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Other ventilators are designed for acute hospital use. These have much more complex interfaces for the variety of treatment modes for which they are capable. They typically do invasive ventilation in which an endotracheal tube is inserted in the nose or mouth and down into the lungs. The biggest factor here is that the expired air is captured by the system and filtered before being released. In an application where the patient has a transmissible disease, this point is particularly important.
Most of these machines have an additional port that takes in supplied oxygen. This can be tanks, but not likely because of the high rate of flow needed. An oxygen concentrator can only supply about 10L/min. In the case of acute hospital ventilators, much more may be required. Most hospitals have central O2, capable of supplying up to 50L/min.
The Many Challenges of Ventilator Design
Now that you have the basics behind the tech, here are some specific challenges.
- You must have a good seal on the mask the person is wearing on their face. If you don’t have a good seal, the mask will leak and you won’t be able to maintain positive pressure. Poor sealing is one of the main reasons for these kinds of devices to fail.
- Monitoring expiration is important. The face mask must allow expired gases to leave, or else the patient will be rebreathing their own air. The machine knows how much it vents and takes that into account when supplying pressure. When the patient breathes out, the expired air doesn’t go into the machine, it goes out through the face mask vents and into the air. In a hospital environment, this would be aerosolizing the virus, which would be very bad, which is why the there are ventilator designs for hospitals that capture the expired air through a different tube and filter it.
- You have to maintain the level of positive pressure consistently; if there’s a leak you have to ramp up to maintain the pressure level, and if the leak is plugged you have to drop down immediately. If you go above the pressure level intended, you can easily do damage to the lungs. Pressures are typically in the 4-40cm H2O range. This is a big important requirement, because messing this one up does a lot of damage fast.
- You have to heat and humidify the air. Usually the sinuses do a good job of this, but on a ventilator, this isn’t possible because the sinuses may be bypassed. When the air is too dry, it can lead to hypothermia, bronchospasm, extra mucus production (which is bad because it blocks more passages), or other problems.
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