Challenging COVID-19 with Creativity: Supporting Design Space Exploration for Emergency Ventilators

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Abstract

The high concentration and rapid increase in lung diseases caused by COVID-19 has suddenly led medical staff to face a lack of ventilators in emergency situations. In this context, many enthusiasts and/or designers all over the world have started to think about low cost and open-source solutions for emergency ventilators, with the aim of providing concrete aid. In a small amount of time, many different solutions have been proposed, most of which are based on the automatic compression of the auxiliary manual breathing unit (AMBU) bag. In particular, many different designs have been conceived for the AMBU compression mechanism, which contains the most critical parts to be designed. Here arises the aim of this work, i.e., to propose a methodological approach to support the creativity of designers involved in inventing increasingly sustainable and reliable low-cost compression mechanisms for AMBU-based ventilators. Accordingly, a conceptual framework is proposed, capable of collecting existing ideas and organizing the underpinning concepts, to provide stimuli for new idea generation and to keep track of (and possibly to share) the explored design space. Illustrative examples are provided in order to show how the proposal can be used in practice. In particular, a set of currently available solutions is schematically shown through the proposed graphical tools, and the generation of new illustrative solutions is presented. Additionally, it is shown how to represent further ideas (e.g., those coming from other teams) in the framework.

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Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Arjen M. Dondorp, Muhammad Hayat, Diptesh Aryal … (2020)

Abstract. The ongoing novel coronavirus disease (COVID-19) pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapidly increasing, this review summarizes current guidance on the best provision of ventilatory support, with a focus on resource-limited settings. Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia and should be a primary focus in resource-limited settings where capacity for invasive ventilation is limited. Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning. The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential. Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome, and limiting the positive end-expiratory pressure level on the ventilator may be important. This ventilation strategy might reduce the currently very high case fatality rate of more than 50% in invasively ventilated COVID-19 patients.

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Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors

Armand H. Matheny Antommaria, Tyler Gibb, Amy McGuire … (2020)

Background: The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies. Objective: To characterize the development of ventilator triage policies and compare policy content. Design: Survey and mixed-methods content analysis. Setting: North American hospitals associated with members of the Association of Bioethics Program Directors. Participants: Program directors. Measurements: Characteristics of institutions and policies, including triage criteria and triage committee membership. Results: Sixty-seven program directors responded (response rate, 91.8%); 36 (53.7%) hospitals did not yet have a policy, and 7 (10.4%) hospitals' policies could not be shared. The 29 institutions providing policies were relatively evenly distributed among the 4 U.S. geographic regions (range, 5 to 9 policies per region). Among the 26 unique policies analyzed, 3 (11.3%) were produced by state health departments. The most frequently cited triage criteria were benefit (25 policies [96.2%]), need (14 [53.8%]), age (13 [50.0%]), conservation of resources (10 [38.5%]), and lottery (9 [34.6%]). Twenty-one (80.8%) policies use scoring systems, and 20 of these (95.2%) use a version of the Sequential Organ Failure Assessment score. Among the policies that specify the triage team's composition (23 [88.5%]), all require or recommend a physician member, 20 (87.0%) a nurse, 16 (69.6%) an ethicist, 8 (34.8%) a chaplain, and 8 (34.8%) a respiratory therapist. Thirteen (50.0% of all policies) require or recommend those making triage decisions not be involved in direct patient care, but only 2 (7.7%) require that their decisions be blinded to ethically irrelevant considerations. Limitation: The results may not be generalizable to institutions without academic bioethics programs. Conclusion: Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation.