Masi: A mechanical ventilator based on a manual resuscitator with telemedicine capabilities for patients with ARDS during the COVID-19 crisis

Enablers and barriers to adopt the locally developed Masi mechanical ventilator amid COVID-19 pandemic in Peru

Background

Limited supply of resources during the COVID-19 emergency encouraged the local development of the Masi mechanical ventilator (MV). Despite the efforts to promote Masi, adopting this innovation faced multiple obstacles, regardless of its performance. We explored the perceptions among healthcare personnel towards incorporating Masi to provide ventilatory support to COVID-19 patients during the second wave in Peru (January to June 2021).

Methods

We conducted twelve in-depth virtual interviews. Topics included experience when handling Masi, the impact of the training received, confidence in the device, barriers perceived, and enablers identified. All participants provided verbal informed consent.

Results

Most of the participants were male physicians. Participants belonged to seven hospitals that exhibited a wide range of healthcare capacities. Globally, the adoption of Masi MV was driven by the scarcity of ventilatory devices in the wards and reinforced by appropriate training and prompt technical support. Participants reported that Masi's structural and operational features played both advantages and disadvantages. Hospital infrastructure readiness, availability of commercial MVs, mistrust in its simple appearance, and resistance to change among healthcare personnel were perceived as barriers, while low-cost, prompt technical support and user-friendliness were valuable enablers. The first two enablers were observed in participants regardless of their attitude towards Masi. Despite the small number of participants for this qualitative study, it is important to note that the sample size was sufficient to reach saturation, as the topics discussed with participants became redundant and did not yield new information.

Conclusions

The perceptions among healthcare personnel to incorporate Masi as a mechanical ventilator for COVID-19 patients showed that communication, training and experience, and peer encouragement were essential to secure its use and sustainability of the technology. A priori judgments and perceptions unrelated to the performance of the novel device were observed, and its proper management may define its further implementation. Altogether our study suggests that along with strengthening local technological development, strategies to improve their adoption process must be considered as early as possible in medical innovations.

Developing of an open-source low-cost ventilator based on turbine technology

The COVID-19 pandemic has revealed numerous global health system deficits, even in developed countries. The high cost and shortage of treatment, health care, and medical devices are the reasons. Aside from new mutations, the availability of respirators is an urgent concern, especially in developing countries. Even after the pandemic, respiratory diseases are among the most prevalent diseases. Researchers can help reduce treatment costs by offering scalable, open-source solutions that are manufacturable. Since March 2020, serious efforts have been made to reduce the problems caused by the lack of respirators at the lowest possible cost. In this research paper, a unique and integrated solution for a fully automatic ventilator is presented and described. The design considers the cost, speed of assembly, safety, ease of use, robustness, portability issues, and scalability to fit all requirements for emergency ventilation. Furthermore, the device was developed using turbine technology to generate air pressure. The work describes a low-cost alternative ventilator that uses a novel proportional-valve approach to control oxygen mixing process, control circuit, and control algorithm. The current software supports pressure mode controllers, and it can be upgraded to volume-mode or dual mode without any modifications in the hardware. In addition, the hardware, particularly the electronic circuit, has idle input/output ports for further development. Based on the evaluations of the developed ventilator using an artificial lung, the system exhibited acceptable accuracy regarding to the pressure, leak compensation, and oxygen concentration levels. The designated safety conditions have been met, and the safety alarms tripped according to any violations. Moreover, all design files are provided with clear instructions to rebuild the device, despite the complexity of electronics assembly. The system can be described as a development kit, which can shorten the time for researchers/manufacturers to develop a device equivalent to the expensive devices available in the market.

COVOX: Providing oxygen during the COVID-19 health emergency

We introduce an autonomous oxygen concentrator that was designed in Peru to fight the oxygen shortage produced worldwide as a consequence of the COVID-19 pandemic. Oxygen concentrators represent a suitable and favorable option for administering this gas at the patient's bedside in developing countries, especially when cylinders and tubed systems are unavailable or when access to them is restricted by lack of accessories, inadequate power supply, or shortage of qualified personnel. Our system uses a pressure swing adsorption technique to provide oxygen to patients at a flow rate of up to 15 l/min ± 1,5 l/min and a concentration of 93 % ± 3 %, offering robustness, safety and functionality. The quality measurements obtained from the validation process demonstrate repeatability and accuracy. The complete design files are provided in the source file repository to facilitate oxygen concentrator production in low and middle income countries, where access to oxygen is still a major problem even after the pandemic. Oxygen is part of the World Health Organization Model List of Essential Medicines and is perhaps the only medicine that has no substitute. This device can provide a reliable supply of oxygen for critically ill patients and improve their chances of survival.

COVID-19 Lessons Learned: Response to the Anticipated Ventilator Shortage

Early in the COVID-19 pandemic predictions of a worldwide ventilator shortage prompted a worldwide search for solutions. The impetus for the scramble for ventilators was spurred on by inaccurate and often unrealistic predictions of ventilator requirements. Initial efforts looked simply at acquiring as many ventilators as possible from national and international sources. Ventilators from the Strategic National Stockpile were distributed to early hotspots in the Northeast and Northwest United States. In a triumph of emotion over logic, well-intended experts from other industries turned their time, talent, and treasure toward making a ventilator for the first time. Interest in shared ventilation (more than one patient per ventilator) was ignited by an ill-advised video on social media that ignored the principles of gas delivery in deference to social media notoriety. With shared ventilation, a number of groups mistook a physiologic problem for a plumbing problem. The United States government invoked the Defense Production Act to push automotive manufacturers to partner with existing ventilator manufacturers to speed production. The FDA granted emergency use authorization for "splitters" to allow shared ventilation as well as for ventilators and ancillary equipment. Rationing of ventilators was discussed in the lay press and medical literature but was never necessary in the US. Finally, planners realized that staff with expertise in providing mechanical ventilation were the most important shortage. Over 200,000 ventilators were purchased by the United States government, states, cities, health systems, and individuals. Most had little value in caring for patients with COVID-19 ARDS. This paper attempts to look at where miscalculations were made, with an eye toward what we can do better in the future.

Mathematical Analysis of a Low Cost Mechanical Ventilator Respiratory Dynamics Enhanced by a Sensor Transducer (ST) Based in Nanostructures of Anodic Aluminium Oxide (AAO)

Mechanical ventilation systems require a device for measuring the air flow provided to a patient in order to monitor and ensure the correct quantity of air proportionated to the patient, this device is the air flow sensor. At the beginning of the COVID-19 pandemic, flow sensors were not available in Peru because of the international supply shortage. In this context, a novel air flow sensor based on an orifice plate and an intelligent transducer was developed to form an integrated device. The proposed design was focused on simple manufacturing requirements for mass production in a developing country. CAD and CAE techniques were used in the design stage, and a mathematical model of the device was proposed and calibrated experimentally for the measured data transduction. The device was tested in its real working conditions and was therefore implemented in a breathing circuit connected to a low-cost mechanical ventilation system. Results indicate that the designed air flow sensor/transducer is a low-cost complete medical device for mechanical ventilators that is able to provide all the ventilation parameters by an equivalent electrical signal to directly display the following factors: air flow, pressure and volume over time. The evaluation of the designed sensor transducer was performed according to sundry transducer parameters such as geometrical parameters, material parameters and adaptive coefficients in the main transduction algorithm; in effect, the variety of the described results were achieved by the faster response time and robustness proportionated by transducers of nanostructures based on Anodic Aluminum Oxide (AAO), which enhanced the designed sensor/transducer (ST) during operation in intricate geographic places, such as the Andes mountains of Peru.

Development of a Simulation Software Algorithm for High-End Mechanical Ventilators with Functionalities to attend COVID-19 Patients

More than 500 millions of people were affected by the COVID-19 pandemic and in Peru there is an increasing the high numbers of cumulative cases; as well as the hospitalized people, where more than 20 % require mechanical ventilation. This condition with other respiratory diseases cause patients to remain connected to a mechanical ventilator until they regain the ability to perform this vital function on their own. Some prototypes with characteristics equivalent to a high-end mechanical ventilator have been developed. And therefore, this paper presents the design and simulation of an algorithm for the pressure-controlled pulmonary ventilation mode of the mechanical ventilator. The functional design of the algorithm uses the linear multi compartment mathematical model to simulate the respiratory system. Finally the results respond adequately under multiple scenarios, including variations of the ventilator and pulmonary parameters, where the algorithm presents encouraging results in the mechanical ventilator simulation. Clinical relevance - The algorithm presented in this study will allow to have better knowledge for a treatment and eventual clinical diagnosis in health centers, especially in eventual variants and outbreaks of COVID-19.

Extension of Non-invasive Ventilation Capabilities of MASI for the Care of Patients Affected by COVID-19

The MASI mechanical ventilator was developed in a state of emergency to meet the demand for ventilators caused by COVID-19. Although it has obtained positive results in its use with patients in intensive care units, not having an optimal quality non-invasive ventilation (NIV) modality prevents it from being used in the early treatment of patients, which has been shown to prevent admission to the ICU and reduce mortality. Therefore, the following study focuses on evaluating MASI's ability to provide NIV using different accessories in order to compare their performance and determine which one would work best with MASI, and under which conditions. To do this, the high-flow nasal cannula, facial mask, and ventilation helmet accessories were tested under different pressure parameter settings. The data was collected using a gas flow analyzer. After that, a statistical analysis of the results was carried out, which showed that the face mask is the best accessory to use for NIV with MASI, and that it performs with optimal accuracy and precision when the peak inspiratory pressure is set at a value lower than 25 cmH20. Clinical Relevance- This study presents an optimization of the non-invasive ventilation (NIV) modality of the MASI me-chanical ventilator by evaluating its performance with different accessories.

Biological evaluation of a mechanical ventilator that operates by controlling an automated manual resuscitator. A descriptive study in swine

The Covid-19 outbreak challenged health systems around the world to design and implement cost-effective devices produced locally to meet the increased demand of mechanical ventilators worldwide. This study evaluates the physiological responses of healthy swine maintained under volume- or pressure-controlled mechanical ventilation by a mechanical ventilator implemented to bring life-support by automating a resuscitation bag and closely controlling ventilatory parameters. Physiological parameters were monitored in eight sedated animals (t₀) prior to inducing deep anaesthesia, and during the next six hours of mechanical ventilation (t₁-₇). Hemodynamic conditions were monitored periodically using a portable gas analyser machine (i.e. BEecf, carbonate, SaO₂, lactate, pH, PaO₂, PaCO₂) and a capnometer (i.e. ETCO₂). Electrocardiogram, echocardiography and lung ultrasonography were performed to detect in vivo alterations in these vital organs and pathological findings from necropsy were reported. The mechanical ventilator properly controlled physiological levels of blood biochemistry such as oxygenation parameters (PaO₂, PaCO₂, SaO₂, ETCO₂), acid-base equilibrium (pH, carbonate, BEecf), and perfusion of tissues (lactate levels). In addition, histopathological analysis showed no evidence of acute tissue damage in lung, heart, liver, kidney, or brain. All animals were able to breathe spontaneously after undergoing mechanical ventilation. These preclinical data, supports the biological safety of the medical device to move forward to further evaluation in clinical studies.

Quality characteristics of the Masi Peruvian mechanical ventilator manufacturing process. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021;2021:1557-1561. [PMID: 34891581 DOI: 10.1109/embc46164.2021.9630439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Three hundred and ten rapid-manufactured mechanical ventilators, named Masi, were produced and validated in Peru, according to applicable standards. From these, a sample of 30 was taken and two ventilation parameters, tidal volume and peak inspiratory pressure, were statically analyzed using control charts and histograms. Results show that several points were outside estimated limits for Shewhart means and ranges charts, which could possibly be due to the quantity of equipment used for data recollection and the fact that the Masi team had over 20 engineers. Nevertheless, Masi ventilators met the tolerance required by their user´s manual and MHRA standard and Peruvian DIGEMID for every parameter.Clinical Relevance-This article shows the performance in the validation stage of the peruvian mechanical ventilator MASI built as an emergency response for the COVID-19 crisis.

MIT Emergency-Vent: An Automated Resuscitator Bag for the COVID-19 Crisis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021;2021:4998-5004. [PMID: 34892330 DOI: 10.1109/embc46164.2021.9630882]

MIT's Emergency-Vent Project was launched in March 2020 to develop safe guidance and a reference design for a bridge ventilator that could be rapidly produced in a distributed manner worldwide. The system uses a novel servo-based robotic gripper to automate the squeezing of a manual resuscitator bag evenly from both sides to provide ventilation according to clinically specified parameters. In just one month, the team designed and built prototype ventilators, tested them in a series of porcine trials, and collaborated with industry partners to enable mass production. We released the design, including mechanical drawings, design spreadsheets, circuit diagrams, and control code into an open source format and assisted production efforts worldwide.Clinical relevance- This work demonstrated the viability of automating the compression of a manual resuscitator bag, with pressure feedback, to provide bridge ventilation support.

Performance of the Masi Peruvian ventilator at high altitude

In response to Covid-19 crisis, 310 Masi ventilators were produced and validated in Lima, Peru, according to applicable standards. Four of them, were transported to Puno, in order to strengthen ICU Services there, but this set a major challenge to Masi team as effects of altitude on ventilators were unknown. Once there, ventilators were acclimated and calibrated. Volume tidal, I:E ratio, respiratory frequency and PEEP were tested, all of them presenting errors under 15%, except for tidal volume, for which a 25% negative correction was applied. After the installation of a new version of Masi software, parameters were tested again, all of them presenting results with errors below 15%, which allowed the Masi team to take them to ICU services for use.Clinical Relevance- Masi Peruvian Ventilators are able to perform according to their specifications at extremely high altitude, after the adequate calibration. These devices are an alternative to treat COVID-19 patients in the middle of the crisis.