12 ms·

Nvidia Releases Low-Cost, Open-Source Ventilator Design

150 points by bcaulfield 6y ago

tasty_freeze 6y ago
Keep in mind that this wasn't made by nvidia. It was a personal project of nvidia's chief scientist, Bill Dally.
clarkevans 6y ago
This design is licensed only for "use in response to the COVID-19 pandemic". http://op-vent.stanford.edu/license.pdf http://op-vent.stanford.edu/license.pdf
Nokinside 6y ago
> Traditional ventilators, by contrast, can cost more than $20,000 Traditional ventilators (ventilator) are very different from bag valve masks, resuscitators, PAP and CPAP, BiPAP machines. This Nvidia design is not alternative to that $20,000 hospital ventilator. It's emergency-response ventilator alternative these other cheap designs you can already order from Amazon. You can't keep people long time in this kind of device without serious risk of damage to the lungs.
- baybal2 6y ago
  Very few countries managed to produce emergency ventilators from scratch. Out of hundreds of ambu bag squeezer designs, find at least one that reached the assembly line. Not a lot. Only 4 countries on record now managed to start mass production of designed from scratch emergency ventilators. Expanding existing capacity would've been an incomparably better option.
  - Nokinside 6y ago
    One German manufacturer recently explained how their company has already outsourced almost all parts and manufacturing phases that can be easily scaled. The company does design, final assembly testing, calibration and quality control. I suspect that the internally used testing and manufacturing equipment and protocols are the hardest thing to scale.
    - baybal2 6y ago
      No, from my experience in OEM manufacturing since 2007 I can say it isn't.
  - dejv 6y ago
    Check out Corovent, its somehow open source (they have to hide their exact BOM for now, because of companies buying full stock of those parts). It is build by university team that actually design ventilators for 25 years and is certified to be used in case when there are no proper ventilators available. They are currently using industrial version of medical parts (due to limited availability of those parts) but full certification is in pipeline. They are just starting mass production now.
- adrianmonk 6y ago
  The article did specifically say it is more advanced than a bag ("provides better care than “bag squeezer” emergency ventilators because it precisely regulates flow, pressure, and volume"). And it linked to the paper (http://op-vent.stanford.edu/docs/need.html http://op-vent.stanford.edu/docs/need.html) with more specifics. The "Prototype Specifications" section of the paper might be a good starting point for information about its capabilities. Are your criticisms based on an understanding of how this specific device actually works? Sorry to be blunt, but by suggesting it is comparable to a bag valve mask, it sounds like you did not learn a lot about the device before making up your mind about it.
  - Nokinside 6y ago
    >Sorry to be blunt, but by suggesting it is comparable to a bag valve mask, it sounds like you did not learn a lot about the device before making up your mind about it. Noting wrong with being blunt. But please, be blunt only after you read whole sentences and trying to decipher the meaning. I listed several different classes of devices of varying complexity that are not equal to those $20,000 ventilators used in ICU. I have experience in design of electronics that becomes part of ventilators and other medical equipment. GE healthcare and other firms. >Are your criticisms based on an understanding of how this specific device actually works? Yes. The system in question is very low-end emergency-response ventilator (explained in documentation). It's simplified design from those you see used in emergency response and patient transport. The operating mode seems to be basic pressure-controlled ventilation PCV.It can also measure tidal and minute volumes. ICU ventilator is device is very different from everything else. It's connected to the patients trachea. You must sedate patients because it's super uncomfortable to use. Patients are put into those ventilators when they are really sick. Removing carbon dioxide is an issue. Long term use can damage lungs so the system monitors large number of variables and it has multiple operating modes.
    - adrianmonk 6y ago
      OK, I see a little better where you're coming from now. Knowing that you have some expertise in this area puts your first comment in a different light. For what it's worth, I did read your comment carefully. The reason I took exception (and reacted strongly, I fully admit) is that since the article addressed the bag thing, that makes it a red herring, so I would have expected you to filter it out of your list. Maybe that's overly rigid or overly literal of me, but that is why I reacted how I did. This device definitely intends to be less than a full-featured ventilator. On the Pneumatics page (http://op-vent.stanford.edu/docs/pneumatics.html http://op-vent.stanford.edu/docs/pneumatics.html) it explains their goal is to produce kind of a stripped down "simple ventilator with the features needed to treat COVID-19". So they believe it can be useful even though they know it lacks features. Whether they're right is certainly up for debate. They mention several optional features, which is interesting because maybe it means they're just trying to be flexible or maybe it means they don't really know what is the minimum necessary to have a net benefit (save more people than you kill) if we run out of full-featured ventilators.
dogma1138 6y ago
All these designs are cool projects but other than being a distraction and some PR nothing will come out of them. There are plenty of proven designs that can be manufactured cheaply, the price of the end units especially for things like ventilators isn't often due to complexity and manufacturing costs but due to the costs of maintaining a supply chain, manufacturing and providing support (including liability) for the healthcare market. None of these things seem to solve these issues other than potentially removing liability to who ever decides to manufacture those units. Any thing can be built with off the shelf parts but the reason why most medical devices aren't it's because you need to take special care in your supply chain. Ventilators use valves that aren't that different and often the same valves that are available for a plethora of other applications like industry and agriculture but the fact that it's the same valve doesn't mean that it's the same supply chain. The suppliers for medical equipment make sure that say the lubricants that are used are safe and that no one can say replace o-ring used in the valve from one supplier to another without recertifying the entire thing making sure that the new o-ring meets the exact same specs. For things like electronics then you have a whole other world of safety from things like resistance to liquids (anything from blood splatter to leaking IV bags), EMI to make sure it won't interfere with any other devices or be susceptible to interference on it's own and ESD to make sure there could no chance of sparks especially in devices that pure or high concentration oxygen can flow through or devices that will be near oxygen feeds. And heck even if all that isn't the reason for ventilators being expensive and the true reason is IP Licensing/Patents then the US government and every other government can easily either compensate the IP holders directly or simply withdraw protection on the IP in question. Many countries have already had legislation in place to allow governments to suspend IP protection or grant protection to violators during an emergency.
- sremani 6y ago
  The effort towards the design of ventilators likely would have started when there was peak anticipated demand. The NY Governor was asking for 40,000 ventilators last month. So, we should not dismiss the effort. There will be lots of wasted effort during the sprint to plug things in a hurry. But it may not be really wasted effort, given that projects like these can be fountainheads to unknown future innovations or relations.
nichohel 6y ago
I appreciate the effort, but it looks like we aren't going to need nearly as many ventilators as expected because COVID lung problems are different than other lung conditions and seem not to respond well to invasive ventilation. https://www.youtube.com/watch?v=Elgct0nOcKY https://www.youtube.com/watch?v=Elgct0nOcKY https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE https://www.reuters.com/article/us-health-coronavirus-ventil... https://www.cnn.com/2020/04/22/health/coronavirus-ventilator-patients-die/index.html https://www.cnn.com/2020/04/22/health/coronavirus-ventilator... The video in particular is telling, highlighting the difficulty in getting a hospital to change what is considered the standard procedure in the face of new conditions (told by a frontline doc). We are going to be up to our eyeballs in excess ventilators. Maybe they'll be handy for the next pandemeic ...
- vlovich123 6y ago
  I think this refrain is a bit over-simplified. TLDR it's a complex evolving situation, lots of uncertainty, insufficient specialists to handle the new influx, & no protocols around effective treatment leaving all doctors to do their best in the face of lots of unknowns. Do we have sufficient ventilators for everyone who would need it? Probably. Are there not enough in practice? Yes. Why? We don't know how to differentiate between who needs it and who doesn't effectively. So people are getting put on them excessively to try to save the ones for whom it would help and we have no way currently to distinguish those people better. Should we fill this knowledge gap? Absolutely. I'm sure doctors & researchers are scrambling to do that. https://time.com/5820556/ventilators-covid-19/ https://time.com/5820556/ventilators-covid-19/ > But Dr. David Hill, a pulmonary and critical care physician who treats COVID-19 patients in Waterbury, Conn. and serves as a volunteer medical spokesperson for the American Lung Association, says arguments against COVID-19 ventilation have been over-simplified. It may be less that ventilators aren’t the proper treatment for coronavirus, and more that they’re not a panacea for a pandemic that has pushed the health care system to its breaking point, Hill argues. > “You have really sick people, [while] the people who have the best training are in short supply and ventilator management is not simple,” Hill says. If a dedicated lung specialist were available for each patient, he believes, outcomes would probably be better. They could make the subtle adjustments required for effective long-term ventilation, or try less-invasive options and only move to intubation when absolutely necessary. But with many hospitals nearly at capacity, last resorts can become first resorts. > Few doctors are saying COVID-19 patients should never be ventilated, but there is a growing subset that thinks it’s happening too quickly. <snip> > Dr. Ken Lyn-Kew, a pulmonologist at National Jewish Health in Colorado, agrees that there are some differences between classic ARDS and COVID-19, but he emphasizes that there’s a lot of variation among COVID-19 patients he’s treated. He says most still meet the criteria for an ARDS diagnosis. In his view, coronavirus patients likely have ARDS plus other issues, but they still have ARDS. With so much unknown, and with treatment protocols being updated on the fly, he thinks it’s too soon for doctors to go off-book and avoid conventional protocols like mechanical ventilation. > “The world is not a dichotomous, black-and-white place, but a lot of people are having trouble with that,” Lyn-Kew says. “We might be able to do better, but in the absence of data on the way to do that, we need to follow our societal guidelines and 25 years of research.”
Dowwie 6y ago
Bill Dally is remarkable human being -- an inspiration!
thanksforfish 6y ago
I'm curious if these companies are OK with the risk that people make these devices, destroy their lungs, and then sue. It's great PR, but the previous systems were expensive for more reasons than just manufacturing cost.
- ekianjo 6y ago
  > but the previous systems were expensive for more reasons than just manufacturing cost. namely lack of competition, regulatory capture, and price not paid directly by end users, for the most part.
  - La1n 6y ago
    Not extensive testing and willingness to take responsibility if something goes wrong?
    - jshevek 6y ago
      Both sets of causes contribute to inflated costs, and probably others as well.
yalogin 6y ago
All these designs should reduce the eventual price of ventilators after the COVID-19 passes. If we all know it’s not going to happen. The cheaper alternatives will be used to reduce manufacturing costs but they will keep the price same. That’s just how the medical industry works.
ultrasounder 6y ago
Atmega328p and no Arduino boot loader? Jokes apart, it’s pure inspiration to see someone like Bill Dally work out of his garage on a project like this. Kind of reminds me of Jim Williams a rekmowned apps engineer from Linear Tech who pretty much created the apps engineering discipline. Anyone willing to roll their sleeves and learn OpAmps/ADC look no further than App notes on Linear Tech website
- ineedasername 6y ago
  >Atmega328p and no Arduino boot loader Forget about that, I'd expect something from Nvidia to at least be able to run Doom.
antisocial 6y ago
“The best minds of my generation are thinking about how to make people click ads.” –Jeff Hammerbacher This is the kind of work I would like to see the best minds of my generation to work on. I am not saying that I am one of the best minds of my generation, but I couldn't work for ad-network companies. I took consulting gigs only when I was trying to gain some big data exposure, and was in that field only for three years over three different occasions. I would like to see more and more people to stop working for ad-tech companies.
rkangel 6y ago
There have been a lot of these 'open source ventilators', and they kind of miss the point. It's easy to make something that performs the basic functionality. I have spent basically every waking hour of the last month and a bit working on a ventilator for my employer (part of Ventilator Challenge UK - project recently suspended). Making something that delivers air in the right duty cycle for breathing is easy. There's a few more things you want to do: Blend O2 and Air ("FiO2"). Ventilators need to deliver Oxygen rich air to patients, but not usually 100%. Blenders are harder than you'd think to make. Note also that having pure O2 in your system means that there's a load of stuff you have to get right to prevent fire. Alarms. This is the big one. most of the implementation (even taking account the next feature), was about checks and associated alarms, for blockages, failures etc. Making sure that we beeped loudly if something looked wrong. Note that 'not beeping' is a much WORSE failure than 'not ventilating'. If something goes wrong (including complete hardware failure of the ventilator), as long as a healthcare practitioner is aware and responds, then there isn't an issue. If the ventilator is happily ventilating away but something is obstructed then the patient might die (there are backup checks like pulse oximetry on the patient, but they're slow). Assisted breathing. Driving a solenoid on and off at a particular rate and duty cycle gets you 'mandatory breathing'. That is great for keeping someone alive. If you're not unconscious though, it is both incredibly unpleasant and doesn't help you get weaned off and get better. What you want is a device capable of sensing attempted breaths and using the ventilation to 'help' them. This feature isn't 100% necessary - the early plans in the UK were for a massive shortage and for the simplest things we could get in a hurry. It quickly became clear that actually we needed ventilators to help people recover.
- jschwartzi 6y ago
  Yes. We spent as much time testing our alarm and monitoring system as we did doing gas delivery changes. And even on the gas delivery side, simple things like the patient changing positions while the ventilator delivered a breath could be damaging without following the standards explicitly. I think there are about 2 or 3 thousand different little functional requirements for building a ventilator. It took us about a year to get to first prototypes and then another year to get to the first passing of our system-level tests. Even just our alarm system was very complicated, with cross-checking alarms and even cross-checking that the audio was indeed playing back. Things like playback tones and frequencies and alarm indicator colors and flash frequencies are highly regulated with relevant standards. And nuisance alarms are almost more important to avoid than having enough actual alarms. No alarm is as useless as the one the clinician turns off because it's the 4th time this hour it's gone off and the patient has been fine every time. These are not easy devices to build, and selling something that doesn't meet the applicable standards and isn't substantially equivalent to something marketed today is unlikely to be particularly safe. You can easily do more harm than good by giving someone an untested ventilator.
stopreformation 6y ago
Will this work with Linux?
- jschwartzi 6y ago
  Linux is a really bad operating system to use in this application. To do gas delivery safely and reliably you need to be using a Real-Time Operating System like QNX, VXWorks, OpenRTOS, etc..
  - solarkraft 6y ago
    I think it was a joke about NVidia actively working to make their cards suck on Linux. Besides: You could, especially now with real time capability moving into being a standard kernel feature.
    - jshevek 6y ago
      When someone makes one of these cancerous ironic joke comments, responding in earnest is a good way to remind people of the culture here.
      - khazhoux 6y ago
        To me the comment was neither cancerous nor ironic. We don't need to excise all humor from our discussions on HN. Humor itself isn't a problem -- though of course no joke appeals to all people.
        jshevek 6y ago
        >We don't need to excise all humor from our discussions on HN. This isn't really relevant here, unless you are trying to create a strawman or frame this as a false dilemma of extremes. You can have a sense of humor while also keeping the conversation substantive. [Edit: Assuming solar is correct: ] Comments like the above are cancer when they inspire more of the same, and not long ago would have been appropriately dis-incentivized by the community. [And if solar turns out to be wrong, then replying in earnest is still a good response.]
deleted 6y ago
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ineedasername 6y ago
There are already FDA approved designs in production & available at similar costs. [0] For this immediate problem, We don't need more designs. [0] https://www.global-medical-solutions.com/Allied-Healthcare-Mass-Casualty-Ventilator-EPV100_p_9461.html https://www.global-medical-solutions.com/Allied-Healthcare-M...
deleted 6y ago
[deleted]
OliverJones 6y ago
We should be careful here. Smarts and creativity go a long way, but they're not a substitute for the years of training and experience of health-care professionals. Other commenters have mentioned delivering mixtures of gas as a requirement. I'll add sterilizing the equipment between uses. It's true that the durable medical equipment (DME) industry is ripe for disruption. But that disruption isn't going to come from cheap stripped-down equipment, even if that equipment has stunningly wonderful software in it. DME industry disruption will come from figuring out how to break the innovation-restricting stranglehold of Group Purchasing Organizations on health care supply chains. That's harder to pull off than quick-turn prototypes. What's needed is market disintermediation. That's a political and financial challenge, not a gadget-creation challenge. Somebody once said to me, "software is the most complex thing ever invented." But that can't be right: look at a modern airplane. It has software in it, but it has plenty of other complexity. DME is the same way. Creativity like Dr. Daily's is great. Really great. But it alone doesn't solve hard problems. If we software types claim it does, we're setting people up for disappointment.
kats 6y ago
Nice!
bobowzki 6y ago
It's quite a good start but far too simple to be of any practical use in a ARDS patient. A PEEP valve is absolutely essential.
webpirahna 6y ago
NVIDIA Chief Scientist Bill Dally this week released an open-source design for a low-cost, easy-to-assemble mechanical ventilator.

150 points by bcaulfield 6y ago

Keep in mind that this wasn't made by nvidia. It was a personal project of nvidia's chief scientist, Bill Dally.

This design is licensed only for "use in response to the COVID-19 pandemic". http://op-vent.stanford.edu/license.pdf http://op-vent.stanford.edu/license.pdf

Nokinside 6y ago

> Traditional ventilators, by contrast, can cost more than $20,000 Traditional ventilators (ventilator) are very different from bag valve masks, resuscitators, PAP and CPAP, BiPAP machines. This Nvidia design is not alternative to that $20,000 hospital ventilator. It's emergency-response ventilator alternative these other cheap designs you can already order from Amazon. You can't keep people long time in this kind of device without serious risk of damage to the lungs.

baybal2 6y ago
Very few countries managed to produce emergency ventilators from scratch. Out of hundreds of ambu bag squeezer designs, find at least one that reached the assembly line. Not a lot. Only 4 countries on record now managed to start mass production of designed from scratch emergency ventilators. Expanding existing capacity would've been an incomparably better option.
- Nokinside 6y ago
  One German manufacturer recently explained how their company has already outsourced almost all parts and manufacturing phases that can be easily scaled. The company does design, final assembly testing, calibration and quality control. I suspect that the internally used testing and manufacturing equipment and protocols are the hardest thing to scale.
  - baybal2 6y ago
    No, from my experience in OEM manufacturing since 2007 I can say it isn't.
- dejv 6y ago
  Check out Corovent, its somehow open source (they have to hide their exact BOM for now, because of companies buying full stock of those parts). It is build by university team that actually design ventilators for 25 years and is certified to be used in case when there are no proper ventilators available. They are currently using industrial version of medical parts (due to limited availability of those parts) but full certification is in pipeline. They are just starting mass production now.
adrianmonk 6y ago
The article did specifically say it is more advanced than a bag ("provides better care than “bag squeezer” emergency ventilators because it precisely regulates flow, pressure, and volume"). And it linked to the paper (http://op-vent.stanford.edu/docs/need.html http://op-vent.stanford.edu/docs/need.html) with more specifics. The "Prototype Specifications" section of the paper might be a good starting point for information about its capabilities. Are your criticisms based on an understanding of how this specific device actually works? Sorry to be blunt, but by suggesting it is comparable to a bag valve mask, it sounds like you did not learn a lot about the device before making up your mind about it.
- Nokinside 6y ago
  >Sorry to be blunt, but by suggesting it is comparable to a bag valve mask, it sounds like you did not learn a lot about the device before making up your mind about it. Noting wrong with being blunt. But please, be blunt only after you read whole sentences and trying to decipher the meaning. I listed several different classes of devices of varying complexity that are not equal to those $20,000 ventilators used in ICU. I have experience in design of electronics that becomes part of ventilators and other medical equipment. GE healthcare and other firms. >Are your criticisms based on an understanding of how this specific device actually works? Yes. The system in question is very low-end emergency-response ventilator (explained in documentation). It's simplified design from those you see used in emergency response and patient transport. The operating mode seems to be basic pressure-controlled ventilation PCV.It can also measure tidal and minute volumes. ICU ventilator is device is very different from everything else. It's connected to the patients trachea. You must sedate patients because it's super uncomfortable to use. Patients are put into those ventilators when they are really sick. Removing carbon dioxide is an issue. Long term use can damage lungs so the system monitors large number of variables and it has multiple operating modes.
  - adrianmonk 6y ago
    OK, I see a little better where you're coming from now. Knowing that you have some expertise in this area puts your first comment in a different light. For what it's worth, I did read your comment carefully. The reason I took exception (and reacted strongly, I fully admit) is that since the article addressed the bag thing, that makes it a red herring, so I would have expected you to filter it out of your list. Maybe that's overly rigid or overly literal of me, but that is why I reacted how I did. This device definitely intends to be less than a full-featured ventilator. On the Pneumatics page (http://op-vent.stanford.edu/docs/pneumatics.html http://op-vent.stanford.edu/docs/pneumatics.html) it explains their goal is to produce kind of a stripped down "simple ventilator with the features needed to treat COVID-19". So they believe it can be useful even though they know it lacks features. Whether they're right is certainly up for debate. They mention several optional features, which is interesting because maybe it means they're just trying to be flexible or maybe it means they don't really know what is the minimum necessary to have a net benefit (save more people than you kill) if we run out of full-featured ventilators.

dogma1138 6y ago

All these designs are cool projects but other than being a distraction and some PR nothing will come out of them. There are plenty of proven designs that can be manufactured cheaply, the price of the end units especially for things like ventilators isn't often due to complexity and manufacturing costs but due to the costs of maintaining a supply chain, manufacturing and providing support (including liability) for the healthcare market. None of these things seem to solve these issues other than potentially removing liability to who ever decides to manufacture those units. Any thing can be built with off the shelf parts but the reason why most medical devices aren't it's because you need to take special care in your supply chain. Ventilators use valves that aren't that different and often the same valves that are available for a plethora of other applications like industry and agriculture but the fact that it's the same valve doesn't mean that it's the same supply chain. The suppliers for medical equipment make sure that say the lubricants that are used are safe and that no one can say replace o-ring used in the valve from one supplier to another without recertifying the entire thing making sure that the new o-ring meets the exact same specs. For things like electronics then you have a whole other world of safety from things like resistance to liquids (anything from blood splatter to leaking IV bags), EMI to make sure it won't interfere with any other devices or be susceptible to interference on it's own and ESD to make sure there could no chance of sparks especially in devices that pure or high concentration oxygen can flow through or devices that will be near oxygen feeds. And heck even if all that isn't the reason for ventilators being expensive and the true reason is IP Licensing/Patents then the US government and every other government can easily either compensate the IP holders directly or simply withdraw protection on the IP in question. Many countries have already had legislation in place to allow governments to suspend IP protection or grant protection to violators during an emergency.

sremani 6y ago
The effort towards the design of ventilators likely would have started when there was peak anticipated demand. The NY Governor was asking for 40,000 ventilators last month. So, we should not dismiss the effort. There will be lots of wasted effort during the sprint to plug things in a hurry. But it may not be really wasted effort, given that projects like these can be fountainheads to unknown future innovations or relations.

nichohel 6y ago

I appreciate the effort, but it looks like we aren't going to need nearly as many ventilators as expected because COVID lung problems are different than other lung conditions and seem not to respond well to invasive ventilation. https://www.youtube.com/watch?v=Elgct0nOcKY https://www.youtube.com/watch?v=Elgct0nOcKY https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE https://www.reuters.com/article/us-health-coronavirus-ventil... https://www.cnn.com/2020/04/22/health/coronavirus-ventilator-patients-die/index.html https://www.cnn.com/2020/04/22/health/coronavirus-ventilator... The video in particular is telling, highlighting the difficulty in getting a hospital to change what is considered the standard procedure in the face of new conditions (told by a frontline doc). We are going to be up to our eyeballs in excess ventilators. Maybe they'll be handy for the next pandemeic ...

vlovich123 6y ago
I think this refrain is a bit over-simplified. TLDR it's a complex evolving situation, lots of uncertainty, insufficient specialists to handle the new influx, & no protocols around effective treatment leaving all doctors to do their best in the face of lots of unknowns. Do we have sufficient ventilators for everyone who would need it? Probably. Are there not enough in practice? Yes. Why? We don't know how to differentiate between who needs it and who doesn't effectively. So people are getting put on them excessively to try to save the ones for whom it would help and we have no way currently to distinguish those people better. Should we fill this knowledge gap? Absolutely. I'm sure doctors & researchers are scrambling to do that. https://time.com/5820556/ventilators-covid-19/ https://time.com/5820556/ventilators-covid-19/ > But Dr. David Hill, a pulmonary and critical care physician who treats COVID-19 patients in Waterbury, Conn. and serves as a volunteer medical spokesperson for the American Lung Association, says arguments against COVID-19 ventilation have been over-simplified. It may be less that ventilators aren’t the proper treatment for coronavirus, and more that they’re not a panacea for a pandemic that has pushed the health care system to its breaking point, Hill argues. > “You have really sick people, [while] the people who have the best training are in short supply and ventilator management is not simple,” Hill says. If a dedicated lung specialist were available for each patient, he believes, outcomes would probably be better. They could make the subtle adjustments required for effective long-term ventilation, or try less-invasive options and only move to intubation when absolutely necessary. But with many hospitals nearly at capacity, last resorts can become first resorts. > Few doctors are saying COVID-19 patients should never be ventilated, but there is a growing subset that thinks it’s happening too quickly. <snip> > Dr. Ken Lyn-Kew, a pulmonologist at National Jewish Health in Colorado, agrees that there are some differences between classic ARDS and COVID-19, but he emphasizes that there’s a lot of variation among COVID-19 patients he’s treated. He says most still meet the criteria for an ARDS diagnosis. In his view, coronavirus patients likely have ARDS plus other issues, but they still have ARDS. With so much unknown, and with treatment protocols being updated on the fly, he thinks it’s too soon for doctors to go off-book and avoid conventional protocols like mechanical ventilation. > “The world is not a dichotomous, black-and-white place, but a lot of people are having trouble with that,” Lyn-Kew says. “We might be able to do better, but in the absence of data on the way to do that, we need to follow our societal guidelines and 25 years of research.”

Dowwie 6y ago

Bill Dally is remarkable human being -- an inspiration!

thanksforfish 6y ago

I'm curious if these companies are OK with the risk that people make these devices, destroy their lungs, and then sue. It's great PR, but the previous systems were expensive for more reasons than just manufacturing cost.

ekianjo 6y ago
> but the previous systems were expensive for more reasons than just manufacturing cost. namely lack of competition, regulatory capture, and price not paid directly by end users, for the most part.
- La1n 6y ago
  Not extensive testing and willingness to take responsibility if something goes wrong?
  - jshevek 6y ago
    Both sets of causes contribute to inflated costs, and probably others as well.

yalogin 6y ago

All these designs should reduce the eventual price of ventilators after the COVID-19 passes. If we all know it’s not going to happen. The cheaper alternatives will be used to reduce manufacturing costs but they will keep the price same. That’s just how the medical industry works.

ultrasounder 6y ago

Atmega328p and no Arduino boot loader? Jokes apart, it’s pure inspiration to see someone like Bill Dally work out of his garage on a project like this. Kind of reminds me of Jim Williams a rekmowned apps engineer from Linear Tech who pretty much created the apps engineering discipline. Anyone willing to roll their sleeves and learn OpAmps/ADC look no further than App notes on Linear Tech website

ineedasername 6y ago
>Atmega328p and no Arduino boot loader Forget about that, I'd expect something from Nvidia to at least be able to run Doom.

antisocial 6y ago

“The best minds of my generation are thinking about how to make people click ads.” –Jeff Hammerbacher This is the kind of work I would like to see the best minds of my generation to work on. I am not saying that I am one of the best minds of my generation, but I couldn't work for ad-network companies. I took consulting gigs only when I was trying to gain some big data exposure, and was in that field only for three years over three different occasions. I would like to see more and more people to stop working for ad-tech companies.

rkangel 6y ago

There have been a lot of these 'open source ventilators', and they kind of miss the point. It's easy to make something that performs the basic functionality. I have spent basically every waking hour of the last month and a bit working on a ventilator for my employer (part of Ventilator Challenge UK - project recently suspended). Making something that delivers air in the right duty cycle for breathing is easy. There's a few more things you want to do: Blend O2 and Air ("FiO2"). Ventilators need to deliver Oxygen rich air to patients, but not usually 100%. Blenders are harder than you'd think to make. Note also that having pure O2 in your system means that there's a load of stuff you have to get right to prevent fire. Alarms. This is the big one. most of the implementation (even taking account the next feature), was about checks and associated alarms, for blockages, failures etc. Making sure that we beeped loudly if something looked wrong. Note that 'not beeping' is a much WORSE failure than 'not ventilating'. If something goes wrong (including complete hardware failure of the ventilator), as long as a healthcare practitioner is aware and responds, then there isn't an issue. If the ventilator is happily ventilating away but something is obstructed then the patient might die (there are backup checks like pulse oximetry on the patient, but they're slow). Assisted breathing. Driving a solenoid on and off at a particular rate and duty cycle gets you 'mandatory breathing'. That is great for keeping someone alive. If you're not unconscious though, it is both incredibly unpleasant and doesn't help you get weaned off and get better. What you want is a device capable of sensing attempted breaths and using the ventilation to 'help' them. This feature isn't 100% necessary - the early plans in the UK were for a massive shortage and for the simplest things we could get in a hurry. It quickly became clear that actually we needed ventilators to help people recover.

jschwartzi 6y ago
Yes. We spent as much time testing our alarm and monitoring system as we did doing gas delivery changes. And even on the gas delivery side, simple things like the patient changing positions while the ventilator delivered a breath could be damaging without following the standards explicitly. I think there are about 2 or 3 thousand different little functional requirements for building a ventilator. It took us about a year to get to first prototypes and then another year to get to the first passing of our system-level tests. Even just our alarm system was very complicated, with cross-checking alarms and even cross-checking that the audio was indeed playing back. Things like playback tones and frequencies and alarm indicator colors and flash frequencies are highly regulated with relevant standards. And nuisance alarms are almost more important to avoid than having enough actual alarms. No alarm is as useless as the one the clinician turns off because it's the 4th time this hour it's gone off and the patient has been fine every time. These are not easy devices to build, and selling something that doesn't meet the applicable standards and isn't substantially equivalent to something marketed today is unlikely to be particularly safe. You can easily do more harm than good by giving someone an untested ventilator.

stopreformation 6y ago

Will this work with Linux?

jschwartzi 6y ago
Linux is a really bad operating system to use in this application. To do gas delivery safely and reliably you need to be using a Real-Time Operating System like QNX, VXWorks, OpenRTOS, etc..
- solarkraft 6y ago
  I think it was a joke about NVidia actively working to make their cards suck on Linux. Besides: You could, especially now with real time capability moving into being a standard kernel feature.
  - jshevek 6y ago
    When someone makes one of these cancerous ironic joke comments, responding in earnest is a good way to remind people of the culture here.
    - khazhoux 6y ago
      To me the comment was neither cancerous nor ironic. We don't need to excise all humor from our discussions on HN. Humor itself isn't a problem -- though of course no joke appeals to all people.
      - jshevek 6y ago
        >We don't need to excise all humor from our discussions on HN. This isn't really relevant here, unless you are trying to create a strawman or frame this as a false dilemma of extremes. You can have a sense of humor while also keeping the conversation substantive. [Edit: Assuming solar is correct: ] Comments like the above are cancer when they inspire more of the same, and not long ago would have been appropriately dis-incentivized by the community. [And if solar turns out to be wrong, then replying in earnest is still a good response.]

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ineedasername 6y ago

There are already FDA approved designs in production & available at similar costs. [0] For this immediate problem, We don't need more designs. [0] https://www.global-medical-solutions.com/Allied-Healthcare-Mass-Casualty-Ventilator-EPV100_p_9461.html https://www.global-medical-solutions.com/Allied-Healthcare-M...

deleted 6y ago

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OliverJones 6y ago

We should be careful here. Smarts and creativity go a long way, but they're not a substitute for the years of training and experience of health-care professionals. Other commenters have mentioned delivering mixtures of gas as a requirement. I'll add sterilizing the equipment between uses. It's true that the durable medical equipment (DME) industry is ripe for disruption. But that disruption isn't going to come from cheap stripped-down equipment, even if that equipment has stunningly wonderful software in it. DME industry disruption will come from figuring out how to break the innovation-restricting stranglehold of Group Purchasing Organizations on health care supply chains. That's harder to pull off than quick-turn prototypes. What's needed is market disintermediation. That's a political and financial challenge, not a gadget-creation challenge. Somebody once said to me, "software is the most complex thing ever invented." But that can't be right: look at a modern airplane. It has software in it, but it has plenty of other complexity. DME is the same way. Creativity like Dr. Daily's is great. Really great. But it alone doesn't solve hard problems. If we software types claim it does, we're setting people up for disappointment.

kats 6y ago

Nice!

bobowzki 6y ago

It's quite a good start but far too simple to be of any practical use in a ARDS patient. A PEEP valve is absolutely essential.

webpirahna 6y ago

NVIDIA Chief Scientist Bill Dally this week released an open-source design for a low-cost, easy-to-assemble mechanical ventilator.