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Partially Reprapable Automated Open Source Bag Valve Mask-Based Ventilator

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Partially Reprapable Automated Open Source Bag Valve Mask-Based Ventilator Michigan Technological University Digital Commons @ Michigan Tech Michigan Tech Publications 10-1-2020 Partially RepRapable automated open source bag valve mask- based ventilator Aliaksei Petsiuk Michigan Technological University, [email protected] Nagendra G. Tanikella Michigan Technological University Samantha Dertinger Michigan Technological University, [email protected] Adam Pringle Michigan Technological University Shane Oberloier Michigan Technological University, [email protected] See next page for additional authors Follow this and additional works at: https://digitalcommons.mtu.edu/michigantech-p Part of the Biomedical Engineering and Bioengineering Commons, Electrical and Computer Engineering Commons, and the Materials Science and Engineering Commons Recommended Citation Petsiuk, A., Tanikella, N., Dertinger, S., Pringle, A., Oberloier, S., & Pearce, J. (2020). Partially RepRapable automated open source bag valve mask-based ventilator. HardwareX, 8. http://doi.org/10.1016/ j.ohx.2020.e00131 Retrieved from: https://digitalcommons.mtu.edu/michigantech-p/2640 Follow this and additional works at: https://digitalcommons.mtu.edu/michigantech-p Part of the Biomedical Engineering and Bioengineering Commons, Electrical and Computer Engineering Commons, and the Materials Science and Engineering Commons Authors Aliaksei Petsiuk, Nagendra G. Tanikella, Samantha Dertinger, Adam Pringle, Shane Oberloier, and Joshua M. Pearce This article is available at Digital Commons @ Michigan Tech: https://digitalcommons.mtu.edu/michigantech-p/2640 HardwareX 8 (2020) e00131 Contents lists available at ScienceDirect HardwareX journal homepage: www.elsevier.com/locate/ohx Partially RepRapable automated open source bag valve mask-based ventilator Aliaksei Petsiuk a, Nagendra G. Tanikella b, Samantha Dertinger c, Adam Pringle b, ⇑ Shane Oberloier a, Joshua M. Pearce a,b,d,e, a Department of Electrical & Computer Engineering, Michigan Technological University, USA b Department of Materials Science & Engineering, Michigan Technological University, USA c Biomedical Engineering, Michigan Technological University, USA d Équipe de Recherche sur les Processus Innovatifs (ERPI) , Université de Lorraine, France e School of Electrical Engineering, Aalto University, Finland article info abstract Article history: This study describes the development of a simple and easy-to-build portable automated Received 26 June 2020 bag valve mask (BVM) compression system, which, during acute shortages and supply Received in revised form 23 July 2020 chain disruptions can serve as a temporary emergency ventilator. The resuscitation system Accepted 30 July 2020 is based on the Arduino controller with a real-time operating system installed on a largely RepRap 3-D printable parametric component-based structure. The cost of the materials for the system is under $170, which makes it affordable for replication by makers around the Keywords: world. The device provides a controlled breathing mode with tidal volumes from 100 to Ventilator 800 mL, breathing rates from 5 to 40 breaths/minute, and inspiratory-to-expiratory ratio Pandemic Ventilation from 1:1 to 1:4. The system is designed for reliability and scalability of measurement cir- Influenza pandemic cuits through the use of the serial peripheral interface and has the ability to connect addi- Coronavirus tional hardware due to the object-oriented algorithmic approach. Experimental results Coronavirus pandemic after testing on an artificial lung for peak inspiratory pressure (PIP), respiratory rate Pandemic ventilator (RR), positive end-expiratory pressure (PEEP), tidal volume, proximal pressure, and lung Single-limb pressure demonstrate repeatability and accuracy exceeding human capabilities in BVM- Open source based manual ventilation. Future work is necessary to further develop and test the system Open hardware to make it acceptable for deployment outside of emergencies such as with COVID-19 pan- COVID-19 Medical hardware demic in clinical environments, however, the nature of the design is such that desired fea- RepRap tures are relatively easy to add using protocols and parametric design files provided. 3-D printing Ó 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY Open source medical hardware license (http://creativecommons.org/licenses/by/4.0/). Embedded systems Real-time operating system ⇑ Corresponding author. E-mail addresses: [email protected] (A. Petsiuk), [email protected] (N.G. Tanikella), [email protected] (S. Dertinger), [email protected] (A. Pringle), [email protected] (S. Oberloier), [email protected] (J.M. Pearce). https://doi.org/10.1016/j.ohx.2020.e00131 2468-0672/Ó 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). 2 A. Petsiuk et al. / HardwareX 8 (2020) e00131 1. Specifications table Hardware name RepRapable Automated Open Source BVM-based Ventilator Subject area Medical Hardware type Medical hardware Open Source License GNU General Public License (GPL) v3.0 and CERN Open Hardware License (OHL) v1.2 Cost of Hardware < $170 Source File Repository https://osf.io/fjdwz/ 2. Hardware in context Coronavirus disease 2019 (COVID-19) is increasing mortality rates by overwhelming medical infrastructure at the regio- nal level [1–4]. Mechanical ventilators, which are essential for treating both influenza and COVID-19 patients in severe acute respiratory failure [5,6], are in critical short supply in some locations [7–10]. During pandemics intensive care units (ICUs) do not have sufficient ventilators to treat all the patients requiring them [11–13], which forces triage and rationing [14,15]. This is despite national stockpiles of proprietary, mass-manufactured ventilators, which are simply not numerous enough due to prohibitive costs to service society during an extreme pandemic [16–20]. Another approach to provide products uses the technically and economically-viable open source small-scale digital tech- nologies and off-the-shelf components for distributed manufacturing [21,22]. There has already been a concerted effort to apply open source hardware and 3-D printing during the COVID-19 pandemic [23–29]. In addition, challenges with supply chains during any type of pandemic can be partially offset by open source recyclebots [30–34] and direct recycling extrusion [35] to close the loop on material supplies with local waste converted into additive manufacturing feedstock [36–41]. The distributed manufacturing of scientific equipment has been shown to provide custom, high-quality scientific tools for sub- stantially lower costs than conventional proprietary products [42–46]. This is because a scientific tool can be developed once and then digitally replicated for approximately the cost of the materials [47] creating enormous distributed value [48] a high return on investment [49], and the ability to focus investments for strategic national goals [50,51]. This same open source hardware design approach [52] can be applied to medical equipment [53–56] to overcome supply shortages [57–61]. There has already been some effort in developing low-cost ventilators in the literature [62–70] as well as in the maker community; however, the former failed to provide full source code and the latter (as of March 2020) was unvalidated and largely untested [71]. To both fill the current critical need for ventilators as well as provide a basis for future pandemics, this article provides the full source code for a fully-functional low-cost 3-D printable open-source pandemic ventilator and includes validation testing using an artificial lung. 3. Hardware description. The open-source pandemic single-limb (with one hose for the respiratory circuit; exhalation occurs through a single ori- fice located at the distal end of the circuit) ventilator (Fig. 1) was designed to be highly reproducible, simple in fabrication, maintenance and use for epidemics, pandemics and in developing and under-resourced communities. The design of the Fig. 1. RepRapable Ventilator System: A) standalone automated BVM-based resuscitation system, B) testing procedure, 1) bag mounting system, 2) self- inflating bag, 3) motor setup, 4) compression mechanism (pusher), 5) Positive End Expiratory Pressure (PEEP) valve [85], 6) feedback pressure sensors, 7) control system, 8) power supply with backup battery, 9) air mask, 10) mechanical lung, 11) airway pressure sensor. A. Petsiuk et al. / HardwareX 8 (2020) e00131 3 device and software was governed by ISO standards [72], the British Medicines & Healthcare Products Regulatory Agency’s rapidly manufactured ventilator system [73] and the Key Ventilation Specifications developed by the E-Vent project [74] along with consultation with health care professionals. The system can be fabricated from readily accessible components, open source Arduino microcontrollers [75,76] open source electronics that can be made with open source mills [77–79] and custom parts with a RepRap-class material extrusion-based 3-D printer [80–84]. Mechanical ventilation, which can be easily controlled by a simple user input, was chosen to be most effective at treating the largest number of people. The system implements two following modes: controlled mechanical ventilation (CMV) and inverse ratio ventilation (IRV). A user can control breathing rates (breaths per minute or BPM), tidal volume (VT, air volume pushed into the lungs), inspiratory/expiration time ratio (I/E ratio). All the mechanical components (Fig. 1: components 1, 4,
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