
- pessimizer 7y ago
  First aid is a list of risky hacks that are used only during emergencies.
pbhjpbhj 7y ago
Have governments made orders (legal or purchase) for manufacture of ventilators by large scale companies? Presumably ventilators are a relatively niche product - what's in them that the World's industrial complexes can't ramp up production of within a couple of weeks? I imagine it's the pumps that's the limiting factor? Given humanity already has the working tested, established designs. Can't governments requisition the design, turn the original factories in to test only, or construct and test, centres. Instruct the mega-corps, publicly, which parts they are to make and by when ... In the West we throw away tens-of-thousands of highly engineered products every day; surely we can step up now?
- meheleventyone 7y ago
  Reporting in the UK says that half a dozen prototypes have been delivered to the NHS for manufacturing approval already.
  - kaetemi 7y ago
    Half a dozen somehow sounds more impressive than six...
    - meheleventyone 7y ago
      Hah, yes! Although six individual companies spinning up a prototype in quick order is pretty impressive as well.
    - hnarn 7y ago
      Tangentially (this is HN after all) I also feel like "half a dozen" gives a more fuzzy confidence interval than a regular number ("6"). Of course, half a dozen literally means the amount 6, but am I the only one that reads them slightly differently? I almost see an implicit "about" before the phrase: "[about] half a dozen".
      - polytely 7y ago
        It's actually a really interesting subject, I think it's closely related to something called "words of estimate probability", the wikipedia article [0] is a good startingpoint. 0: https://en.wikipedia.org/wiki/Words_of_estimative_probability https://en.wikipedia.org/wiki/Words_of_estimative_probabilit...
Continuous 7y ago
This is ridiculous! Hacks are ok with web and app deployments where you are able to patch and fix to your heart's content and the damage is not life threatening. I have worked with the medical industry, the amount of formal validation and verification that goes through on software is insane compared to what we have in the "move fast and break things" world. Even if it is "temporary" and "desperate" I would stay away from this mentality as much as humanly possible.
- varjag 7y ago
  In Northern Italy patients are being turned down on triage because there is not enough treatment capacity. They go home and many of them die. Just like you would use a sweaty t-shirt over an open wound in a life or death situation if there is no certified sterile bandage at hand. The calculus is different.
  - deleted 7y ago
    [deleted]
- fifteenforty 7y ago
  On more than one occasion I have "broken the rules" or Macgyvered my way out of a life-threatening situation (for my patients), either with equipment or drugs. This is a crisis. Our systems aren't working fast enough to cope.
- jariel 7y ago
  This is completely the wrong attitude. Different circumstances with different levels of risk, require the ability to adapt. Nobody is suggesting 'sharing ventilators' would be normal practice because in normal circumstances we want to make sure that equipment is 99.999% reliable. But as you imply, this requires extensive testing and regulation. Within these regulations are also significant safety margins that can be exploited if conditions change. If we can multiply the usage and maintain 99.99% reliability, then this is probably a risk worth taking. Also - if you've worked in the medical industry, you know how vastly overpriced and bureaucratized everything is. The situation of 'not enough ventilators' is literally happening right in front of us, and it is causing death. The risk tolerance for utilizing the gear in such a manner is such that it may very well be possible to create better outcomes. The individuals involved are medical practitioners who are well versed in the equipment, procedures, and inherent moral dilemmas, they're not fools. This is exactly the kind of procedural innovation required in times of crises - hopefully, a few doctors and especially the Engineers from the manufacturer can be involved. The people who built the gear may be able to give a much better articulation of the actual risks involved, and they may even be able to mitigate, for example 'the risk will be power consumption' or 'the risk will be this specific valve which could wear and break' thereby implying the 'new operational procedure' would involve daily checking of said valve etc.. The world is facing crises we absolutely must be adaptive while trying to quantify risk and outcomes.
asdf333 7y ago
if it comes to it, you can probably do three to a ventilator according to some people in the industry i have spoken with
- wcoenen 7y ago
  Despite the title, the article talks about hooking four patients up to one ventilator.
mrob 7y ago
Is negative pressure ventilation any use in treating Covid-19? Iron lungs are easier to build than positive pressure ventilators. I imagine many HN readers could build something like a Both respirator[0] in their garage over a weekend. Using negative pressure ventilation might be a better option than trying to attach multiple patients to a positive pressure ventilator. [0] https://en.wikipedia.org/wiki/Both_respirator https://en.wikipedia.org/wiki/Both_respirator
- fifteenforty 7y ago
  Theoretically yes, in fact it may actually be better. We have largely abandoned negative pressure ventilatory support for a number of practical reasons. Not least is that once you have intubated a patient, they are less contagious!
- JshWright 7y ago
  No, in the case of ARDS, you need positive pressure (especially "back pressure" during exhalation) in order to keep the alveoli open. https://en.m.wikipedia.org/wiki/Positive_end-expiratory_pressure https://en.m.wikipedia.org/wiki/Positive_end-expiratory_pres...
  - fifteenforty 7y ago
    We are talking about negative pressure mechanical ventilation. Positive end expiratory pressure is just one way of splinting open alveoli. Maintaining recruitment and V/Q matching in ARDS can be achieved in multiple ways, including negative pressure mechanical ventilation.
    - JshWright 7y ago
      Interesting, I'd be curious to know more. My understanding of NPV is that it's primarily useful in cases when the lungs are generally "functional" and some other issue is preventing adequate ventilation.
    - AstralStorm 7y ago
      Anyway, the ventilator hardware is relatively easy to make, a gas pump, reduction and humidifier, plus a few hoses. Literally your granddad's CPAP sleep apnea machine is (almost?) good enough, if it has tuned oxygen intake. I would wager intubating actually makes most problems worse in case of damaged lungs, but with low odds only. The real problem will be getting actual oxygen (concentrators are not free) and people to tune the system.
atdrummond 7y ago
There are some odd quotes and grammatical mistakes in this article. For example: “You wouldn’t want to put a patient with severe bronchospasm [sudden contractions of bronchial muscles in the lungs] with a patient that does not have bronchospasm because that would.” Likewise, one of the cited authors’ names, Babcock, is misspelled in the piece as Babcok. I’m not qualified to assess whether this risk is worth it but I am surprised that Vice’s editing is so shoddy. It certainly doesn’t engender faith in the veracity/accuracy of their reporting.
- mkl 7y ago
  > one of the cited authors’ names, Babcock, is misspelled in the piece as Babcok. And also "Babock".
- Wowfunhappy 7y ago
  Vice’s articles are always full of typos. I suspect they don’t have a copy editor. It’s unfortunate, because their reporting seems to be quite good.
- surround 7y ago
  It looks like they have since fixed the errors you mentioned, yet they still misspell the author’s name as “Babock.”
  - DHPersonal 7y ago
    Also a spelling error here: “Let’s say 10 people are dying in front of you and you have one ventialtor. That’s a tough call.
  - mushufasa 7y ago
    guess they prioritize shipping and just debug in production!
- mlok 7y ago
  Maybe typos are good for SEO ? People often make mistakes or typos while searching.
- 7y ago
Mvandenbergh 7y ago
Interesting. This has been done before (after LV shooting) but has conventionally been considered as an intervention suitable for treating mass trauma. That's because people who are otherwise in good health are easier to ventilate than people with stiff, non-compliant lungs caused by inflammatory viral ARDS. Ventilating people with ARDS is hard. You have to use low, carefully considered tidal volumes and essentially allow the patient to be hypercapnic (CO2 higher than ideal), sometimes quite severely. You're doing a delicate dance between ventilating in a way the lungs can take and maintaining blood gases compatible with life.
- fifteenforty 7y ago
  As you say, we have many patients already in our ICUs who need ventilation, but aren’t /difficult/ to ventilate. Perhaps they could get the split ventilators and the COVID-19 patients could get their own?
  - koheripbal 7y ago
    Yes, but the demand projected for ventilators seems to exceed the entire existing supply, and obviously dwarf the uses for all other conditions combined.
tyingq 7y ago
Makes me wonder if there's now a black market and/or hoarding for CPAP and BiPAP machines. Not really a substitute for a ventilator, but better than nothing if the hospital has nothing for you.
- AstralStorm 7y ago
  You do need oxygen though, moistened and well tuned percentage to pressure. Would require a modification to the mask or hose for most of these machines. (One way valve from O2 source at least.)
test6554 7y ago
Middle-out! How could I have not seen this...
Hendrikto 7y ago
If some untested and unapproved method like this is used and something goes wrong, I would image that being a huge liability problem. Good on them for trying to save human lives, but our legal system does not always reward the ethical behavior.
- Waterluvian 7y ago
  I would hope that our legal systems account for the context in which these actions occur. It feels like a larger version of the Good Samaritan Act. They might do harm but they're doing nothing else but trying to save lives. This isn't carelessness or greed driving this behaviour. Our laws are not a suicide pact and sometimes they must be broken.
- bhoover 7y ago
  I believe the government is working to reduce liability risk so that more n95 masks can be used in medical environments. Perhaps that can be done for this too.
- gizmo686 7y ago
  Governments are already loosening licensing requirements to practice medicine. If this approach has support among the relevant healthcare workers and agencies, then we see executive action to allow for such a measure.
- Havoc 7y ago
  These type of "save lives" things tend to have bipartisan support so you can ram through any laws needs fairly fast. Very much doubt any politician will be caught on the wrong side of such a vote
bhoover 7y ago
Terrible choice of words for the headline. Adding two negative-persuasion terms (risky hack) to bias the reader. What we need right now is encouragement of innovation in all sectors, not some inflammatory headline scaring people. Vice is not helping our combined effort.
Herodotus38 7y ago
I encourage anyone wanting to help to try and finds ways of manufacturing the essentials of PPE that we need to limit spread, as that will have a much bigger impact. Every hospital and clinic in my area is running out of masks (both N95 and surgical), gowns, plastic goggles and starting to get into issues with disinfectants. Having double ventilator use is a nightmare scenario for various reasons. There are much better proactive things you can make and donate, but please reach out to your local clinic or hospital and ask first if they have guidelines or material information on what they need before assuming.
- bootlooped 7y ago
  It would be good if they found a way to decontaminate the masks so they could be reused a finite number of times, instead of treated as totally disposable. As far as what I've read, there are many things that can kill the virus: hydrogen peroxide, alcohol, uv sanitizing lights, heat, time... Seems like you could come up with a cheap and simple routine that would be 99+% effective, at least for coronavirus specifically. Sure this isn't optimal, but a lot of things aren't optimal these days.
  - anon946 7y ago
    Something that occurred to me was a "hot closet" of some kind that was held at a temperature high enough to accelerate deactivation of the virus without damaging the masks. Perhaps around 130 F would be the right temperature. Advantage would be that it would not require liquids of any kind and not be labor intensive.
  - Herodotus38 7y ago
    We are reusing all N95 masks where I work because there aren’t enough. Each employee gets one. To try and protect the N95 and make it reusable without risk (they are not designed to be reusable) we are wearing a standard surgical mask over it, and this standard mask gets thrown away with each use. Nobody here is going to be able to independently make N95 masks but the simple masks can be made of well filtering thick materials. Plastic goggle/face shields can also be made from clear plastic.
  - 7y ago
pizzaknife 7y ago
i dont know if im stoked or depressed that "risky hack" manifested in my mind after reading the title, as it has in irl
anonuser123456 7y ago
People keep talking about ventilators. The only study I've seen w.r.t. ventilator success for COVID-19 treatment showed something like 3% survival for those mechanically ventilated. Do we have more data showing they even move the needle?
- radicalbyte 7y ago
  I've seen figures showing a 50% success rate. I assume that the success rate is very low with much older patients because intubation itself causes a lot of damage.
- markmichalski 7y ago
  This isn't right--almost all with beds in the ICU right now are mechanically ventilated; >50% will survive.
  - asah 7y ago
    Wuhan study of COVID showed 31/32 died: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... non-COVID mortality is typically a coin-toss: https://www.google.com/search?q=mortality+rate+ventilators https://www.google.com/search?q=mortality+rate+ventilators
    - anonuser123456 7y ago
      The lancet article is what I've seen. I think early on, it was assumed ARDS was the worst outcome; your lungs stopped functioning and ventilation would tide you over. But the more we dig in, there are multiple systems failing and ARDS is just one of many destructive processes going on. This is one of the really important data points to work out. If almost everyone ventilated will die... it makes no sense for hospitals to extensively treat this way. Give people palliative care. It directs resources away from other, more productive efforts... for example ... running clinical trails on potential treatments to PREVENT ARDS/sepsis.
    - AntonStratiev 7y ago
markhollis 7y ago
This is another article seems to be written by someone who has deep knowledge about this topic. https://emcrit.org/pulmcrit/split-ventilators/ https://emcrit.org/pulmcrit/split-ventilators/ Continuous mandatory ventilation (CMV) is required, however it is necessary to accept permissive hypercapnia.
gentleman11 7y ago
I hope the legal framework does not lead to people like her getting sued over their attempts to help

257 points by spookybones 7y ago

sjg007 7y ago

This will become standard in about a month I bet

bitexploder 7y ago
I hope not, but if this can save a few extra lives that would probably be better than any hack I ever pulled off.

bitexploder 7y ago

This is really neat. It seems a lot of the risk is how specific lung capacities and conditions interact with the ventilator and how much oxygen someone needs. My question to any MDs reading this: how often do you have to tweak ventilator volume for patients using one? What is the feedback loop? Blood oxygen levels?

theturingnerd 7y ago
(physician here) Vents can be quite tricky to get right; primarily because as disease progression continues on many things change. We are always trying to balance the deleterious effects of the intervention (in this case, the vent) with the goals of care. What most people don't know is that vents cause a lot of injuries on their own. (See ARDS). Hypoxemic respiratory failure is serious stuff, and it's almost always not the only insult we're dealing with. So, it's about balance. In the feedback loop is a lot of things. Certainly, oxygen saturation is a core measure, but we are also thinking about things like hypercapnia (and acidosis); overall perfusion status (blood circulation); infection management; etc. Gas exchange is important, but there are a lot of things that have to go right for the lungs to take oxygen in, get it into the right transport, and get carbon dioxide back out. You can over-optimize for any of those at the expense of the other (see: hypercapnia). In short, it's complex and there isn't a solid formula that will work for every patient. It's actually the subject of a lot of debate on details (some of it quite passionate in our Critical care / pulmonology community). This is why we call it PRACTICING medicine ;)
- djsumdog 7y ago
  What do you think are the risks of cross contamination in this setup (let's say, just for 2 people sharing one unit)? She mentions how, in a situation where you'd have to use this, they'd have the same infection. What if they have different secondary infections or different types of pneumonia? The example of the Vegas disaster is different because they were all gunshot victims; they were healthy, but wounded. I hope we would never need to see if these would be effective.
  - markmichalski 7y ago
    MD here. There is an inhalation and exhalation tube for each patient; the exhalation tubes would be in continuity using the described configuration. However, at least for part of the transmission route, viral particles would have to move against flow. So there is likely some cross-contamination. All that being said in the situation where this is deployed I think it would be a risk most providers would take.
- bitexploder 7y ago
  Thanks for this explanation.
- gdubs 7y ago
  I can't even figure out what my HVAC vents do, or how not to mess up my entire heating and cooling situation – so I leave them alone. Utter respect for you and all the other medical professionals who are having to adapt and deal with this unfolding situation. Many thanks for what you do.
- forkexec 7y ago
  IANAMDOMP. After respiratory therapists, it seems like perfusionists will be stretched thin too because there are so few of them globally. I would predict lots of ECMOs and long waiting lists for lung transplants in the next few months, but also lots of poor outcomes for COVID patients with preexisting cardiopulmonary issues. I just hope young and middle-aged people take it seriously and don't avoidably waste healthcare resources through irresponsible behavior.
- 7y ago

ummonk 7y ago

The virus doubles in less than a week, so this hack (which is being used extensively in Italy from my understanding) can only by you so much time to stop its spread with mitigation measures.

grej 7y ago
Depends on whether you flatten out the growth rate. It won't/can't keep growing like that when everyone is sheltering in place.
- Polylactic_acid 7y ago
  Seems likely. Italy is currently seeing a 13% increase per day while the US is now very close to a 50% increase per day. There are news reports showing beaches and bars in the US are still fully packed. It probably relates the US culture of disregarding expert advice and doing the opposite to "own the scientists"
  - nathanlied 7y ago
    It's not just the US. This happened across countries in Europe as well; Italy had it happen, Germany had "Coronavirus Parties", even. It happens because some people are idiots, and others aren't quite aware of how serious the situation is. Once reality sets in, only the absolute idiots that don't care for being socially ostracized (or in some cases even legal consequences) will continue that behaviour. And luckily those are normally a minority.
  - loeg 7y ago
    The US federal government isn't actually doing much at the top level. Individual states are shutting down at variable times and rates. The beaches and bars are mostly in these slow-moving states.
    - gwright 7y ago
      That is because that is how our system of executive administration is designed. It is a federal system with the vast, vast majority of police powers (https://en.wikipedia.org/wiki/Police_power_(United_States_constitutional_law) https://en.wikipedia.org/wiki/Police_power_(United_States_co... residing in the state, not federal authorities.

609venezia 7y ago

I thought I remembered reading somewhere recently that 2:1 is already in use in some cases (maybe in Italy?), but I can't find a source. Is there increased risk of ventilator failure with this approach? That seems like it could be an additional terrible factor to weigh, because parts have become so scarce.

froindt 7y ago
The article makes it sound like the ventilators have a wide enough range of operation to accommodate. It may not work for the tail end (set of 4 people each with large lung capacity), but could work for many.
pzlarsson 7y ago
The 2:1 setup was used to save lives after a mass shootings in Las Vegas a few years ago. They paired patiets of similar size, put them on the same ventilator and double the flow rate. It was mentioned in a blog post by an ER physician linked from hn back then.
- enchiridion 7y ago
  The article for the interested. It's a tough but good read. https://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/ https://epmonthly.com/article/not-heroes-wear-capes-one-las-...
gizmo686 7y ago
I spoke with a father (a pulmonary and critical care doctor) about this. Based on the specs, he estimates that a single ventilator could support up to 4 patients [0]. The bigger issue is the control system. Ideally, a ventilator will allow the patient to decide when to breath, and provide assistance; only forcing a breath when the patient fails to breath at all. WIth multiple patients, this is impossible, and you are forced to use continuous mandatory ventilation mode, where the ventilator cycles air pressure at a constant pattern regardless of what the patient is doing. Modern ventilators do not even support such a mode; although it can be emulated by programming the ventilator such that it would never detect a breath. Another issue is doctor error. When programming a ventilator you can either program it in terms of air-flow or pressure. With multiple patients, programming in terms of air-flow is almost certainly wrong, and would cause a change in condition of one patient to negatively effect the treatment of all attached patients. This problem goes away with pressure based controls. However, if you have doctors who are used to using flow based controls, and are overworked, while using a novel treatment method, I would expect to see accidents where they either continue to use flow-based controls, or do switch to pressure based but are less effective at it due to it being yet another change from their normal practice. Another downside is that all patients attached to the same ventilator need the same settings. You could potentially mitigate this cheaply by using analog pressure step-downs on the valves, but this just compounds the above problems, and introduces even more room untested elements to the equation. [0] The exact number depends on how much airflow you want to provide. Apparently, in cases such as this, you actually want to provide relatively little airflow to avoid further damaging the lungs by over-inflating them.

riffraff 7y ago

It was my understanding ventilators also do CO2/O2 analysis to understand how to work on the fly, how would that work in this case?

djsumdog 7y ago
I would assume those numbers would be meaningless. This is a hack, so the main goal would be to simply keep as many people alive as possible.

liquidify 7y ago

They kept giving reasons why this might not work... * not tested in humans * cross infection potential * different sized people mess it up ... but I see no reason why any of these things would stop me from using this in the real world. If things are bad enough that we need to do this, then we should be able to find relatively similar sized people. Cross contamination is not a concern when someone is dying here and now and likely has the same disease as the guy next to him who is also dying. Priority 1 is save them. Make their next of kin sign a waver or something, but save them. Lastly, who cares if it hasn't been "tested"? It was used in the real world, in a real life and death scenario, and it worked. I'd absolutely take my chances with it given that the failed option is to pull people off and set it back to single person mode. At least try. Lastly, I would imagine that some common pressure regulation values could be used to compensate for different sized people.

tathougies 7y ago
> Cross contamination is not a concern when someone is dying here and now and likely has the same disease as the guy next to him who is also dying If COVID evolves into multiple strains, then there is a real risk of cross-infection that would make the immune system forced to work harder? Moreover, a lot of the pneumonia deaths are not due to covid itself but rather due to opportunistic infections (often bacterial) that end up causing the pneumonia that causes death. Letting two COVID patients share a ventilator could mean that now one is exposed to a novel bacteria in the other that causes them to develop pneumonia.
- lordnacho 7y ago
  But it doesn't have to be covid patients. There will still be people who need a ventilator but aren't part of the epidemic, freeing up ventilators for covid patients.
  - tathougies 7y ago
    As an example, my aunt just recently had a heart attack about two weeks before this covid stuff and had to be put on a ventilator. While in the ICU she developed an infection from a rare fungal disease that had been in her lungs for a while but suddenly had the opportunity to grow and cause respiratory distress. A lot of people have strange microbes in them that are being held at bay by the immune system. When all of a sudden you expose an already immuno-distressed person to someone else's novel microbes, you risk opportunistic infections, even in non-covid patients. I'm sure they can figure out how to re-use ventilators, but there probably needs to be some kind of assurance so that things can't cross.

nayuki 7y ago

This sounds like a real-life kind of trolley problem ( https://en.wikipedia.org/wiki/Trolley_problem https://en.wikipedia.org/wiki/Trolley_problem ).

blackrock 7y ago

Cross infection? F! This solution might be worse than the disease.

lostlogin 7y ago
More than one person needs the only ventilator. Could you explain how they are worse of sharing a ventilator than being dead?
- blackrock 7y ago
  What types of infections are transmitted? Is it blood borne? What if you get cross infected with HIV? You get saved from the coronavirus, only to get HIV and die of AIDS. This is not a good trade off either.
  - wtallis 7y ago
    > You get saved from the coronavirus, only to get HIV and die of AIDS. This is not a good trade off either. Dying from COVID19 in the next few days vs risking HIV and maybe AIDS years or decades later is a pretty obvious choice.
    - blackrock 7y ago
      I don’t know. Having HIV and AIDS is the ultimate scarlet letter. It’s the mark of death. Even in this day and age, over 30 years later, the stigma of having it is socially unacceptable, regardless of what is publicly promoted.
      - tempestn 7y ago
        What are you talking about? You're saying given the choice between dying of COVID-19 right now due to lack of a ventilator, and a hypothetical chance of getting AIDS (a treatable disease that you could very well live with for decades), you don't find the choice obvious? That doesn't make any sense.

yread 7y ago

I've seen it discussed by intensivists on Twitter in January, that they've used it during 2009 pandemic

qiqitori 7y ago
Here's a tweet saying they're already doing it now: https://twitter.com/PeterAttiaMD/status/1240293938684018688 https://twitter.com/PeterAttiaMD/status/1240293938684018688
- Havoc 7y ago
  That's terrifyingly soon

yread 7y ago

There is quite some discussion of it here https://emcrit.org/pulmcrit/split-ventilators/ https://emcrit.org/pulmcrit/split-ventilators/ It has certain disadvantages (like not being able to trigger a breath on yiur own)

Robadob 7y ago
The video's here, in Italy, show the ventilators used with a bag over the patient's head to create a bubble of positive pressure (and quarantine off their head). So presumably in a scenario like this it's less of a problem about 'triggering own breath'. https://news.sky.com/story/coronavirus-they-call-it-the-apocalypse-inside-italys-hardest-hit-hospital-11960597 https://news.sky.com/story/coronavirus-they-call-it-the-apoc...

fifteenforty 7y ago

There are lots of problems with this, but I think it is possibly a better move than some of the home-built ventilators you see floating around. I’m biased though: I’ve designed a 3D printed improvement on this idea that potentially allows you to ventilate multiple patients with different pressures: https://www.prusaprinters.org/prints/25808-3d-printed-circuit-splitter-and-flow-restriction-d https://www.prusaprinters.org/prints/25808-3d-printed-circui...

RegBarclay 7y ago
I was thinking as I read the article that there was a next step innovation in the wings to vary the treatment by patient.
markmichalski 7y ago
Fellow MD trying to help with engineered solutions. Perhaps check this out as well; someone used a common valve from a hardware store to titrate pressures up and down: https://www.youtube.com/watch?v=eSVbwWANqRI&feature=youtu.be https://www.youtube.com/watch?v=eSVbwWANqRI&feature=youtu.be. I've been thinking about how we might increase ventilation to one part of the circuit if the pCO2 drops too badly--any thoughts there?
- fifteenforty 7y ago
  Thank you for pointing this out! I’m trying work out how to get in touch with this guy, unfortunately he has turned off all comments. I’m not sure I understand your question: do you mean if the one patient is getting hyperventilated? My suggestion is to set the pressure settings to ventilate the poorly compliant compliant lung, then use the flow restrictor to compensate on the more compliant lung.

_ZeD_ 7y ago

"Risky hack" is not something I want to apply during a sanitary emergency

newsbinator 7y ago
This may sound hyperbolic, but world wars are full of risky hacks, when things are dire. It's good to have them on napkins in back pockets, just in case.
appleflaxen 7y ago
it's all about tradeoffs of course you don't want to but in italy, fatalities increased because there aren't enough ventilators. US is days away from that point so if it's a matter of no ventilator or a dirty ventilator, most people will take the dirty vent. after all: the sanitary crisis is for Coronavirus, and you already have it.
- _ZeD_ 7y ago
  I was wondering about he infamous Liston's most famous case https://en.wikipedia.org/wiki/Robert_Liston#Liston's_most_famous_cases https://en.wikipedia.org/wiki/Robert_Liston#Liston's_most_fa...
solarkraft 7y ago
What's the alternaitive, just not even trying to help half of the people you could theoretically save?
pessimizer 7y ago
First aid is a list of risky hacks that are used only during emergencies.

pbhjpbhj 7y ago

Have governments made orders (legal or purchase) for manufacture of ventilators by large scale companies? Presumably ventilators are a relatively niche product - what's in them that the World's industrial complexes can't ramp up production of within a couple of weeks? I imagine it's the pumps that's the limiting factor? Given humanity already has the working tested, established designs. Can't governments requisition the design, turn the original factories in to test only, or construct and test, centres. Instruct the mega-corps, publicly, which parts they are to make and by when ... In the West we throw away tens-of-thousands of highly engineered products every day; surely we can step up now?

meheleventyone 7y ago
Reporting in the UK says that half a dozen prototypes have been delivered to the NHS for manufacturing approval already.
- kaetemi 7y ago
  Half a dozen somehow sounds more impressive than six...
  - meheleventyone 7y ago
    Hah, yes! Although six individual companies spinning up a prototype in quick order is pretty impressive as well.
  - hnarn 7y ago
    Tangentially (this is HN after all) I also feel like "half a dozen" gives a more fuzzy confidence interval than a regular number ("6"). Of course, half a dozen literally means the amount 6, but am I the only one that reads them slightly differently? I almost see an implicit "about" before the phrase: "[about] half a dozen".
    - polytely 7y ago
      It's actually a really interesting subject, I think it's closely related to something called "words of estimate probability", the wikipedia article [0] is a good startingpoint. 0: https://en.wikipedia.org/wiki/Words_of_estimative_probability https://en.wikipedia.org/wiki/Words_of_estimative_probabilit...

Continuous 7y ago

This is ridiculous! Hacks are ok with web and app deployments where you are able to patch and fix to your heart's content and the damage is not life threatening. I have worked with the medical industry, the amount of formal validation and verification that goes through on software is insane compared to what we have in the "move fast and break things" world. Even if it is "temporary" and "desperate" I would stay away from this mentality as much as humanly possible.

varjag 7y ago
In Northern Italy patients are being turned down on triage because there is not enough treatment capacity. They go home and many of them die. Just like you would use a sweaty t-shirt over an open wound in a life or death situation if there is no certified sterile bandage at hand. The calculus is different.
- deleted 7y ago
  [deleted]
fifteenforty 7y ago
On more than one occasion I have "broken the rules" or Macgyvered my way out of a life-threatening situation (for my patients), either with equipment or drugs. This is a crisis. Our systems aren't working fast enough to cope.
jariel 7y ago
This is completely the wrong attitude. Different circumstances with different levels of risk, require the ability to adapt. Nobody is suggesting 'sharing ventilators' would be normal practice because in normal circumstances we want to make sure that equipment is 99.999% reliable. But as you imply, this requires extensive testing and regulation. Within these regulations are also significant safety margins that can be exploited if conditions change. If we can multiply the usage and maintain 99.99% reliability, then this is probably a risk worth taking. Also - if you've worked in the medical industry, you know how vastly overpriced and bureaucratized everything is. The situation of 'not enough ventilators' is literally happening right in front of us, and it is causing death. The risk tolerance for utilizing the gear in such a manner is such that it may very well be possible to create better outcomes. The individuals involved are medical practitioners who are well versed in the equipment, procedures, and inherent moral dilemmas, they're not fools. This is exactly the kind of procedural innovation required in times of crises - hopefully, a few doctors and especially the Engineers from the manufacturer can be involved. The people who built the gear may be able to give a much better articulation of the actual risks involved, and they may even be able to mitigate, for example 'the risk will be power consumption' or 'the risk will be this specific valve which could wear and break' thereby implying the 'new operational procedure' would involve daily checking of said valve etc.. The world is facing crises we absolutely must be adaptive while trying to quantify risk and outcomes.

asdf333 7y ago

if it comes to it, you can probably do three to a ventilator according to some people in the industry i have spoken with

wcoenen 7y ago
Despite the title, the article talks about hooking four patients up to one ventilator.

mrob 7y ago

Is negative pressure ventilation any use in treating Covid-19? Iron lungs are easier to build than positive pressure ventilators. I imagine many HN readers could build something like a Both respirator[0] in their garage over a weekend. Using negative pressure ventilation might be a better option than trying to attach multiple patients to a positive pressure ventilator. [0] https://en.wikipedia.org/wiki/Both_respirator https://en.wikipedia.org/wiki/Both_respirator

fifteenforty 7y ago
Theoretically yes, in fact it may actually be better. We have largely abandoned negative pressure ventilatory support for a number of practical reasons. Not least is that once you have intubated a patient, they are less contagious!
JshWright 7y ago
No, in the case of ARDS, you need positive pressure (especially "back pressure" during exhalation) in order to keep the alveoli open. https://en.m.wikipedia.org/wiki/Positive_end-expiratory_pressure https://en.m.wikipedia.org/wiki/Positive_end-expiratory_pres...
- fifteenforty 7y ago
  We are talking about negative pressure mechanical ventilation. Positive end expiratory pressure is just one way of splinting open alveoli. Maintaining recruitment and V/Q matching in ARDS can be achieved in multiple ways, including negative pressure mechanical ventilation.
  - JshWright 7y ago
    Interesting, I'd be curious to know more. My understanding of NPV is that it's primarily useful in cases when the lungs are generally "functional" and some other issue is preventing adequate ventilation.
  - AstralStorm 7y ago
    Anyway, the ventilator hardware is relatively easy to make, a gas pump, reduction and humidifier, plus a few hoses. Literally your granddad's CPAP sleep apnea machine is (almost?) good enough, if it has tuned oxygen intake. I would wager intubating actually makes most problems worse in case of damaged lungs, but with low odds only. The real problem will be getting actual oxygen (concentrators are not free) and people to tune the system.

atdrummond 7y ago

There are some odd quotes and grammatical mistakes in this article. For example: “You wouldn’t want to put a patient with severe bronchospasm [sudden contractions of bronchial muscles in the lungs] with a patient that does not have bronchospasm because that would.” Likewise, one of the cited authors’ names, Babcock, is misspelled in the piece as Babcok. I’m not qualified to assess whether this risk is worth it but I am surprised that Vice’s editing is so shoddy. It certainly doesn’t engender faith in the veracity/accuracy of their reporting.

mkl 7y ago
> one of the cited authors’ names, Babcock, is misspelled in the piece as Babcok. And also "Babock".
Wowfunhappy 7y ago
Vice’s articles are always full of typos. I suspect they don’t have a copy editor. It’s unfortunate, because their reporting seems to be quite good.
surround 7y ago
It looks like they have since fixed the errors you mentioned, yet they still misspell the author’s name as “Babock.”
- DHPersonal 7y ago
  Also a spelling error here: “Let’s say 10 people are dying in front of you and you have one ventialtor. That’s a tough call.
- mushufasa 7y ago
  guess they prioritize shipping and just debug in production!
mlok 7y ago
Maybe typos are good for SEO ? People often make mistakes or typos while searching.
7y ago

Mvandenbergh 7y ago

Interesting. This has been done before (after LV shooting) but has conventionally been considered as an intervention suitable for treating mass trauma. That's because people who are otherwise in good health are easier to ventilate than people with stiff, non-compliant lungs caused by inflammatory viral ARDS. Ventilating people with ARDS is hard. You have to use low, carefully considered tidal volumes and essentially allow the patient to be hypercapnic (CO2 higher than ideal), sometimes quite severely. You're doing a delicate dance between ventilating in a way the lungs can take and maintaining blood gases compatible with life.

fifteenforty 7y ago
As you say, we have many patients already in our ICUs who need ventilation, but aren’t /difficult/ to ventilate. Perhaps they could get the split ventilators and the COVID-19 patients could get their own?
- koheripbal 7y ago
  Yes, but the demand projected for ventilators seems to exceed the entire existing supply, and obviously dwarf the uses for all other conditions combined.

tyingq 7y ago

Makes me wonder if there's now a black market and/or hoarding for CPAP and BiPAP machines. Not really a substitute for a ventilator, but better than nothing if the hospital has nothing for you.

AstralStorm 7y ago
You do need oxygen though, moistened and well tuned percentage to pressure. Would require a modification to the mask or hose for most of these machines. (One way valve from O2 source at least.)

test6554 7y ago

Middle-out! How could I have not seen this...

Hendrikto 7y ago

If some untested and unapproved method like this is used and something goes wrong, I would image that being a huge liability problem. Good on them for trying to save human lives, but our legal system does not always reward the ethical behavior.

Waterluvian 7y ago
I would hope that our legal systems account for the context in which these actions occur. It feels like a larger version of the Good Samaritan Act. They might do harm but they're doing nothing else but trying to save lives. This isn't carelessness or greed driving this behaviour. Our laws are not a suicide pact and sometimes they must be broken.
bhoover 7y ago
I believe the government is working to reduce liability risk so that more n95 masks can be used in medical environments. Perhaps that can be done for this too.
gizmo686 7y ago
Governments are already loosening licensing requirements to practice medicine. If this approach has support among the relevant healthcare workers and agencies, then we see executive action to allow for such a measure.
Havoc 7y ago
These type of "save lives" things tend to have bipartisan support so you can ram through any laws needs fairly fast. Very much doubt any politician will be caught on the wrong side of such a vote

bhoover 7y ago

Terrible choice of words for the headline. Adding two negative-persuasion terms (risky hack) to bias the reader. What we need right now is encouragement of innovation in all sectors, not some inflammatory headline scaring people. Vice is not helping our combined effort.

Herodotus38 7y ago

I encourage anyone wanting to help to try and finds ways of manufacturing the essentials of PPE that we need to limit spread, as that will have a much bigger impact. Every hospital and clinic in my area is running out of masks (both N95 and surgical), gowns, plastic goggles and starting to get into issues with disinfectants. Having double ventilator use is a nightmare scenario for various reasons. There are much better proactive things you can make and donate, but please reach out to your local clinic or hospital and ask first if they have guidelines or material information on what they need before assuming.

bootlooped 7y ago
It would be good if they found a way to decontaminate the masks so they could be reused a finite number of times, instead of treated as totally disposable. As far as what I've read, there are many things that can kill the virus: hydrogen peroxide, alcohol, uv sanitizing lights, heat, time... Seems like you could come up with a cheap and simple routine that would be 99+% effective, at least for coronavirus specifically. Sure this isn't optimal, but a lot of things aren't optimal these days.
- anon946 7y ago
  Something that occurred to me was a "hot closet" of some kind that was held at a temperature high enough to accelerate deactivation of the virus without damaging the masks. Perhaps around 130 F would be the right temperature. Advantage would be that it would not require liquids of any kind and not be labor intensive.
- Herodotus38 7y ago
  We are reusing all N95 masks where I work because there aren’t enough. Each employee gets one. To try and protect the N95 and make it reusable without risk (they are not designed to be reusable) we are wearing a standard surgical mask over it, and this standard mask gets thrown away with each use. Nobody here is going to be able to independently make N95 masks but the simple masks can be made of well filtering thick materials. Plastic goggle/face shields can also be made from clear plastic.
- 7y ago

pizzaknife 7y ago

i dont know if im stoked or depressed that "risky hack" manifested in my mind after reading the title, as it has in irl

anonuser123456 7y ago

People keep talking about ventilators. The only study I've seen w.r.t. ventilator success for COVID-19 treatment showed something like 3% survival for those mechanically ventilated. Do we have more data showing they even move the needle?

radicalbyte 7y ago
I've seen figures showing a 50% success rate. I assume that the success rate is very low with much older patients because intubation itself causes a lot of damage.
markmichalski 7y ago
This isn't right--almost all with beds in the ICU right now are mechanically ventilated; >50% will survive.
- asah 7y ago
  Wuhan study of COVID showed 31/32 died: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... non-COVID mortality is typically a coin-toss: https://www.google.com/search?q=mortality+rate+ventilators https://www.google.com/search?q=mortality+rate+ventilators
  - anonuser123456 7y ago
    The lancet article is what I've seen. I think early on, it was assumed ARDS was the worst outcome; your lungs stopped functioning and ventilation would tide you over. But the more we dig in, there are multiple systems failing and ARDS is just one of many destructive processes going on. This is one of the really important data points to work out. If almost everyone ventilated will die... it makes no sense for hospitals to extensively treat this way. Give people palliative care. It directs resources away from other, more productive efforts... for example ... running clinical trails on potential treatments to PREVENT ARDS/sepsis.
  - AntonStratiev 7y ago

markhollis 7y ago

This is another article seems to be written by someone who has deep knowledge about this topic. https://emcrit.org/pulmcrit/split-ventilators/ https://emcrit.org/pulmcrit/split-ventilators/ Continuous mandatory ventilation (CMV) is required, however it is necessary to accept permissive hypercapnia.

gentleman11 7y ago

I hope the legal framework does not lead to people like her getting sued over their attempts to help