Ventilators – FAQs

If you are experiencing a medical emergency, respiratory or otherwise, please call your country’s emergency phone number or doctor immediately. Be sure to tell them of any exposure you may have had to COVID-19.

To reduce your risk of contracting and/or spreading COVID-19, please follow these published guidelines:

  • Healthy hygiene: WHO
  • Tips for health workers: WHO
  • Tips for people at higher risk for serious illness: CDC
  • Rights, roles, and responsibilities of health workers, including key considerations for occupational safety and health: WHO

Very precisely engineered Intensive Care Unit (ICU) class ventilators.
The database we created here is not official, nor is it maintained by the companies that manufacture the devices. This site aims to centralise expertise and information about suppliers and supply to help in this crisis.

Updated 28 March 2020
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Note changes to specifications with increased BPM and I:E ratios. Adjusting one of these parameters may influence the other, since at higher BPM, the tidal volume is usually decreased. Consult a clinician.

From the Clinical Guidance this document summarizes the minimum set of requirements for ventilation:

  1. Patients must be under the management of a trained clinician.
  2. The minimum controllable parameters in order to ventilate a patient include:
    1. Respiratory Rate (RR) (breaths per minute): between 8 – 40
    2. Tidal Volume (TV) (air volume pushed into lung): between 200 – 800 mL based on patient weight
    3. I/E Ratio (inspiratory/expiration time ratio): recommended to start around 1:2; best if adjustable between range of 1:1 – 1:4*
    4. Assist Detection pressure. When a patient tries to inspire, they can cause a dip on the order of 1 – 5 cm H2O, with respect to PEEP pressure (not necessarily = atmospheric).
  3. Airway pressure must be monitored
    1. Maximum pressure should be limited to 40 cm H2O at any time; Plateau pressure should be limited to max 30 cm H2O
    2. The use of a passive mechanical blow-off valve fixed at 40 cm H2O is strongly recommended
    3. Clinician require readings of plateau pressure and PEEP (refer to clinical documentation tab)
    4. PEEP of 5-15 cm H2O required; many patients need 10-15 cmH2O
  4. Failure conditions must permit conversion to manual clinician override, i.e. if automatic ventilation fails, the conversion to immediate ventilation must be immediate.
  5. Ventilation on room air is better than no ventilation at all. Blending of oxygen and air gas mixture to adjust FiO2 is not important in an emergency scenario.  It is certainly nice to have that ability and can easily be implemented with an oxygen / air gas blender that some hospitals already have.
  6. COVID-19 can get aerosolized (airborne), so HEPA filtration on the patient’s exhalation is required or between the ventilator unit and the patient (at the end of the endotracheal tube) to protect clinical staff from certain infection. In-line HEPA filters can usually be purchased alongside manual resuscitator bags.
  7. Heat and moisture exchanger should be used in line with the breathing circuit.
  8. Failure conditions must result in an alarm.

This is a minimum requirement set for emergency use. Equipment designed for more regular use, even if for emerging markets, will require additional features to be used on a regular basis. 

*Range determined based on several COVID-19 patients’ ventilator settings reported from Boston area ICUs

Non-invasive mechanical ventilation modalities in supporting patients in ARDS
(Source)

This page addresses continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) which are modes of non-invasive ventilatory support. It is important to point out that mask-based solutions are not sufficient for patients experiencing hypoxic respiratory failure. At best, these are temporary solutions. These solutions both risk aerosolizing COVID-19 in the expired air, which, generally, is not filtered.

CPAP is primarily used to help with oxygenation by applying a constant positive pressure throughout the patient’s respiratory cycle.  It is commonly used for patients with obstructive airway or oxygenation problems. Patients have hypoxic respiratory insufficiency, but they do not yet have respiratory failure.

BiPAP detects the patient’s inspiratory and expiratory efforts and provides a differential positive airway pressure to help ease the work of respiration. Patients who are “tiring out” and demonstrate hypercarbic respiratory insufficiency would benefit from BiPAP over CPAP. Care must be taken to identify failure and intubate.

Intubation is necessary for patients experiencing respiratory failure because the effort of breathing is removed. The patient can be sedated and paralyzed, if need be, and higher pressures used to keep gas exchange occurring in a diseased lung. Some patients can recover with CPAP and BiPAP, so clinical discretion should be used before intubation, but with ARDS it is likely.

In COVID-19 positive patients, non-invasive mechanical ventilation modalities can certainly be trialed, but careful monitoring for worsening of the patient towards respiratory failure should be diagnosed without delay so that invasive ventilatory therapy can be initiated. Delay and/or failure to provide timely invasive positive pressure ventilatory support can lead to patient self-inflicted lung injury.  See this article. At this point the only solution is invasive ventilation.

There is little information available on reprocessing requirements for equipment used in treating COVID-19 patients. The following information is based on research that has been conducted on similar viruses, and some limited data on COVID-19.

Published guidance from health authorities reinforces the need to maintain standard cleaning and disinfection procedures. To prevent cross-contamination, antibacterial filters are used on air intake and breathing tubes, and tube accessories are replaced or sterilised by the staff in the care setting. Instructions are provided on the materials and method for cleaning surfaces. Surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide, or 0.1% sodium hypochlorite have been shown to reduce SARS coronavirus infectivity within one minute.

A CPAP machine is intended to treat sleep apnea.
CPAP devices are designed to provide only PAP (positive airway pressure) and would require significant rework in order to function as an invasive ICU class ventilator.

Video Primer - What is the complexity behind the ventilators?

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