Author Topic: Ventilator made from car parts  (Read 9852 times)

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Online Psi

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Re: Ventilator made from car parts
« Reply #50 on: April 07, 2020, 12:48:49 pm »
@Psi...

Not really.  That line of thought only works until:

1. You inflate someone like a cane toad, followed by a loud pop and bits of lung everywhere by accident because the equipment wasn't qualified and tested properly.
2. You turn a viable outcome into a poor outcome or life long disability because someone gets a lung full of machine oil.
3. It fails after 3 hours and kills the patient silently.
4. You get an American lawyer anywhere in the process.

Rules and standards are there for a reason. There's no space for iteration in these things.

I've worked on "safety critical systems" albeit ones that are supposed to kill only the people you point them at (I regret this if I'm honest) and the standards there are as high as the medical side of things. There are whole teams of people who's jobs are to come up with what ifs.

They're not stupid, they not going to put anyone on a non-approved ventilator unless it's a last resort to keep them alive.
In those situations it really doesn't matter if it fails and kills the patient because it was the only thing keeping them alive to start with.
« Last Edit: April 07, 2020, 12:51:30 pm by Psi »
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Offline bd139

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Re: Ventilator made from car parts
« Reply #51 on: April 07, 2020, 12:49:53 pm »
They're not going to do it without consent and there's no mechanism for consent then.
 

Online Psi

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Re: Ventilator made from car parts
« Reply #52 on: April 07, 2020, 12:53:46 pm »
Needing consent goes out the window in a disaster situation.

It's run more like a military hospital

They do the best they can with what they have.
They get so numb from all the stress and death that the idea of being brought before a medical board and fired actually starts to sounds nice because it's quiet and no one is dying.
« Last Edit: April 07, 2020, 12:56:06 pm by Psi »
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Offline 2N3055

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Re: Ventilator made from car parts
« Reply #53 on: April 07, 2020, 12:57:58 pm »
It's not legal problem. Those things are medical ventilators in same manner that bicycle tire pump is a medical ventilator.
..
And then, probably, you will understand why a real MD will not connect anybody to such contraption.... It is not a real ventilator, it's a Rube Goldberg contraption made by people who don't understand real problem and is equivalent to elementary school science project.

That doesn't matter.

I will restate
There's only so many times you can turn up to work and see people die because you don't have the gear to save them before you stop caring about company policy or rules in general.
If it moves air in and out the medical staff will connect it to a person because 'no air moving in and out' is not a valid option!
eg You can worry about weather or not the lubrication in the pump was medical grade later,


Watch the video. And you will see that connecting people to a pump that mechanically moves air in and out will KILL them... Especially if they have damaged lungs...
Hand pumps work only of short periods of time and are administered by a trained operators who match squeezing with patients breathing. Or those who are being revived and have no natural motion of air in their lungs and there is nothing to lose. As soon as a person is revived, they stop bagging them and give them oxygen mask..
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Offline Simon

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Re: Ventilator made from car parts
« Reply #54 on: April 07, 2020, 01:20:41 pm »
It looked like they are using precompressed air so no pump. there was no mention of the patient sensors that get the machine working with the patient not against them destroying their lungs. I did hear talk of working out how one ventilator could be used on two people, I don't doubt that he politician that said that too near a medic got hit and not heard nothing since.

Again at best if the parts can be used in a current design do that.
 

Offline max_torque

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Re: Ventilator made from car parts
« Reply #55 on: April 07, 2020, 01:28:39 pm »
@Psi...

Not really.  That line of thought only works until:

1. You inflate someone like a cane toad, followed by a loud pop and bits of lung everywhere by accident because the equipment wasn't qualified and tested properly.
2. You turn a viable outcome into a poor outcome or life long disability because someone gets a lung full of machine oil.
3. It fails after 3 hours and kills the patient silently.
4. You get an American lawyer anywhere in the process.

Rules and standards are there for a reason. There's no space for iteration in these things.

I've worked on "safety critical systems" albeit ones that are supposed to kill only the people you point them at (I regret this if I'm honest) and the standards there are as high as the medical side of things. There are whole teams of people who's jobs are to come up with what ifs.

At what point does a battle become a war, and other options become viable?   :-DD  That is what we are talking about here potentially? Unfortunately, as in most wars, the actual statistics, without which descisions had to be made anyway, will only become understandable when it's too late, after the war has finished.  For example, overall, if a bodged together ventilator saves more people than otherwise woudl have died, then it's correct to use it, as it was an overal "greater good". only after the crisis has passed will that information become available and reliable   :-//
 
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Offline Simon

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Re: Ventilator made from car parts
« Reply #56 on: April 07, 2020, 01:47:24 pm »
They need to seperate the project in two parts, the human interfacing bit and the electro mechanical bit. The human interface is the hard bit so try and ramp production of that part of it and then interface that to any mechanics that will do the job.
 

Online Psi

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Re: Ventilator made from car parts
« Reply #57 on: April 07, 2020, 01:50:21 pm »
For example, overall, if a bodged together ventilator saves more people than otherwise would have died, then it's correct to use it, as it was an overal "greater good". only after the crisis has passed will that information become available and reliable   :-//

+1 to this fact.

And Tesla knows this all too well.
Tesla autopilot will never be perfect and it will/has made wrong decisions that killed people but as long as it's saving more lives than it's killing then it's a good thing.
« Last Edit: April 07, 2020, 01:51:52 pm by Psi »
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Offline SiliconWizard

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Re: Ventilator made from car parts
« Reply #58 on: April 07, 2020, 02:21:29 pm »
It's not legal problem. Those things are medical ventilators in same manner that bicycle tire pump is a medical ventilator.

Watch the video.

https://www.eevblog.com/forum/projects/ventilator-made-from-car-parts/msg3001626/#msg3001626

And then, probably, you will understand why a real MD will not connect anybody to such contraption.... It is not a real ventilator, it's a Rube Goldberg contraption made by people who don't understand real problem and is equivalent to elementary school science project.

Exactly.
(But yes it is a legal problem too. If some patient dies after being connected to one of those dodgy respirators, the family is very likely to sue. Wouldn't you?)

As I often say, just ask yourself if you'd be OK with some close relative being treated with this.
Now you may keep answering that it would be better than nothing. Which, first, is not necessarily the case as 2N3055 pointed out. But second, there comes the question of whoever gets treated with the real deal and whoever gets the "dodgy" stuff. (Inequalities are already there. Just look at the Boris Johnson case. He was directly put in ICU just in case, whereas the average joe who gets hospitalized in a similar state would just get isolated in a room full of other patients until their symptoms get so bad they need to be transfered to ICU. BJ was not in a life-critical state when he was transfered to ICU AFAIK. And I bet he would get a proper respirator if alternative ones were available. Just a side-thought...)

As to the point of these projects potentially saving more lives than they would kill, we have absolutely ZERO proof of that by nature as they wouldn't get a chance to be properly tested clinically as they should before being deployed.

Now as I said above, I'm all for companies HELPING medical device companies in any sane way they can, under proper supervision. That's a different story. But suddenly improvising, not so much.

Anyway, as many of us have said, there are so many ways people can currently help the world that just improvising medical devices doesn't make much sense IMHO.
This pandemic is putting the whole world on hold and is going to have lasting effects way beyond health problems.
 
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Offline bd139

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Re: Ventilator made from car parts
« Reply #59 on: April 07, 2020, 03:28:17 pm »
At what point does a battle become a war, and other options become viable?   :-DD  That is what we are talking about here potentially? Unfortunately, as in most wars, the actual statistics, without which descisions had to be made anyway, will only become understandable when it's too late, after the war has finished.  For example, overall, if a bodged together ventilator saves more people than otherwise woudl have died, then it's correct to use it, as it was an overal "greater good". only after the crisis has passed will that information become available and reliable   :-//

This is not a war. We need to consider more than just the body count which is what the stats portray gleefully, but the patient's overall health outcome as well. If someone leaves that ventilator with extensive physical injury but alive that doesn't necessarily mean they're going to have a good quality of life outcome. Does being permanently disabled from heart and nervous system damage and requiring dialysis from kidney failure sound like fun?

That's my father-in-law for reference who is on ventilation with proper equipment for this at the moment who luckily probably isn't going to make it and I'm sure because I know him well, would not want to be chucked on a hacked up ventilator as a last resort so he can life the rest of his life in misery with no escape while someone fanfares over the body count improvement...

Edit: A point I'd like to add is we don't know what the health outcomes are going to be without thorough analysis and we don't even have enough data to rationalise that without introducing new variables into the recovery outcomes like equipment which is new and untrusted.
« Last Edit: April 07, 2020, 03:33:24 pm by bd139 »
 
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Offline james_s

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Re: Ventilator made from car parts
« Reply #60 on: April 07, 2020, 04:55:39 pm »
And then, probably, you will understand why a real MD will not connect anybody to such contraption.... It is not a real ventilator, it's a Rube Goldberg contraption made by people who don't understand real problem and is equivalent to elementary school science project.

I've got some news for you. Real MDs are already doing crazy unapproved hacks like connecting multiple patients up to a single ventilator designed for one person. People with your attitude are going to result in potentially many additional deaths. "We can't do this right so we'll just do nothing" and when we run out of ventilators people die.
 
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Offline james_s

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Re: Ventilator made from car parts
« Reply #61 on: April 07, 2020, 05:02:12 pm »
As I often say, just ask yourself if you'd be OK with some close relative being treated with this.

Yes! Absolutely! I would personally connect my own mother to a device some kid built in his bedroom if it looked like it might actually work and she was almost certain to die without it. I cannot comprehend why anyone would even question this? It boggles my mind how regulations and rules would even be discussed in such a situation.
 

Offline bd139

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Re: Ventilator made from car parts
« Reply #62 on: April 07, 2020, 05:39:43 pm »
I think that’s up to the patient isn’t it? You’re potentially asking for someone to suffer for your emotional attachment. I still remember the look in my grandmothers eyes when they brought her back the second time from cardiac arrest while she was dying from cancer. It was a cross between sheer terror and annoyance that she had to suffer longer. Fortunately the third time didn’t work the day after and she passed away without hours of intense suffering.

And then, probably, you will understand why a real MD will not connect anybody to such contraption.... It is not a real ventilator, it's a Rube Goldberg contraption made by people who don't understand real problem and is equivalent to elementary school science project.

I've got some news for you. Real MDs are already doing crazy unapproved hacks like connecting multiple patients up to a single ventilator designed for one person. People with your attitude are going to result in potentially many additional deaths. "We can't do this right so we'll just do nothing" and when we run out of ventilators people die.

Real MDs would know the contamination risk between patients. Perhaps you don’t have any real MD’s there. Based on my relatively simple knowledge of ventilation that wouldn’t work or even make sense for invasive ventilation anyway so I call bull shit.

People are shallow and hold on to every little grasp of life without thought for the patient and their wishes. That’s universal.
« Last Edit: April 07, 2020, 06:19:20 pm by bd139 »
 
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Offline noname4me

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Re: Ventilator made from car parts
« Reply #63 on: April 07, 2020, 06:10:03 pm »
The humidifier part can actually be bolted on using a separate humidifier.  This is not mandatory for short term use anyway.

https://www.alibaba.com/product-detail/Humidifier-for-baby-ventilator-CPAP_60818792542.html

is an example of what I mean...

What Tesla have designed is viable as a ventilator - albeit without many of the other features normally available on standard ventilators.

He has pressure sensing incorporated on the ventilator...

In terms of getting through an acute shortage of ventilators it's a good solution.

https://www.dailymail.co.uk/news/article-8136299/Doctors-turns-one-ventilator-nine-genius-DIY-mechanics.html

Qualified MD ventilating 9 patients using a single ventilator.

 

Offline bd139

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Re: Ventilator made from car parts
« Reply #64 on: April 07, 2020, 06:20:50 pm »
He’s also running it way out of spec. He’s a quack and will probably end up with 9 dead patients. Also the source is risky even to use as toilet paper.
 

Offline noname4me

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Re: Ventilator made from car parts
« Reply #65 on: April 07, 2020, 06:22:58 pm »
If it lasts for the duration of time the patients need it - the alternative being that 8 of them die anyway - is that not a good thing?

He has a PhD in respiratory medicine - I would trust his judgement on this, unless you are similarly qualified? (Check the tweet out, it links to it - I agree re: Daily Mail)
 

Offline bd139

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Re: Ventilator made from car parts
« Reply #66 on: April 07, 2020, 06:29:20 pm »
I’m sure it lasts the first 8 patients. Maybe not the next 8.  And I’d like more than the trite factoids to be presented by the daily mail which as a distinct reputation of spouting utter bullshit and distorting reality.

I’ll take a second opinion thanks. I can get one if I need it easily enough...
 

Offline noname4me

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Re: Ventilator made from car parts
« Reply #67 on: April 07, 2020, 06:31:35 pm »
I just wanted to underline the severity of the situation:

The government is pushing through device approvals at the moment such that a lot of the required safety documentation and testing is being curtailed - this only happens if there is a dire need.

Yes, normally approvals take a long time, and have a necessarily rigorous V&V cycle.  They are also produced by companies which have the approvals in place to produce such devices.

The ventilator group - I don't know for certain if it actually has such certification, although the automotive industry is similarly well controlled.

It really in unprecedented, the way that everyone is working to a single aim to get these designed and produced in the shortest possible time.  Don't know if I'll ever see it again in my lifetime (hopefully not).
 

Offline james_s

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Re: Ventilator made from car parts
« Reply #68 on: April 08, 2020, 06:25:18 am »
I think that’s up to the patient isn’t it? You’re potentially asking for someone to suffer for your emotional attachment. I still remember the look in my grandmothers eyes when they brought her back the second time from cardiac arrest while she was dying from cancer. It was a cross between sheer terror and annoyance that she had to suffer longer. Fortunately the third time didn’t work the day after and she passed away without hours of intense suffering.

What are you talking about?! Are you seriously suggesting that dying of Covid is a painless and peaceful exit? Are you suggesting that Covid is the same situation as terminal cancer? I'm talking about people who stand a chance of making a nearly full recovery with treatment vs virtually certain death without treatment. Would you *seriously* not try an un-approved but apparently functional ventilator on someone who was virtually guaranteed to die without it? Holy hell, I certainly hope if I end up in that position that I've got a doctor who is less concerned about consent and more willing to try anything they have at their disposal to save me. If it ends up killing me, well at least they tried, the alternative of dying by drowning slowly in my own juices does not sound like an improvement. A lack of approval does not automatically mean something is dangerous or ineffective.

I'm honestly baffled that someone would even suggest it's better to throw our hands up and let who knows how many people die because we know we can't get a sufficient number of certified machines. That's just... wow.  :o
 
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Offline bd139

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Re: Ventilator made from car parts
« Reply #69 on: April 08, 2020, 07:40:29 am »
My point is it’s a hell of a lot more complicated than “saving lives” and people “living happily ever after” and throwing new untested technology into the mix can have a net negative on quality of life outcomes. Your point disregards nearly all of the complex matters and the probabilistic outcomes of forced ventilation.
 

Offline noname4me

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Re: Ventilator made from car parts
« Reply #70 on: April 08, 2020, 11:16:48 am »
It might be helpful to read through the specs of what is being designed - it isn't simply connecting someone up to an air compressor...

https://www.gov.uk/government/publications/coronavirus-covid-19-ventilator-supply-specification/rapidly-manufactured-ventilator-system-specification

They are doing things properly, but with speed
 

Offline 2N3055

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Re: Ventilator made from car parts
« Reply #71 on: April 08, 2020, 11:46:24 am »
It might be helpful to read through the specs of what is being designed - it isn't simply connecting someone up to an air compressor...

https://www.gov.uk/government/publications/coronavirus-covid-19-ventilator-supply-specification/rapidly-manufactured-ventilator-system-specification

They are doing things properly, but with speed

Who does?

What you linked is exactly proof how all these "open crap respirators" and such are piece of crap, despite fact that many of those people have good intentions.
You linked to professionally made specification by people that know what are they talking about.
Read it carefully, and than go and, one by one, check all those "cowboy breathing devices" and tell us how many would have those specifications, parts and operating principle.

Those that do comply with those specs are not "improvised devices", but real respirators, and than it can be argued if those can be used without formal approval process, and just after good functional test.
Those that don't have all the functions listed there are simply not respirators, and are dangerous by design, because they cannot be used as respirators.

"Just hard work is not enough - it must be applied sensibly."
Dr. Richard W. Hamming
 
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Online Psi

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Re: Ventilator made from car parts
« Reply #72 on: April 08, 2020, 11:52:20 am »
What he linked to is what *we* are talking about, emergency build requirements for min spec COVID respirators thrown together in a hurry,  exactly what Tesla is doing.
« Last Edit: April 08, 2020, 11:55:26 am by Psi »
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Offline bd139

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Re: Ventilator made from car parts
« Reply #73 on: April 08, 2020, 12:12:12 pm »
And it still has to go through validation and approval...
 

Offline noname4me

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Re: Ventilator made from car parts
« Reply #74 on: April 08, 2020, 12:30:26 pm »
Quote
Standards
There are many standards that exist in this area. Below is a list of the most relevant ones. They are not formal regulatory requirements but many are harmonised against regulatory requirements. Consider them as helpful advisory standards for now. MHRA will lead an exercise to define which can be ‘safely’ relaxed for this emergency situation:
BS EN 794-3:1998 +A2:2009: Particular requirements for emergency and transport ventilators
ISO 10651-3:1997: Lung ventilators for medical use – emergency and transport
BS ISO 80601-2-84:2018: Medical electrical equipment. Part 2 to 84. Particular requirements for basic safety and essential performance of emergency and transport ventilators – especially the parts on ‘patient gas pathway’ safety (very similar to IEC 60601)
BS ISO 19223:2019: Lung ventilators and related equipment. Vocabulary and semantics

I think this is what I was referring to in the context of this discussion...
 


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