Mechanical Ventilation Amid the COVID-19 Pandemic: A Guide for Physicians and Engineers PDF
Preview Mechanical Ventilation Amid the COVID-19 Pandemic: A Guide for Physicians and Engineers
Amir A. Hakimi Thomas E. Milner Govind R. Rajan Brian J-F Wong Editors Mechanical Ventilation Amid the COVID-19 Pandemic A Guide for Physicians and Engineers Mechanical Ventilation Amid the COVID-19 Pandemic Amir A. Hakimi • Thomas E. Milner Govind R. Rajan • Brian J-F Wong Editors Mechanical Ventilation Amid the COVID-19 Pandemic A Guide for Physicians and Engineers Editors Amir A. Hakimi Thomas E. Milner Otolaryngology – Head and Neck Surgery Beckman Laser Institute and Medical Clinic Medstar Georgetown University Hospital Irvine, CA, USA Washington D.C., WA, USA Brian J-F Wong Govind R. Rajan Otolaryngology – Head and Neck Surgery Anesthesiology & Critical Care Medicine University of California, Irvine University of California, Irvine Orange, CA, USA Orange, CA, USA ISBN 978-3-030-87977-8 ISBN 978-3-030-87978-5 (eBook) https://doi.org/10.1007/978-3-030-87978-5 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface The surge in COVID-19 cases leading to hospitalizations around the world quickly depleted hospital resources and reserves, forcing physicians to make extremely dif- ficult life-or-death decisions on ventilator allocation between patients. Leaders in academia and industry have developed numerous ventilator support systems using both consumer- and industry-grade hardware to sustain life and to provide interme- diate respiratory relief for hospitalized patients. This book is the first of its kind to discuss the respiratory pathophysiology underlying COVID-19, explain pulmonary and ventilator mechanics, provide and evaluate a repository of innovative emer- gency resuscitators conceived amid the pandemic, and explain both hardware and software components necessary to develop an inexpensive emergency resuscitator. The book serves both as a historical record of the collaborative and innovative response to the anticipated ventilator shortage during the COVID-19 pandemic and as a guide for physicians, engineers, and DIY-ers interested in developing emer- gency resuscitator devices. Several mechanisms for these transitory emergency resuscitators or “bridge ven- tilators” have been proposed including automatic compression of resuscitation bags through various mechanical and pneumatic means, repurposing CPAP and BiPAP devices to function as ventilators, and noninvasive ventilation through oxygen hel- mets, snorkel masks, and more. Herein, the authors explore and appraise the func- tionality of each unique approach. Additionally, expert leaders behind several emergency ventilator designs provide a detailed review of resuscitation bag and motor mechanics and impart insight on their ventilator models. This resource pro- vides a thorough framework for basic ventilatory support and guides readers toward developing their own bridge ventilators through evidence-based expert recommen- dations. We also encourage readers to go to our website www.bli.uci.edu/bvc or scan the QR code below to access supplemental videos and posts. v vi Preface Washington, DC, USA Amir A. Hakimi Irvine, CA, USA Thomas E. Milner Orange, CA, USA Govind R. Rajan Orange, CA, USA Brian J.-F. Wong Contents 1 Establishment of the Bridge Ventilator Consortium . . . . . . . . . . . . . . 1 Amir A. Hakimi, Thomas E. Milner, Govind Rajan, and Brian J. F. Wong Part I Lung Physiology and Ventilator Basics 2 An Overview of Lung Anatomy and Physiology . . . . . . . . . . . . . . . . . 5 Karen Katrivesis, Jennifer Elia, Brent Etiz, Keaton Cooley-Rieders, Sina Hosseinian, and Sean Melucci 3 Respiratory Mechanics and Ventilation . . . . . . . . . . . . . . . . . . . . . . . . 25 Sonali Rao, Meleeka Akbarpour, and Jessica J. Tang 4 Mechanical Ventilators and Monitors: An Abridged Guide for Engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Jay Shen, Luke Hoffmann, and Linsey Wilson 5 An Overview of Mechanical Ventilation and Development of the UC San Diego MADVent . . . . . . . . . . . . . . . . 53 Lonnie Petersen, Sidney Merritt, and James Friend 6 An Introduction to Noninvasive Ventilation . . . . . . . . . . . . . . . . . . . . . 73 Melissa Huang, Karen Katrivesis, and Trung Q. Vu 7 Noninvasive Ventilation and Mechanical Ventilation to Treat COVID-19-Induced Respiratory Failure . . . . . . . . . . . . . . . . 79 Timmy Cheng, Richard Anthony Lee, and Walter B. Gribben Part II SARS CoV-2 Transmission and Innovative Protective Barriers 8 COVID-19 Pathophysiology and COVID- 19- Induced Respiratory Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Nikhil A. Crain, Ario D. Ramezani, and Taizoon Dhoon vii viii Contents 9 Spread of COVID-19 and Personal Protective Equipment . . . . . . . . . 103 Ario D. Ramezani, Nikhil A. Crain, and Taizoon Dhoon 10 An Overview of Personal Protective Equipment and Disinfection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Ario D. Ramezani, Nikhil A. Crain, and Taizoon Dhoon Part III Bridge Ventilator Design and Components 11 What Is a Bridge Ventilator? Basic Requirements, the Bag Valve Mask, and the Breathing Circuit . . . . . . . . . . . . . . . . . . 125 Amir A. Hakimi, Govind Rajan, Brian J. F. Wong, Thomas E. Milner, and Austin McElroy 12 Hardware Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Austin McElroy, Nitesh Katta, Scott F. Jenney, Tim B. Phillips, and Thomas E. Milner 13 Software Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Austin McElroy, Nitesh Katta, Scott F. Jenney, Tim B. Phillips, and Thomas E. Milner 14 Development of Emergency Resuscitators: Considerations for Mechanical and Electrical Components. . . . . . . . 145 Shijun Sung 15 Incorporating Patient Assist Mode: The ABBU Experience . . . . . . . . 153 Aleksandra B. Gruslova, Nitesh Katta, Andrew G. Cabe, Scott F. Jenney, Jonathan W. Valvano, Tim B. Phillips, Austin B. McElroy, Robert K. LaSalle, Aydin Zahedivash, Van N. Truskett, Nishi Viswanathan, Marc D. Feldman, Richard Wettstein, Thomas E. Milner, and Stephen Derdak 16 A Qualitative Overview of Emergency Resuscitators Approved in the COVID-19 Pandemic . . . . . . . . . . . . . . . . . . . . . . . . . 159 Karthik R. Prasad, Shijun Sun, and Scott F. Jenny Part IV Regulatory Factors and Device Testing 17 Innovation and Regulation: The FDA’s Response to the COVID-19 Pandemic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Rachel Fenberg, Emma McKinney, and Peter Kahn 18 Regulatory Considerations for Bridge Ventilators . . . . . . . . . . . . . . . . 185 Elisa Maldonado-Holmertz and Sarah Mayes 19 Human Factors Considerations in the User Interface Design of Bridge Ventilator Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Edmond W. Israelski Contents ix 20 Preclinical Animal Testing of Emergency Resuscitator Breathing Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Aleksandra B. Gruslova, Nitesh Katta, Andrew G. Cabe, Scott F. Jenney, Jonathan W. Valvano, Tim B. Phillips, Austin B. McElroy, Van N. Truskett, Nishi Viswanathan, Marc D. Feldman, Thomas E. Milner, Richard Wettstein, and Stephen Derdak Part V Pandemic Innovations 21 Multiplex Ventilation: Requirements and Feasibility of Ventilator Splitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Pratyushya Yalamanchi, Peter Kahn, and Kyle VanKoevering 22 CPAP-to-Ventilator: Open-Source Documentation, UC Irvine . . . . . 233 Cody E. Dunn, Christian Crouzet, Mark T. Keating, Thinh Phan, Matthew Brenner, Elliot L. Botvinick, and Bernard Choi 23 Alternatives to Conventional Noninvasive Positive-Pressure Ventilation Devices . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Pauline Yasmeh, Annie Chen, Alexis Ha, Riley Oh, and Grant Oh 24 Development of an Inexpensive Noninvasive Ventilation Hood . . . . . 251 Ellen Hong, Amir A. Hakimi, and Brian J.-F. Wong 25 Collaborations and Accomplishments Among the Bridge Ventilator Consortium Teams . . . . . . . . . . . . . . . . 257 Amir A. Hakimi, Govind Rajan, Brian J. F. Wong, Thomas E. Milner, and Austin McElroy Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 About the Editors Amir A. Hakimi, MD is a resident in the Department of Otolaryngology-Head and Neck Surgery at MedStar Georgetown University Hospital. He received his Bachelor of Science degree in Neuroscience at the University of California, Los Angeles. He then graduated from Chicago Medical School at Rosalind Franklin University of Medicine and Science. During medical school, he became involved in clinical and translational research under the mentorship of Dr. Brian Wong. Dr. Hakimi has published numerous articles in peer-reviewed scientific journals, and he has developed a medical application for the iPhone to expedite the diagnosis of ocular injury. Thomas E. Milner, PhD is Director of the Beckman Laser Institute and Medical Clinic and Professor of Biomedical Engineering and Surgery at the University of California, Irvine. He received his bachelor’s and master’s degrees from the Colorado School of Mines and his Ph.D. from the University of Arizona. Dr. Milner’s research interests are in the fields of optical based therapeutics and diag- nostic imaging, biomedical optics sensors, and optical tomography. He has pub- lished more than 180 journal articles, holds 55 issued US patents, and has started two technology companies. Dr. Milner is a fellow of the National Academy of Inventors, the American Institute for Medical and Biological Engineering, and the American Society for Lasers in Medicine and Surgery. Govind R. Rajan, MBBS is an anesthesiologist in Orange, CA, and is affiliated with the UC Irvine Medical Center. He received his medical degree from Maulana Azad Medical College and has been in practice for 29 years. He also speaks multi- ple languages, including Hindi. He specializes in critical care medicine. Brian J.-F. Wong, MD, PhD is Professor and Director of the Division of Facial Plastic Surgery in the Department of Otolaryngology-Head and Neck Surgery at the University of California Irvine Medical Center. Dr. Wong’s clinical practice is based at both the UC Irvine Medical Center and the Beckman Laser Institute and Medical Clinic. He graduated summa cum laude with a bachelor’s degree in biomedical xi
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