Mar 16, 2020
Respiratory Ventilators — A Life Saving Device
The outbreak of the COVID-19 virus in Italy has been devastating. It has led to a lockdown of many familiar places, including cafes, bars and restaurants. Popular tourist attractions have also been closed as an effect of social distancing in order to prevent the further spread of the virus. In the EU, Italy has been the hardest hit nation reporting 24,700 cases (as of March 16, 2020). The response to mitigate the crisis was originally to self-quarantine for those with symptoms, but the virus rapidly spread in a matter of days. It is now beyond containment, as cases continue to increase daily.
In more severe cases the virus affects the lungs of patients, requiring the use of a device called a respiratory ventilator. This device helps patients to breathe. The problem in Italy was there were not enough of these devices available. It is also not just in Italy, but around the world the supply of ventilators is rather limited. It is not a one to one ratio of ventilators for every patient admitted to a hospital. It is thus of utmost concern since these devices are vital in saving the lives of certain COVID-19 patients. The most at risk patients are those aged 65 and over.
How COVID-19 Affects The Lungs
In severe cases of COVID-19, the patient’s lungs or lower respiratory tract is affected. It is actually another disease that can bring this about, like pneumonia. In almost all of the serious cases in COVID-19 there is a presence of pneumonia. According to observations by the WHO, individuals who have underlying health problems that involve the lungs are most likely going to develop a severe case of COVID-19 that develops into pneumonia.
In susceptible patients, pneumonia develops as a result of inflammation in the lungs from coughing. This can lead to infections that affect the air sacs in the lungs. When this happens, the lungs don’t get enough oxygen into the bloodstream, which reduces the oxygen intake and release of carbon dioxide (yes, that CO2 that causes global warming). Our lungs, which are a vital part of the respiratory system, is where an exchange of gases takes place for metabolism. When we inhale oxygen, we exhale carbon dioxide from our lungs. If we cannot release the carbon dioxide from our lungs, it affects our breathing and can lead to death. To prevent this from happening, ventilators are used as a form of artificial respirator to expel carbon dioxide from the body.
How Ventilators Work
First, a patient is intubated by inserting a nasogastric tube into the patient’s nose and into the stomach. An endotracheal tube is then placed into the patient’s mouth and into the windpipe. These tubes are all connected to the respiratory ventilator device, which pumps oxygen rich air into the airways of the patient. The air passing through the tubes first passes through a humidifier to moisten the air (also to make it warmer). The carbon dioxide is then expelled from the patient’s lungs, which is then removed by the ventilator.
The device is powered from an AC or DC outlet. The power source supplies electrical current to an electro-motor to operate the compressor for pumping air into the tubes and pumping gases out. A battery unit provides reserve power for the device electronics. It is an electro-pneumatic system as well, since it involves the use of pressurized air and gases. These are often deployed in hospital ICU (Intensive Care Units).
These devices come with an LCD display that provides real-time patient monitoring information. The data can be stored and saved under the patient’s medical records profile for HIM (Health Information Systems) purposes. The operation of the device does require a medical professional, mainly nurses or respiratory therapists.
Benefits Of Ventilators
The main benefits of ventilators are the following (from Cleveland Clinic):
- The patient does not have to work as hard to breathe — their respiratory muscles rest.
- The patients are allowed time to recover in hopes that breathing becomes normal again.
- Helps the patient get adequate oxygen and clears carbon dioxide.
- Preserves a stable airway and preventing injury from aspiration.
It is like a mechanical lung, that aids patients who have a difficulty in breathing due to infection. Unfortunately, these devices are not available at scale to meet the demands of the worst pandemics. Shortage of ventilators in Italy, a developed country, is the reality of this problem.
Engineering Challenge
According to the Financial Times, EU countries are in demand of more ventilators as virus cases surge. It appears that most countries, even developed nations, are having a problem with a shortage in supply. In Italy for example, the only producer of ventilators is Siare Engineering. The company has been asked to produce more ventilators to meet the growing needs of hospitals as the virus crisis has gotten worse. Unfortunately, when you have only one producer making these devices, it cannot be done quickly enough.
In order to meet the demands, Siare Engineering has canceled orders from abroad. They are expected to deliver 2,000 ventilators by the end of July 2020. It will not only be Italy, but other countries like Germany and the USA are requesting for more ventilators. The issue here appears to be whether this situation is going to get better or worse in order to determine how many ventilators will be needed. If the crisis becomes worse, it could overwhelm the capacity of the existing healthcare system. That will definitely mean less ventilators will be available for patients who need them.
There are plenty of logistics involved in allocating resources to affected areas. For example, certain cities could demand ventilators more than others. In that case there has to be a balance of supply with demand, and the proper distribution of the devices. According to Dr. James Lawler, University of Nebraska Medical Center, over 1 Million Americans might need ventilators in the course of the virus. It doesn’t specify though if that means 1 Million people requiring it at the same time or in the duration of the pandemic.
There have been discussions of open sourced ventilation device production that doesn’t involve proprietary designs. This means that no licensing is required and any developer can build it. It is not as easy when certain companies have the expertise and trade secrets for a certain device. These devices still require regulation from health departments per jurisdiction, so that is also going to be an important consideration. When demand does exceed supply, this may be an alternative to providing a solution to much needed ventilators.
